seizures for nurses

2. Subject; ACN

3. Subject
Adult Health Nursing
Meningitis and seizures

4. At the end of Presentation Students will be able to
 Define Meningitis.
 Discuss classification
 Explain Sign& Symptoms of meningitis.
 Describe Causes of meningitis.
 Explain its Complications.
 Discuss Medical Diagnosis and management.
 Explain Treatment regimen for meningitis.
 Identify Nursing diagnosis and intervention.
Objectives

5.  Define Seizure.
 Explain pathophysiology of Seizures.
 Identify Causes of Seizures.
 Discuss Sign & Symptoms of Seizures.
 Explain its Complications.
 Discuss medical diagnosis and management of
seizures.
 Identify Nursing Diagnosis related to seizures.
 Explain Nursing Intervention with rationale.
 Identify nursing Evaluation for seizure patient.

6.  Meningitis is the inflammation of the
protective membranes (meninges) that cover
the brain and spinal card.
 A bacterial or viral infection of the
fluids(cerebrospinal fluids) that surround the
brain and spinal card.

8. Septic:
 Caused by bacteria.
 most common pathogens are streptococcus
pneumonia and Neisseria meningitidis
Aseptic:
 caused by viral or secondary to lymphoma,
leukemia, or HIV

9.  Meningitis is characterized by the entry of
bacteria or virus into the cerebrospinal fluid
(CSF) and bacterial growth in this
compartment leading to inflammation within
the CSF and the adjacent brain tissue.
initiate a inflammatory process in the
meninges and lead to swelling and increase
CSF in the compartments. This process
results to increase CSF production and
increase intracranial pressure.

10. Infections generally originate in one of two
ways:
 Through the bloodstream as a consequence
of other infections
 Or by direct spread, such as might occur
after a traumatic injury to the facial bones
or
secondary to invasive procedure.

12.  Initial headache.
 High grade fever.
 Vomiting.
 Body steepness.
 Light intolerance or photophobia.
 Neck stifness and joints pains.
 In 30% of patients seizures also occurs.

13. • Each type of meningitis has a slightly different
cause, but each ultimately acts in the same way: A
bacterium, fungus, virus, or parasite spreads through
the bloodstream until it reaches the brain, or spinal
cord. There, it sets up in the lining or fluids around
these vital body parts and starts developing into a
more advanced infection.

14.  Non-infectious meningitis is the result of a
physical injury or other condition; it doesn’t
involve an infection ,or intrathecal cytotoxic
drugs.[methotrexate ,cytosine] .

17.  Blood tests most likely bacterial culture.
 CSF for culture and sensitivity
 CT brain
 EEG
 Physical examination

18.  Antibiotics that cross the blood-brain barrier into
subarachnoid space
 Penicillin antibiotics or one of the cephalosporins
 If resistant strains of bacteria identified, vancomycin
hydrochloride alone or in combination with rifampin may
be used
 Dexamethasone as adjunct therapy for 6 days.
 Fluid to prevent dehydration.
 Phenytoin to treat the seizures.

19.  Initial Assessment
 Obtain a history of recent infection such as
upper respiratory tract infection.
 Assess neurological status and vital signs.
 Assess sensorineural hearing loss
[vision,hearing]cranial nerve damage [facial
nerve palsy]and cognitive function.
 Maintaining fluid and electrolyte balance.

20. 1) Infective tissue perfusion[cerebral] related to
infectious process and cerebral edema.
2) Hyperthermia related to the infectious process
and cerebral edema
3) Acute pain related to meningeal irritation.
4) Impaired physical mobility related to prolonged
bed rest.
5) Risk for imbalanced fluid volume related to fever
and decreased intake.

21. Nursing interventions with rationale
 Reduce risk of fall to prevent patient from injury or
trauma.
 Assess LOC (level of consciousness) to decrease further
deterioration.
 Maintain a quiet,calm enviroment to prevent
agitation,which may cause an increased ICP.
 Administer medications as prescribed by ensuring 5
rights.
 Avoid i.v fluid overload,which may worsen cerebral
edema and enhance the disease process.

22.  Expected patient outcomes include:
 Avoidance of injury.
 Avoidance of infection.
 Restoration of normal cognitive function
 Prevention of complication (post meningitis).

