Nursing care plan seizure disorders

I. Pathophysiology
a. Sudden unregulated electrical discharge within the gray
matter of the cortex that temporarily interrupts normal brain
activity
b. Genetics plays a role in some cases.
c. May be idiopathic or acquired
i. Idiopathic: In approximately 75% of all seizures, which
includes epilepsy, no cause is identified (Fagley, 2007).
ii. Acquired: Possible causes include acidosis, electrolyte
imbalances, hypoglycemia (particularly related to type 1
diabetes), hypoxia, alcohol and drug withdrawal, dehydration,
systemic lupus, hypertension, septicemia, tumors,
and head trauma (Fagley, 2007).

II. Classification
a. Depends on whether the source of the seizure within the
brain is localized (partial or focal onset seizures) or distributed
(generalized seizures).
b. In adults, partial seizures are the most common type; can be
classified depending on whether consciousness is unaffected
(simple-partial seizure) or affected (complex-partial seizure).
i. Simple (partial motor, partial sensory) seizure may be
motor, for example, may manifest as a rhythmic jerking of
one hand; sensory, autonomic, or psychic; individual can
remember what happens but cannot control what is
occurring.
ii. Complex seizure lasts 30 seconds to 2 minutes and
usually begins in temporal or frontal lobe before affecting
other areas of the brain; individual appears dazed and
confused with or without motor activity being apparent
and may be preceded by an aura.
c. Generalized seizures involve loss of consciousness and are
classified according to the effect on the body.
i. Absence seizures (petit mal seizures): brief periods of
impaired consciousness lasting up to 20 seconds without
aura or postictal phase; there are no convulsions
ii. Myoclonic: brief, jerky motor movements lasting more
than 1 second that often cluster within several minutes
iii. Clonic: rhythmic, jerky motor movements involving
upper and lower extremities, with or without impaired
consciousness
iv. Tonic: sudden tonic extension or flexion of head, trunk,
and extremities lasting several seconds
v. Tonic-clonic (grand mal seizures): all areas of the cortex
are involved, with generalized extension of extremities
for several seconds, followed by rhythmic clonic movements
and a prolonged postictal phase
vi. Atonic: brief loss of postural tone, often resulting in falls
and injury (Cavazos & Lum, 2007)

III. Etiology
a. Major causes in adults include conditions that alter how the
brain works or that affect the brain’s blood supply (National
Institute for Neurological Disorders and Stroke [NINDS],
2008).
i. Cerebral pathology: traumatic head injury, stroke, infections,
hypoxia, expanding brain lesions, and increased
intracranial pressure
ii. Toxic agents: poisons, alcohol, overdoses of prescription
or nonprescription drugs, and drugs of abuse (with drugs
being the leading cause)
iii. Chemical imbalances: hypoglycemia, hypokalemia,
hyponatremia, hypomagnesemia, and acidosis
iv. Fever: acute infections and heatstroke
v. Eclampsia: prenatal hypertension and toxemia of pregnancy
vi. Idiopathic: unknown origin (also known as epilepsy)
b. Risk factors for seizure by adult age group (Franges, 2006)
i.Young adults: trauma, alcohol withdrawal, illicit drug
use; brain tumor; cardiovascular disease
ii. Adults: brain tumor; cerebrovascular disease, metabolic
disorders; alcohol withdrawal
iii. Older adults: stroke, brain tumor, Alzheimer’s-type
dementia

IV. Statistics
a. Morbidity: Epilepsy and seizures affect over 3 million
Americans of all ages, with 200,000 new cases annually;
about 1 in 100 people in the United States have
experienced an unprovoked seizure or been diagnosed with
epilepsy (NINDS, 2008).
b. Mortality: Most deaths are accidental due to impaired
consciousness (Cavazos & Lum, 2007).
c. Cost: Estimated at $12.5 billion in direct and indirect costs
annually (Epilepsy Foundation, 1995–2005).

Care Setting
Seizure disorders are treated in a community setting; however,
client with convulsive seizures may require brief inpatient care
on a medical or subacute unit for stabilization or for treatment
of status epilepticus (a life-threatening emergency).

Related Concerns
Cerebrovascular accident (CVA)/stroke
Craniocerebral trauma (acute rehabilitative phase)
Psychosocial aspects of care
Substance dependence/abuse rehabilitation

Nursing Priorities
1. Prevent or control seizure activity.
2. Protect client from injury.
3. Maintain airway and respiratory function.
4. Promote positive self-esteem.
5. Provide information about disease process, prognosis,
and treatment needs.

Discharge Goals
1. Seizure activity controlled.
2. Complications and injury prevented.
3. Capable, competent self-image displayed.
4. Disease process, prognosis, therapeutic regimen, and limitations
understood.
5. Plan in place to meet needs after discharge.

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