N334 IC Regulation part two

IC Regulation

​Part Two

​​Seizure

​Parkinson's

SDSU College of nursing

N334 Patient Centered Care

Concepts II

Types of seizure: Generalized, Focal, Motor, nonmotor, unknown

Generalized:

Tonic-clonic: stiffening and jerking movements, loss of consciousness (<20 secs)

Clonic: jerking movements no loss of consciousness

Tonic: Muscle tone intensifies, loss of consciousness

Myoclonic: stiff extremities, bilateral or unilateral

Atonic (akinetic) "Drop" seizure, loss of muscle tone, Rare

Drag and Drop

What is the definition of a seizure?​

Placeholder

Drag these tiles and drop them in the correct blank above

Abnormal electrical discharge in the brain

I cannot recall

uncontrolled diabetes

Tonic-Clonic (previously known as Grand Mal)

Loss of consciousness

Body rigidity (10-20 secs)

Jerking movement (clonic)

Partial aka Focal seizures

A single side of the brain in the cerebral cortex

Pt's are alert or impaired but complain of different sensations.

May experience a variety of different impulses such as taste, smell, or tactile sensations

​Etiology vary by age

Primary

• Genetics

​

Secondary

• tumor or trauma

• Metabolic dx

• Acute ETOH withdrawl

• Electrolyte disturbances

• Fever

• Stroke

• Other substance abuse

• Heart disease

​

​

Etiology continued

Newborn to 6 months - congenital defects

​

​2 to 20 y/o - Infection, head trauma or genetics

​

​20-30 - Tumor or vascular disease

​

​>50 Metastatic tumor or stroke

​

​33% are idiopathic (unk cause)

Nursing Care during a seizure

• Protect patient

• Maintain airway

• Avoid restraining

• Do not place anything in the mouth

• Loosen restrictive clothing

• After seizure, maintain airway assess for injury

• Record and document duration of seizure

Multiple Choice

A nurse is caring for a child who is having a tonic-clonic seizure and vomiting. Which of the following actions is the nurse's priority?

• Position the child on their side

• Positioning the client in bed

• Loosen restrictive clothing

• Clear the area of hazards

Peditric concerns

• Up to 10% of children have one seizure by the age of 16

• Most common pediatric neurological disorder

• Many causes or idopathic

• Epilepsy: West syndrome and Lennox Gastaut (most common)

Parkinson's Disease

Gradual onset

​

Chronic, and progressive

​Etiology of Parkinson's

• Environmental and genetic factors

• Exposure to chemicals and metals

• >40 years old

• Familial tendency

​Cause of PD

​Unknown cause

​​Most recognize environmental and genetics play a role

​​-Family history in 15% of cases

​-Illicit drug use, will reverse if stopped

​-Reduced dopamine - reduced production or disruption of dopa-acetylcholine balance

​-An increased risk with:

​ -Well water

​ -Pesticides/Herbicides

​ -Industrial chemicals

​ -Wood pulp mills

​ -Rural residence

​ -Lewy Body

​Parkinson's Incidence and Prevalence

• ​1 million Americans (50 years old)

• 60,000 new cases yearly

• ​Increase incidence with age

• ​Men are 50% more likely to have PD than women

​Diagnostics

​No specific diagnostic test

​ -Based on Hx and physical assessment

Presence of TRAP Tremor, Rigidity, Akinesia or bradykinesia, Postural instability

Facial expression (masklike appearance)

Changes in emotion (emotional lability)

Bowel and bladder changes

+ Response to Parkinson medication

MRI

R/O side effects of medication

​Manifestations

​Early (beginning stages)

​ -Mild tremor

​ -Slight limp

​ -Arm swing

​ -Pill rolling

​Late

​ -Festination (shuffling gait)

​ -propulsive gait

​ -Loss of postural reflexes

​ -Difficulty with speaking

​ -Drooling

​-Masked face (blank facial expression)

Additional symptoms

Non-motor sx

• ​Depression, Axiety

• ​Pain

• ​Fatigue

• ​Constipation, urine retention

• ​Sleep disturbance

• ​Short-term memory loss

​Complications

​Psychological changes

​Increased mortality

​High fall risk

​Risk for aspiration

​Sx worsening

Treatment

Goal is to promote mobility and manage cognitive dysfunction

• Antiparkinsonian drugs

• Surgery

• DBS (deep brain stimulation)

• Ablation

• PT/OT

• Dietary

Multiple Choice

When caring for a client with Parkinson's disease, the nurse understands that progressive difficulty with which factor is a primary expected outcome?

• Motor Ability

• Nutrition

• Speech and Language

• Social Interaction

Multiple Choice

A 65 year old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is

• Promoting physical exercise and well balanced diet

• Administering medications and monitoring vital signs

• Providing emotional support and educating the patient

• Encouraging social activities and providing safety measures