23.  Boyer jo Mary[2004].textbook of medical
surgical nursing philadelphia,Lippincott
Willium and Wilkins.
 Lippinoctt[2001].mannual of nursing practice
,j.p.Brothers,philadelphia.
 www.medicinenet.com
 www.ijidonline.com article

24. 2nd Topic:
Seizures

25. Seizures are physical findings or changes in
behavior caused by uncontrolled electrical firing or
discharges from the nerve cells of the cerebral
cortex and are characterized by sudden, brief
attacks of altered consciousness, motor activity
and sensory phenomena. The term “seizure” is
often used interchangeably with “convulsion.”
Seizures are the
symptoms of brain
problems.

26.  During a seizure, there are bursts of
electrical activity in your brain, sort of
like an electrical storm. This activity
causes different symptoms depending on
the type of seizure and what part of the
brain is involved.

27.  Abnormal levels of sodium or glucose in
the blood.
 Brain infection, including meningitis and
encephalitis.
 Brain injury that occurs to the baby
during labor or childbirth.Brain problems
that occur before birth (congenital brain
defects)Brain tumor (rare)Drug
abuse.Electric shock.
When Meningitis causes brain swelling
or pressure,it can disrupt the brain
normal function it cause seizures.

28.  Confusion
 Changes in emotions like anxiety or irritability
 muscles weakness or abnormal motor
activities.
 Tremors and sweating.
 Drowsiness
 Hallucinations “unreal sensation which not
exist in reality”

29. Types of
seizures
Generalized
seizures
Partial
seizures

30.  A generalized seizure occurs when the
abnormal electrical activity causing a seizure
begins in both halves [hemispheres] of he
brain at the same time.
 Generalized seizures includes
absence,atonic,clonic,tonic,myoclonic,and
febrile seizures.

31.  Generalized seizures starts by the activation of group neuron.its
involves both hemispheres.
1,Tonic phase
 In the tonic phase the body becomes entire rigid.
2.Clonic phase
 There is uncontrolled jerking alternating contraction and
relaxation, causing a reciprocating movement,which could be
bilaterally symmetrical or ‘running' movements.
3.Absence seizures
 Brief and abrupt loss of consciousness. Usually of short duration
5-10sec ,no loss of postural control.
4, Myoclonic.
 It has short episode of muscles contractions for several minutes
.It occur after wakening .it may occur at any age.
5,Atonic .It is also called drop attack.have no muscle tone.

33.  Partial seizures happen when unusual
electrical activity affects a small area of the
brain .when the seizures does not effect
awareness ,it is known as a simple partial
seizures and it effecting the muscles of the
body .

34. Breathing in food or saliva into the lungs
during a seizure, which can cause aspiration
pneumonia.
Injury from falls, bumps, self-inflicted bites,
driving or operating machinery during a
seizure.Permanent brain damage (stroke or
other damage)Side effects of medicines.
Encephalitis
Oral trauma

35.  HISTORY
 Physical examination
 Blood test
 EEG [electroencephalogram]
 MRI [magnetic resonance imaging]
 CT scan
 SPECT[single photon emission computerized
tomography
 LP
EEG result show
changes in brain
activity.

36.  Pass iv line.
 Anticonvulsant –carbamezapine 500mg
 Valproic acid.
 Antiseizures –phenytoin 50mg iv
 tab Phenobarbital.

37. Risk for trauma or suffocation related to loss
of large or small muscle coordination.
Risk for ineffective airway clearance related
to neuromuscular impairment.
Situational low self-esteem related to stigma
associated with the condition.
Deficient knowledge related to information
misinterpretation.
Anxiety related to change in activities.

38.  Prevent Trauma injury
 Promote airway clearnce
 Improve self esteem
 Turn head to side and suction airway as
indicated support head place on soft area
 Monitor vital signs
 Assist to floor if out of bed
 Educate the patient family about the disease
and current situation.
 Relief the stressanxiety

39.  Remove near by objects and stay with the patient, to
minimize risk of trauma.
 Position the patient to maximize the ventilation.
 Promote airway clearance to prevent from tongue bite
and suffocation.
 Provide oxygen that brain tissues have high oxygen
supply.
 The bed is placed in a low position with side rails up to
reduce risk of fall.
 Keep NPO to prevent aspiration.
 Educate the patient and its family, provide psychological
support.

40.  Patient will verbalize understanding of factors
that contribute to the possibility of trauma.
 Patient will identify actions or measures to
take when seizure activity occurs.
 Patient will modify environment as indicated
to enhance safety.
 Patient will demonstrate behaviors, lifestyle
changes to reduce risk factors and protect self
from injury.

41.  www.hopkinmedicine.org
 www.cedars-sinai.org health library
 www.medicalnewstoday.com articles
 www.msdmanuals.com
 www.mayoclinic.org