Epilepsy in Children Schuyler Wilson Nursing Care Through the Lifespan III June 28, 2005 Epilepsy is the name for a condition of recurrent seizures where no underlying cause can be determined. Seizures occur as a result of abrupt, explosive, unorganized discharges of cerebral neurons. This causes a sudden alteration in brain function involving sensory, motor, autonomic and / or psychic clinical manifestations. Epilepsy can be a result of other conditions including: SS Genetic predisposition Brain tumor Injury, trauma InfectionS S FeverS S Alcohol or drug use Congenital malformation as well as many others. Many different things such as fatigue, stress, environmental factors such as strobe lights, TV, loud noises, and even some music may trigger seizures. (Heathers, 363) There are many different types of seizures.
These fall into three broad categories: Generalized, partial, and unclassified seizures. Generalized seizures involve both hemispheres of the brain. There are six different types of generalized seizures. Tonic-Clonic: begin with tonic phase which includes stiffening of the muscles usually in the arms and legs and loss of consciousness.
The clonic phase includes a rhythmic jerking movement of the extremities. Incontinence of urine and feces may occur. A period of confusion, and fatigue may last up to an hour following this type of seizure. Absence: these seizures tend to run in families and are more common in children. They are characterized by moments (seconds to minutes) of loss of consciousness and staring that looks much like the child is daydreaming. When these seizures are the only ones the child presents with they are at a risk of being thought to have Attention Deficit Disorder and not receive the treatment they really need.
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Myo clonic: these are characterized by brief contracting of muscle groups in the extremities. These episodes are seen more often in school-aged children and adolescents than in young children. Atonic: a sudden loss of muscle tone followed by a period of confusion. These seizures often lead to a all possibly causing injury to the child.
Partial seizures are also sometimes called local or focal seizures. They take place in one hemisphere of the brain. There are two subcategories of partial seizures including simple partial and complex partial. Simple partial: seizures do not cause a loss of consciousness. During a simple partial seizure the person will experience motor, sensory or autonomic symptoms such as abdominal discomfort, strange tastes in their mouth, and an increase in heart rate. Complex partial: often cause the patient to loose consciousness for one to three minutes.
During this time symptoms such as lip smacking, hallucinations, chewing or teeth grinding will occur. A period of confusion will also follow this type of seizure. Unclassified seizures are seizures with no apparent cause and do not fall into the generalized or partial categories. Unclassified seizures account for about half of all seizure activity. (Ignataicius, 950; JAD, 971; Benbadis, 1) Treatment for epilepsy is often focused on controlling the seizures with the least amount of medication as possible.
Anti epileptic drugs (AEDs) are the class used to accomplish this. Some of the AEDs that are used most often are Clonazepam, Diazepam, Divalproex, Gabapentin, and Phenytoin. The most common side effects of these medications include nausea, vomiting, sedation, fatigue, and lethargy. (Kwan, 1; Benbadis, 3-5; Huethers, 637) Nursing interventions used when caring for a child with epilepsy are: SS Make sure AEDs are administered as scheduled Monitor for side effects of AEDs and report to doctor Place patient in seizure precautions Do not put anything into child’s mouth during seizure Stay with the child during seizures Record seizures, precipitating event and if incontinence takes place during the seizure Determine child’s and parents’ educational needs related to diagnosis Refer family to epilepsy support group in area Teach parents and child Child must always wear protective equipment when riding bike or playing on playground equipment It is a good idea for the child to wear a life jacket when swimming even when parent is close by The importance of administering AEDs on schedule and not missing dose so How to identify side effects of the child’s medication and what to report Educate parents about need for child to wear a medic-alert bracelet or necklace (JAD, 971; Carpanito, 97) Nursing Diagnoses for a child with epilepsy would include 1) Risk for injury related to seizure activity As Manifested By: SS child having frequent seizures at and away from home falls resulting from seizure activity have already taken place Goal: patient will be free from injury as a result of appropriate use of protective measures. Interventions: SS place child in seizure precautions; bed rails padded, suction equipment near bed stay with child during seizure activity SS record the seizure; precipitating event, time, incontinence keep floor free of debris and furniture out of the way keep sharp objects put away and always stay with the child when they are using sharp objects 2) Knowledge deficit related to new diagnosis of epilepsy As Manifested By: SS patient and family express need for more information about new diagnosis Goal: patient and family will demonstrate a level of knowledge about diagnosis to maintain a safe environment for the patient Interventions: SS teach the use of protective equipment when child is climbing or riding a bike teach the importance of administering medications on schedule and not skipping any doses educate parents about the need for a medic-alert tag for the child SS instruct the patient and parents the common side effects associated with their medication and how to report them to the doctor 3) Anxiety related to risk of seizures As Manifested By: SS child withdrawn from social activities because of fear of possible seizure child expressing anxiety about other people knowing about diagnosis child is apprehensive about taking medication where others can see because of concern about other children’s fears of them Goal: patient will be more comfortable with diagnosis and possibility of seizures and be active on the planning of what to do when one occurs Interventions: SS teach patient ways to simply explain their diagnosis to friends, family and teachers at school so they will be more comfortable with the subject teach patient appropriate coping mechanism for their age and situation listen to patients worries and concerns refer patient to support group for epilepsy praise patient for effective coping involve child in play to distract from anxiety (JAD, 972; Carpanito, 97) ReferencesCarpenito, L, (2002).
... Springhouse, PA: Springhouse Corporation. Catalano, J. T.(1996). Contemporary professional nursing. Philadelphia: F. A. Davis Company. Hunt, G.(Ed. ). (1994). Ethical ... dilemma about HIV and confidentiality in a prominent Philadelphia hospital. 'The nurse's ethical belief in the patient's ... in a substance abuse center at a prominent Philadelphia hospital. Sally has been active with her hospital's ...
Adrienne Asch makes a valid point about prenatal diagnosis in Potok's book, "A Matter of Dignity: Changing the World of the Disabled." She states, "I dislike prenatal diagnosis because disability is only one characteristic of a person's life, infant or not (169)." Although I agree with her, I still believe that this one characteristic is so time consuming, costly and emotionally draining that many ...
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