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CONVULSION Lecture cum LCD

discussion slides
INTRODUCTION
Introduce the A seizure occurs when the brain functions abnormally, resulting in a change in
topic movement, attention, or level of awareness. Different types of seizures may occur in
different parts of the brain and may be localized or widespread. Seizures may occur for
many reasons, especially in children. Seizures in newborns may be very different than
seizures in toddlers, school-aged children, and adolescents. Seizures, especially in a
child who has never had one, can be frightening to the parent or caregiver.
TERMINOLOGIES:
Epilepsy
A neurological condition characterized by recurring seizures
Seizure

Recall some of A sudden attack of altered cerebral function Lecture cum LCD
the terminologies discussion slides
Epileptic Seizure
The result of altered cerebral function caused by abrupt , abnormal , excessive,
uncontrolled , repetitive electrical discharges of cerebral neurons
Convulsion
A serious of forceful involuntary contractions and relaxations of the voluntary muscles
Or,
It is caused by the abnormal electrical discharges from the brain resulting in abnormal
involuntary paroxysmal , motor, sensory , autonomic or sensorial activity
Incidence
About 5% experiences it during the first 5 yrs of life
 Causes
In neonates

• Birth asphyxia, difficult obstructed labour

Enlist the causes • Intra ventricular , intracerebral haemorrhage

• Metabolic disturbances

• In born errors of metabolism

• Accidental injection of LA into fetal scalp

• Kernicterus

• Developmental malformations, microcephaly , porencephaly etc

Lecture cum LCD
• Meningitis, septicemia and Intrauterine infection discussion slides
In children…..

• Simple febrile convulsions

• Infections of CNS

• Post infectious

• Metabolic causes

• ICSOL
• Drugs and poisons and Epilepsy
Discuss the
pathophysiology Pathophysiology
1. Hereditory or genetic theory
2. Biochemical theory Lecture cum LCD
discussion slides
3. Electrophysiological theory
4. Neuropathological theory
 Hereditory or genetic theory

• Epilepsy can be familial

• 12% risk if parents or siblings of parents were affected

Biochemical theory

• Na+-K+ ATP ase theory

• Neurotransmitter theory
Na+-K+ ATP ase theory
In the epileptic cortices Na+-K+ ATP ase are low Lecture cum LCD
discussion slides
Discuss the ↓
pathophysiology
Na+ accumulates in the cell and
K+ accumulates outside

↓
Depolarization

↓
Electrical discharges

• K+ causes excitation of the nerve

Neurotransmitter theory
Seizures occurs due to imbalances of the neurotransmitter

↓inhibitory(GABA) excitatory ( Ach)

Imbalances favoring excitation

↓
Epileptic attack
 Glucose
Glutamine GABA
Protein
Cofactor pyridoxine(B6)
Electrophysiological theory
RMP altered

↓
Cell excited

↓
Neuronal firing
Discuss the ↓
pathophysiology
Seizures
Neuropathological theory Lecture cum LCD
discussion slides
• Tumor, infection , scar , inflammation, vascular blockade
IN NUTSHELL,
Etiological factors

↓
Epileptic neurons behaves differently from their healthy counterparts

↓
Usually stable neuronal voltage may suddenly decrease

↓
 Cell membrane reaches the critical threshold for discharge

↓
Excessive firing of nerve impulse
Classification and clinical features
Enumerate the Generalised
classification
a) Tonic clonic or grand mal
b) Tonic
c) Clonic Lecture cum LCD
discussion slides
d) Absence (petit mal)
e) Atonic
f) Bilateral epileptic myoclonus
Localised
Simple partial with elementary symptoms & no impairment of consciences with
 Motor, sensory , autonomic or mixed symptoms

 Complex partial seizures with impaired LOC

 Simple partial but with LOC

 With automatism
Undifferentiated
• Neonatal seizures
• Severe myoclonic epilepsy of infancy
• Acquired epileptic aphasia
Clinical features
 Tonic – clonic seizures
Aura
o Recognises impending seizure

Tonic
o Sustained spasm of Skeletal muscle

o Shrill cry

o Muscular rigidity
Identify the o Face become pale, pupil dilated, eyes rolled up
clinical features
o Frothing, incontinence

o Last for 30 mts

Clonic
o Rhythmic alternative contractions
Lecture cum LCD
o Last for few seconds discussion slides
Post ictal
o C/o headache , confusion, perform automatic actions which have
no recollections later
Absence attack

• Starts abruptly in childhood

• No aura

• Abrupt lapse of awareness

• May show sudden discontinuation of activities

• Lasts for 30 sec

Enlist the
diagnostic
measures Simple Partial seizures

• It begins with a focal epileptiform discharge

• Sensory sensation like pain , cold, burning…..

