Epilepsy is a disorder in which nerve cells of the brain from time to time release abnormal electrical impulses. These cause a temporary malfunction of the other nerve cells of the brain, resulting in alteration of, or complete loss of consciousness.

A. Etiology and pathophysiology

1. Abnormal discharge of electric impulses by the nerve cells in the brain from idiopathic or secondary causes resulting in the typical manifestation of seizures
2. Onset of idiopathic epilepsy generally before age 30
3. Other conditions associated with seizures include brain tumor, CVA, hypoglycemia, and head trauma
4. Types of seizures

• Partial seizures (seizures beginning locally)

1. Simple: focal motor or sensory effect; no loss of consciousness
2. Complex: cognitive, psychosensory, psychomotor, or affective effect; brief loss of consciousness

• Generalized seizures (bilaterally symmetric and without local onset)

1. Absence (petit mal): brief transient loss of consciousness with or without minor motor movements of eyes, head, or extremities
2. Myoclonic: brief, transient rigidity or jerking of extremities, singly or in groups
3. Tonic-clonic (grand mal): aura, loss of consciousness, rigidity followed by tonic and clonic movements, interruption of respirations, loss of bladder and bowel control

• Status epilepticus: prolonged partial or generalized seizures without recovery between attacks; may completely exhaust the client and lead to death

B. Clinical findings (tonic-clonic seizures)
Subjective: Aura or warning sensation such as seeing spots or feeling dizzy often precedes a tonic-clonic seizure, Loss of consciousness during   seizure, Lethargy often follows return to consciousness (postictal phase), Dyspnea,

Objective: Pupils become fixed and dilated, Often the client cries out as seizure begins or as air is exhaled forcefully, Tonic and clonic movement of the muscles, Incontinence, Abnormal EEG

C. Therapeutic interventions

• Anticonvulsant therapy continued throughout life

1. Phenytoin sodium (Dilantin), carbamazepine (Tegretol), valproic acid (Depakene), mephenytoin (Mesantoin) and primidone (Mysoline) often used to control tonic-clonic seizures
2. Trimethadione (Tridione), phensuximide (Milontin), and
3. ethosuximide (Zarontin) to control absence seizures
4. Diazepam (Valium) given IV to treat status epilepticus

• Sedatives (e.g., phenobarbital) used to reduce emotional stress
• Neurosurgery is sometimes indicated if seizures are caused by tumors, abscesses, or vascular problems

Nursing Care of Clients with Epilepsy
A. Assessment
1. History of type, frequency, and duration of seizures
2. History to identify precipitating factors
3. Sensations associated with the seizure that may constitute an aura
4. Detailed list of client’s medications

B. Analysis/Nursing Diagnoses

• Refer to General Nursing Diagnoses for Clients with
• Neuromusculoskeletal Systems Disorders for the following diagnoses: B, M 4, X, and CC

C. Planning/Implementation

1. Provide protection for the client during and after the seizure by maintaining and protecting from injury; nothing should be forced into a client’s mouth since this may cause the tongue to occlude the airway or may loosen teeth
2. Help the client who can identify an aura to prepare and provide some protection before the seizure develops
3. Encourage the client to carry and wear a medical alert tag
4. Help the client plan a schedule that provides for adequate rest and a reduction of stress
5. Instruct the client to refrain from excessive use of alcohol, since it is contraindicated with the medications
6. Teach the client and family to observe the aura, initial point of seizure, type of seizure, level of consciousness, loss of bladder and bowel control, progression of seizure, and postictal condition
7. Encourage the client to express feelings about illness and the necessary changes in life-style and self-image
8. Assist the client and family to accept the diagnosis and develop some understanding of the disease process
9. Help the client understand that medication must be taken continuously for the remainder of life under continued medical supervision
10. Refer the client for job counseling as needed
11. Encourage the client and family to attend meetings of the local epilepsy association
12. Refer client to individual state laws regarding driving
13. Teach client about anticonvulsant therapy (see Nursing Care under Anticonvulsants in Pharmacology Related to Neuromusculoskeletal Systems Disorders)

D. Evaluation/Outcomes

1. Remains free from injury
2. Experiences a reduction in frequency of seizures
3. Verbalizes willingness to follow lifelong medication regimen
4. Lists activities sponsored by the local epilepsy association

Tagged with: Nursing Care Plans For Alzheimer's Disease, Nursing Care Plans for Epilepsy

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