Peds, part 33: Nervous Disorders - Seizures
by Cathy Parkes January 04, 2022 Updated: December 07, 2022 5 min read
Hi, I'm Cathy, with Level Up RN. In this video, we are going to talk about seizures, including febrile seizures. If you have our Level Up RN Pediatric Nursing Flashcards, be sure to pay close attention to the bold red text on the these cards because there are a lot of important facts that you need to know. At the end of this video, I'm going to give you guys a little quiz and test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that.
Seizures are the uncontrolled electrical discharge of neurons in the brain. If a patient has two or more unprovoked seizures, then they would be diagnosed with epilepsy. Seizures can be caused by a disease, an injury, or an unknown cause. No matter the cause, it results in the hyper excitability of neurons and a decrease in the inhibition of neuron activity. Risk factors associated with seizures include a fever, so febrile seizures are going to be the most common form of seizures in children. Other risk factors include cerebral edema infections, such as meningitis, toxin exposure, head trauma, hypoxia, electrolyte imbalances, as well as a brain tumor and hypoglycemia.
Let's now briefly discuss some different types of seizures. First of all, we have a tonic clonic seizure, which is sometimes preceded by an aura, which is a visual or sensory disturbance. There are three phases in a tonic clonic seizure. The first is the tonic episode. This is where we have the stiffening of muscles and the loss of consciousness. Then we move into the clonic episode. This is where we have one to two minutes of rhythmic jerking of the extremities. And then we move into the postictal phase, which is characterized by confusion, sleepiness, and possible agitation.
Another important type of seizure to know is an absence seizure, which involves a loss of consciousness for a few seconds and it really resembles daydreaming. So I had a good friend when my kids were younger, and her daughter would go to school, and the teacher would complain that her daughter was always daydreaming and not paying attention. And as it turns out, her daughter was having all of these absence seizures and was later diagnosed with epilepsy. So absence seizures are characterized by blank staring, lip smacking, picking at the clothes, as well as eye fluttering.
Another type of seizure to be familiar with is a myoclonic seizure. This is where we have the brief stiffening of the extremities. I would also be familiar with an atonic seizure, which is the loss of muscle tone that often results in falling. So atonic means lack of tone, so loss of that muscle tone. And then finally, status epilepticus is a prolonged seizure, so a seizure lasting more than five minutes, or failure to regain consciousness between seizures. This is a medical emergency. Diagnosis of seizures can be done with the help of an EEG, which is an electroencephalogram. In terms of treatment, we would treat seizures with antiepileptics or anticonvulsive agents. So this can include valproic acid, carbamazepine, as well as phenytoin, and there are many others. I actually have a whole video dedicated to antiepileptic agents in my pharmacology playlist. So if you want details about those medications, definitely check that out.
In terms of procedures, the patient can have a vagal nerve stimulator surgically implanted. So this device goes under the skin on the left side of the chest, and it sends electrical pulses about every 5 seconds to the vagus nerve, which in turn alters levels of neurotransmitters in the brain. Another procedure that can be used is a craniotomy to remove the part of the brain tissue that is responsible for the seizures.
In terms of nursing care, when a patient is having a seizure, it's incredibly important for you to know what you should and should not do during the seizure. So if your patient is standing or sitting, you want to lower them to the floor or the bed and turn them to their side. You should loosen any restrictive clothing. You do not place anything in their mouth, and you do not restrain the patient at all either. And while the patient is having their seizure, you should note the onset and duration of the seizure. After the seizure is complete, you want to check your patient's vital signs and their neurological status. You want to reorient the patient, and then implement seizure precautions if that has not already been done. So that means padding the side rails of the bed, and then you want to help determine what a possible trigger was for the patient's seizure.
Finally, let's talk a bit more about fibrile seizures, which, if you may recall I mentioned is the most common seizure disorder in children, as caused by a sudden spike in body temperature over 38 degrees Celsius without an underlying seizure provoking disorder or cause. So risk factors include children between the ages of six months and five years of age. In terms of signs and symptoms, you will see loss of consciousness and uncontrollable shaking of the arms and legs. Diagnosis of fibrile seizures is really focused on ruling out other causes of the seizures, such as meningitis. Treatment is typically not required. However, for prolonged seizures, antiepileptics, as well as benzodiazepines, can be used. And then we need to educate our families that if the child has a seizure that lasts more than five minutes, then they should call 911 because this would be indicative of status epilepticus.
All right. It's quiz time. I'm going to do something a little different for this quiz. I'm going to give you a symptom or a fact about a type of seizure, and I want you to tell me what kind of seizure I'm talking about. So this is name that seizure. Are you guys ready? All right. First one, this type of seizure is characterized by blank staring, eye fluttering, and picking at clothes. The answer is an absence seizure. Next one, this is a prolonged seizure that lasts more than five minutes. I'm talking about status epilepticus. Third one, this seizure causes a loss of muscle tone and often results in falling. This is an atonic seizure. And then finally, this is the most common seizure disorder in children. I'm talking about a febrile seizure.
All right. I hope that was helpful. If it was, definitely leave me a comment, and give us a thumbs up, like this video. And if you haven't already, be sure to subscribe to our channel. We have hundreds and hundreds of free videos to help you all the way through nursing school. Take care and good luck with studying.
Sometimes tonic clonic seizures are preceded by an aura, which is a visual or--
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