• No loc

• Jacksonian march Lecture cum LCD

discussion slides
Complex Partial seizures

• Extension of Simple Partial seizures with LOC

• Secondary to parital lobe impairment

Discuss the
Diagnostic measures
medical
management • X ray

• CT scan

• MRI

• EEG

• History and physical examination Lecture cum LCD

discussion slides
Management of seizures:
Goals
1. Ensure adequate systemic & cerebral oxygenation
2. Terminate seizure activity
3. Prevent seizure recurrence
4. Establish a diagnosis & treat the underlying disorder if present
Management of seizures:
Emergency supportive treatment
 • Secure airway

• Maintain O2 and BP

• Obtain I/V line

• Protect patient from injury

• Keep air way open

• Suction if needed…..

• O2 administration

• Determine blood sugar→25% dextrose(2ml/kg)

• Lab investigation should be performed

• Temperature
Management of seizures: Anticonvulsants:

• Diazepam 0.1-0.5mg/kg initial dose(1mg/mt)

• If seizure doesnot stop in 5 mts repeat…

Lecture cum LCD
• Lorazepam 0.1mg/kg discussion slides

• Midazolam ..Less resp. Depression

• Benzodiazepines should be followed by I/V Phenytoin at 20mg/kg at a rate

1mg/kg/mt

• Management of seizures
Discuss the
nursing  If seizure remain uncontrolled
management  Phenobarbitone 20mg/kg I/V

 At a rate 1mg/kg/ mt

• I/V dextrose, mannitol to reduce brain edema

Nursing management:
Assessment:

• Monitor the physiological status of the child

• Observe specific seizure activity

• Collect history about chief complaint, symptoms, any trauma, medications ,

special type of movements etc
Nursing Diagnosis
1. Ineffective breathing pattern related to dysfunctional neuro muscular function

2. Ineffective airway clearance related to inability to control secretions during

seizure
3. Risk for trauma related to uncontrolled movement of seizure activity

4. Potential for self esteem disturbance related to chronic illness

5. Anxiety related to unpredictable nature of the disease condition

6. Ineffective therapeutic regimen management related to poor adherence with

medication
7. Potential for aspiration related to inability to control the secretions

8. Potential for impaired social interaction related to chronic illness

Planning and implementation:

• Maintain the air way

 Place nothing into child’s mouth during convulsion

 Position the child in recovery position

 Monitor for adequate oxygenation

 Administer o2
 • Ensure safety
 Protect the child from self harm

 Keep the padded side rails up

 Wear the helmet in repeated cases

• Administer medication
 Slow I/V administration of the drugs

 Dilute phenytoin in NS

 Monitor the respiratory status

• Provide emotional support

 Verbalization of the feelings

 Support groups

 Stress on the importance of treatment

• Discharge planning and home teaching

 Importance of follow up
CONCLUSION:
Convulsions are a series of diseases of the CNS and refers to the chronic condition
where repeated attacks of unconsciousness occur with violent shivers. Early and
effective management is essential to prevent mortality and morbidity associated with
prolonged seizure.
BIBLIOGRAPHY:
1. Wong D.L etal . Essentials Of Paediatric Nursing. 6th edition. Missouri:
Mosby;2001
2. Marlow D.R. Redding B. Textbook of Paediatric nursing. 1st edition.Singapore:
Harwourt Brace & company; 1998
 3. Dr.Chaudari KC. Indian Journa of Paediatrics. Nov22 2007
4. Parthasarathy IAP textbook of Paediatrics. 2nd edition. jaypee: NewDelhi; 2002

LESSON PLAN
TOPIC : CONVULSION IN CHILDREN
SUBJECT : PAEDIATRIC NURSING
GROUP : II YEAR MSc NSG STUDENTS
METHODS : LECTURE CUM DISCUSSION
VENUE : MSc NSG CLASS ROOM
DATE : 22. 06. 2010
STUDENTR TEACHER: Ms. SHESLY P. JOSE
AVAIDS : LDC
PREVIOUS KNOWLEDGE:
Students have had classes on convulsion in children in their BSc nsg course
General Objective
On completion of the class the students will be able to understand the disease condition convulsion so as to apply this knowledge in their future
practice with a positive attitude.
Specific objective:
On completion of the class the students will be able to;
1. Recall some of the terminologies
2. Enlist the causes
3. Discuss the pathophysiology
 4. Enumerate the classification
5. Identify the clinical features
6. Enlist the diagnostic measures
7. Discuss the medical management
8. Discuss the nursing management

Lesson plan
on
convulsions in children
Submitted to: Submitted by:
Mrs. Reshma Ms. Shesly P . Jose
Lecturer II MSc (N)
NUINS NUINS