Convulsion Nursing Care Plan Notes

 

Description

A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body.Because a convulsion is often a symptom of an epileptic seizure, the term convulsion is sometimes used as a synonym for seizure. However, not all epileptic seizures lead to convulsions, and not all convulsions are caused by epileptic seizures. Convulsions are also consistent with an electric shock.

Epilepsy – Symptom complex characterized by attacks of unconsciousness that may or may not be associated with convulsions, sensory phenomenon or abnormalities in behaviour.

Predisposing Factors

1. Head injury due to birth trauma
2. Genetics
3. Presence of brain tumor
4. Toxicity from
   • Lead
   • carbon monoxide
5. Nutritional and Metabolic deficiencies
6. Physical and emotional stress
7. Sudden withdrawal to anti convulsant drug is predisposing factor for status epilepticus (drug of choice is Diazepam, Valium)

Signs and Symptoms

I. Generalize

Primarily generalized seizures can be sub-classified into a number of categories, depending on their behavioural effects:

• Petit mal Seizures (Absence seizures) involve an interruption to consciousness where the person experiencing the seizure seems to become vacant and unresponsive for a short period of time (usually up to 30 seconds). Slight muscle twitching may occur.
• Myoclonic seizures involve an extremely brief (< 0.1 second) muscle contraction and can result in jerky movements of muscles or muscle groups.
• Clonic seizures are myoclonus that are regularly repeating at a rate typically of 2-3 per second. in some cases, the length varies.
• Tonic–clonic seizures (Grand Mal Seizures) involve an initial contraction of the muscles (tonic phase) which may involve tongue biting, urinary incontinence and the absence of breathing. This is followed by rhythmic muscle contractions (clonic phase). This type of seizure is usually what is referred to when the term ‘epileptic fit’ is used colloquially.
• Atonic seizures involve the loss of muscle tone, causing the person to fall to the ground. These are sometimes called ‘drop attacks’ but should be distinguished from similar looking attacks that may occur in cataplexy.

II. Partial or Localized Seizures

Partial seizures (also called focal seizures and localized seizures) are seizures which affect only a part of the brain at onset.The brain is divided into two hemispheres, each consisting of four lobes – the frontal, temporal, parietal and occipital lobes. In partial seizures the seizure is generated in and affects just one part of the brain – the whole hemisphere or part of a lobe. .

Partial seizures can be further characterized as:

• Simple — not affecting awareness or memory
• Complex — affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behavior

Jacksonian (focal Seizure)

• Jacksonian seizure (or Jacksonian march) is a phenomenon where simple partial seizure spread from distal part of limb to face ipsilaterally (on same side of body). They involve a progression of the location of the seizure in the brain, which leads to a “march” of the motor presentation of symptoms.

Complex partial seizures (AKA Psychomotor Seizure and focal motor seizure)

• A complex partial seizure is an epileptic seizure that is associated with bilateral cerebral hemisphere involvement and causes impairment of awareness or responsiveness, i.e. alteration of consciousness.
• Complex partial seizures are often preceded by a seizure aura.The seizure aura is a simple partial seizure. The aura may manifest itself as a feeling of déjà vu, jamais vu, fear, euphoria or depersonalization.The seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia).Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing.There may also be loss of memory (amnesia) surrounding the seizure event. The person may still be able to perform routine tasks such as walking. Witnesses may not recognize that anything is wrong.
• Complex partial seizures might arise from any lobe of the brain.Complex partial seizures most commonly arise from the mesial temporal lobe, particularly the amygdala, hippocampus, and neocortical regions. A common associated brain abnormality is mesial temporal sclerosis. Mesial temporal sclerosis is a specific pattern of hippocampal neuronal loss accompanied by hippocampal gliosis and atrophy.Complex partial seizures occur when excessive and synchronous electrical brain activity causes impaired awareness and responsiveness.The abnormal electrical activity might spread to the rest of the brain and cause a secondary generalized tonic–clonic seizure.

III. Status Epilepticus

• A continuous uninterrupted seizure activity, if left untreated can lead to hyperpyrexia and lead to coma and eventually death.
• Drug of choice: Diazepam, Valium and Glucose

Diagnostic Procedures

1. CT Scan – reveals brain lesions
2. EEG – reveals hyper activity of electrical brain waves

Nursing Management

1. Maintain patent airway and promote safety before seizure activity
   • clear the site of blunt or sharp objects
   • oosen clothing of client
   • maintain side rails
   • avoid use of restrains
   • turn clients head to side to prevent aspiration
   • place mouth piece of tongue guard to prevent biting or tongue
2. Avoid precipitating stimulus such as bright/glaring lights and noise
3. Administer medications as ordered
   • Anti convulsants (Dilantin, Phenytoin)
   • Diazepam, Valium
   • Carbamazepine (Tegretol) – Trigeminal neuralgia
   • Phenobarbital, Luminal
4. Institute seizure and safety precaution post seizure attack
   • administer O2 inhalation
   • provide suction apparatus
5. 5. Document and monitor the following
   • onset and duration
   • types of seizures
   • duration of post ictal sleep may lead to status epilepticus
   • assist in surgical procedure cortical resection