1. The client/caregiver can define epilepsy and seizure.
   1. Epilepsy is a chronic neurological disorder with repeated occurrence of any form of seizure activity.
   2. Seizures (convulsions) are episodes of abnormal electrical brain activity that produces involuntary muscle contractions.
   3. These involuntary muscle contraction can cause
      • Disturbances of consciousness
      • Disturbances in behavior
      • Disturbances in sensation
      • Disturbances in anatomic functions
   4. About 10% of Americans will experience a seizure sometime in their life.
   5. About 30% will have had a diagnosis of epilepsy by the age of 80 years.
2. The client/caregiver can list factors, causes, and risk factors.
   1. Idiopathic (no specific cause identified)
   2. Brain tumor
   3. Trauma
   4. Infections (encephalitis and meningitis)
   5. Fever
   6. Drug and alcohol intoxication
   7. Metabolic and nutritional disorders
   8. Genetic factors
   9. Toxins
   10. Extreme fatigue
   11. Flashing lights
3. The client/caregiver can recognize signs and symptoms of various types of seizures.
   1. General
      • Involuntary recurrent muscle movements
      • Jerking, patting, and rubbing
      • Sudden contractions of muscle groups
      • Fluttering of eyelids
      • Lip smacking
      • Movements confined to one area or spreading from one side to the other
      • Head and eyes deviating to the side
   2. Specific
      • Tonic-clonic (grand mal) lasting 2 to 5 minutes. Tonic phase is when the body stiffens. Clonic phase alternates between muscle spasm and relaxation.
      • Other signs are tongue biting, incontinence, dyspnea, apnea, and cyanosis.
      • After seizure is postictal stage with sleepiness and confusion.
   3. Petit mal
      • Lasts 5 to 30 minutes
      • Blinking, rolling eyes, and blank stare
4. The client/caregiver can explain course of action during and after a grand mal seizure.
   1. Remain calm.
   2. Never try to restrain the client. Prevent or break fall by easing to ground.
   3. Never leave client alone.
   4. Note the time and type of seizure activity.
   5. Do not place anything in person’s mouth.
   6. Protect head by clearing area and place padding.
   7. After seizure, turn person on side to avoid aspiration.
   8. Loosen tight clothing.
   9. Call physician and report seizure activity.
   10. Maintain quiet environment.
   11. Reassure and reorient the person.
5. The client/caregiver can explain course of action during and after a petit mal seizure.
   1. Remain with the person. Do not attempt to awaken or startle them.
   2. Person will resume normal activity when seizure is over.
6. The client/caregiver can list additional measures to prevent or manage seizures.
   1. Take medications as ordered, and avoid over-the-counter medications without approval by physician.
   2. Keep follow-up appointments with physician.
   3. Identify and avoid possible precipitating factors such as stress, alcohol, fatigue, and so forth.
   4. Identify and avoid stimuli that can trigger seizure activity such as flashing lights or loud music.
   5. Advise the person to lower water heater temperature to avoid burns if seizure occurs during shower/bath.
   6. Check state regulations regarding driving an automobile.
   7. Avoid using heavy equipment or dangerous equipment until cleared by physician.
   8. Seek vocational counseling or job retraining if needed.
   9. For females of childbearing age, discuss risks and options of pregnancy with healthcare provider.
   10. Eat a well-balanced diet, avoiding caffeine and alcohol. Space meals and snacks throughout the day to avoid hypo- glycemia.
   11. Avoid activities that create excessive visual stimulation such as video games and the use of computer for long periods of time.
   12. Wear a Medic Alert bracelet.
7. The client/caregiver is aware of possible complications.
   1. Status epilepticus (rapid succession of seizures)
   2. Physical injury (fracture, tongue or lip laceration)
   3. Respiratory impairment

Resources

Epilepsy Foundation of America
www.epilepsyfoundation.org

Centers for Disease Control and Prevention
www.cdc.gov/epilepsy/resources.htm

National Institute of Neurologic Disorders and Stroke
www.ninds.nih.gov

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins. Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott
Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com