Question

A 3-year-old boy is a new patient with a diagnosis of seizure disorder. What possible types of seizures might the child be experiencing, and how are they characterized? What aspects of the boy’s seizure activity should the nurse observe and document? What instructions regarding the seizures should the nurse provide to his parents? Please answer this question in no less than 300 words..

Answer 1

Seizures is transient disturbance of cerebral functions due to abnormal neuronal discharge (abnormal electrical activity of the brain).

Epilepsy is a group of neurological disorders characterized by recurrent seizures.

Possible types of seizures that might be experienced by the child are:

Generalised seizures

• Tonic - Clonic (Grandmal seizures)
• Absence (petitmal seizures)
• Others ( Tonic , Clonic , myoclonic, atonic)

Partial seizures

• Simple partial
• Complex partial ( temporal lobe or psychomotor)
• Partial seizures with secondary generalisation

Characteristics :

Generalised tonic clinic seizures / grand- mal seizures : These are attacks in which consciousness is lost usually without aura(abnormal sensation felt by the patient like hearing something) or warning sign.

In tonic phase : tonic contractions of muscles ,stiffening of upper and lower limb muscles, lasts for 10- 30 seconds. There will be extension of limbs and opisthotonus posture

In Clonic phase : There is alternate rhythmic contraction and relaxation(flexion/extension), jerking movements of all extremities, associated with tongue bite, incontinence(urine /faecal) , moan groans, froathing from mouth .It lasts for 30- 60 seconds .

In recovery phase : there will be

• Post ictal confusion: after 10-30 minutes there will be full orientation of the patient.
• Todd's paralysis : transitional weakness or hemiparesis , patient recovers in 10 -15 minutes .

Characteristics of Absence seizures

• most common in children
• few periods of loss of consciousness with subtle motor manifestation like eye blinking, slight head turning.
• Episodes of blank staring in children
• Tone is normal
• Full orientation immediately after cessation of seizures
• 1-100 spells per episode so child cannot focus on studies.

Myoclonic seizures : are characterized by sudden, brief ,shock like contraction which may be localized to few muscles or one or more extremities. Myoclonic seizures are Idiopathic or may be associated with hereditary disorders. Patient experiences symmetric or asymmetric muscle contraction with small jerking movements of extremities.

Atonic seizures : sudden loss of muscle tone ,or loss of postural tone ,post seizure confusion may lead to fall or injury.

Simple partial seizures characterized by :

• Preserved consciousness
• During seizures patient experiences pain and unable to move extremities
• Unusual sensations like aura is there ,& patient retains the memory of aura.

Complex partial seizures characterized by

• Consciousness, responsiveness &memory is impaired.
• Episode begins with aura ,patient might have olfactory hallucinations
• Seizures last for less than 30 min (average 1-3 min)
• Motor manifestations : inco-ordinated ,involuntary motor activity which takes the form of oro- bucco-lingual movement in most of the patients & facial or neck movements in 50% of the patients

Aspects of the boy's seizure activity the nurse should observe and document are :

1. How did child behaves during the episode.

2. When did it happen?

3. How was the child after the seizure episode ?

4. Had any Previous history of seizures?

5. Observe above mentioned characteristics of different types of seizures and document different manifestations seen during the boy's seizure episode.

6. Monitor carefully & document it.

Instructions provided by the nurse to his parents are :

1. Loose the clothes around the neck

2. Protect the child by using pillows or blankets from head injury and other injuries because of falls and jerking movements.

3. Don't open patient's mouth forcefully to put anything in mouth during the episode.

4. Don't try to move the patient

5. Turn the patient to the left side to prevent aspiration and to open airways.

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