<h3>Overview</h3>
<ol>
<li style="font-weight: 400;">Seizures diagnosed using EEG brain wave measurement</li>
<li style="font-weight: 400;">Medications given to stop or prevent seizures</li>
</ol>
<h3>Nursing Points</h3>
<h4 style="padding-left: 30px;">Therapeutic Management</h4>
<ol style="padding-left: 60px;">
<li style="font-weight: 400;">EEG Diagnostics
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">Types of brain waves</li>
<li style="font-weight: 400;">Where seizures occurring</li>
<li style="font-weight: 400;">How severe</li>
</ol>
</li>
<li style="font-weight: 400;">Medications
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">Antiepileptic drugs</li>
<li style="font-weight: 400;">Stop seizures:
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">Lorazepam (Ativan)
<ol>
<li style="font-weight: 400;">First-line drug</li>
<li style="font-weight: 400;">2 mg IV push during seizure</li>
</ol>
</li>
<li style="font-weight: 400;">Diazepam (Valium)</li>
<li style="font-weight: 400;">Phenobarbital</li>
</ol>
</li>
<li style="font-weight: 400;">Prevent seizures:
<ol style="list-style-type: lower-roman;">
<li style="font-weight: 400;">Phenytoin (Dilantin)</li>
<li style="font-weight: 400;">Fosphenytoin (Cerebyx)</li>
<li style="font-weight: 400;">Levetiracetam (Keppra)</li>
<li style="font-weight: 400;">Lacosamide (Vimpat)</li>
</ol>
</li>
</ol>
</li>
<li style="font-weight: 400;">Procedures
<ol style="list-style-type: lower-alpha;">
<li style="font-weight: 400;">Surgical removal of lesion</li>
<li style="font-weight: 400;">Cutting connections in brain</li>
<li style="font-weight: 400;">Deep Brain Stimulation</li>
</ol>
</li>
</ol>

A client who has a seizure disorder has been prescribed carbamazepine for control of the seizures. Which information is most important for the nurse give to the client before starting this medication?

 Which of the following medication is used for absence seizures?

The nurse is caring for a client who has a confirmed seizure disorder and is currently in a postictal state after a seizure. Several hours after the seizure, the client starts to develop hallucinations and becomes aggressive with caregivers. Which action is by the nurse is most appropriate for the treatment of this condition?

Which of the following is a priority nursing intervention following a seizure?

A nurse is caring for a client with a seizure disorder. While in the hospital, the client experienced a tonic-clonic seizure. What interventions of the nurse are most appropriate during the postictal state? Select all that apply.

A 36-year-old client with a history of epilepsy is in the hospital and experiences a seizure. For several minutes following the seizure, the client is calm but does not regain consciousness. The client then starts having another seizure. Which action is the first priority for the nurse?

 The nurse is caring for a client who exhibits seizure-like activity. What action should the nurse do first?

A client with a history of seizures takes medications to help control the seizures, but must start an additional anti-seizure medication. The client remembers that they are taking levetiracetam. However, the client cannot remember the name of the medication that the provider has just prescribed. Which of the following medications is most appropriate to help manage this client’s condition?

 The nurse is caring for a client who has a history of seizures and takes carbamazepine. Which of the following drugs does the nurse question for this client?

 The nurse is caring for 4 clients who each have levetiracetam (Keppra) ordered. Which client will need this medication first?

Pretty Little Liars Forever

Common medications proven to be effective in preventing seizure activity

Medications to Prevent Seizures

Seizure Patho Chart

EEG showing hyperactivity of brain waves in a seizure

EEG Showing Seizure

Cap to hold EEG Electrodes in place for monitoring

EEG Electrode Cap

Rectal Diazepam prescribed for home caregivers of epileptic patients

Rectal Diazepam

Deep Brain Stimulation - example location of electrodes

Deep Brain Stimulation

Seizure Interventions

05.04 Seizure Therapeutic Management

So now that we've looked at types of seizures and their causes as well as what nursing assessments we need to perform, let's look at therapeutic management for patients with seizures.
 
The first thing we'll see is our diagnostic testing. Seizures are diagnosed and named based on their clinical signs so that we know what type they are. Beyond that we will perform something called an electroencephalogram or EEG. Now this is something that is set up and managed by a technician with special training, but we want you to know what it looks like and what the purpose is. To perform an EEG, dozens of electrodes are placed on the patient's head like what you see here. These measure brain waves in different parts of the brain. We will get a readout that looks like this and can show us when we begin to have seizure activity. Remember that seizures are overactive nerve impulses, so on the EEG we will see the waves become taller and much more active. An EEG can tell us what types of brain waves there are, where the seizures are occurring, and how severe they are. A lot of times patients will be placed on continuous EEG for 24 hours or more so that we can catch a seizure on the tracing.
 
Now when we talk about medications for seizures were talking about antiepileptic drugs, or AED’s. There are two sets of drugs that we give to patients who are having seizures, one set to stop seizures when they're happening, and one set to prevent them and to be maintenance medications for these patients. The first line drugs for seizures are benzodiazepines. Specifically Lorazepam is our most common first-line drug when a patient is having a seizure. We will give 1 to 2 mg of Ativan IV push as soon as possible to try to stop the seizure. We could also use diazepam or Valium which is commonly used rectally for patients without IV access. For patients in status epilepticus that doesn't break with Ativan, we will give them barbiturates like phenobarbital to try to stop the seizures. Once we stabilize the patient they need to be started on prevention medications, which they will likely take for the rest of their lives. The two most common that you will be tested on are phenytoin and Levetiracetam or Dilantin and Keppra. Two others that you may see are fosphenytoin and lacosamide or Cerebyx and Vimpat. The most important thing to understand is that these medications have very specific half lives so the timing is extremely important. Not only do we need to make sure that we give their medications on time, but the patients need to be taught how important it is to be compliant with their medication instructions. If the patient is on Dilantin, we also need to monitor therapeutic drug levels to prevent toxicity, but honestly Dilantin is not given as commonly these days. 
 
Now there are a few procedural options for patients who have frequent seizures, although it's very rare to see this happen. Ultimately the goal is to either remove the overactive neurons or redirect the electrical activity. That could mean lesionectomy where they remove the portion of the brain that's causing the seizures. It could be neurotomies which is where connections between nerves are cut to stop impulses from traveling. Or we could do something called deep brain stimulation where electrodes are placed in the brain to attempt to redirect the electrical activity. Again, these are relatively uncommon, however you may see a patient who has had one or more of these.
 
So to recap, in order to get effective diagnosis we need to get an EEG. Again the EEG Tech will take care of this but if we notice any of the electrodes have dislodged we will notify the technician. We have our rescue meds like Ativan to administer went the patient has a seizure. If allowed by your facility, it is good practice to have Ativan locked up at the bedside for easy access, instead of having to go get it out of the med room. We will also make sure that the patients get their maintenance medications like Keppra or Dilantin, making sure that we are giving them on time, that the patient’s being compliant, and that we’re monitoring therapeutic levels if applicable. And then, remember these procedures are relatively rare, but they will come with the same post-op precautions as any other brain surgery.
 
Make sure you check out the nursing care lesson within this module to learn more about specific nursing interventions, and to find a care plan and case study for a patient with seizures. We love you guys, we hope you're really getting the big picture taking care of a seizure patient. Now, go out and be your best selves today. And, as always, happy nursing!

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