Pediatric Seizures: Diagnosis and Treatment (Nursing)

by Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

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    00:01 Alright, let's talk a little bit about how pediatric seizures are diagnosed and treated. Most of my experience as a nurse has been in a pediatric emergency department and we see pediatric seizures a lot. One of the first things we find out when a child is brought in by their parents for a seizure or seizure activity that they think is seizure activity, is "Do they have a history of seizures? "Has it ever happened before?" Because that is something that really affects the treatment and their diagnostic test that they receive. Many events can be mistaken for seizures. Some of the top 2 ones that affect children are breath holding spells which is something that toddlers sometimes do. If they're having a tantrum especially, they can hold their breath until they actually pass out and they can have some shaking or their eyes can roll back and it can really look like a seizure to the caregiver. Another thing that could be mistaken for a seizure is just syncope in general and that could happen from somebody being sick or dehydrated or can also happen if they pass out from like a head injury, so if they are knocked unconscious from a head injury. All these things can mimic a seizure or some types of seizures so often people are brought in for things and we don't quite know whether it was a seizure or not. So, they usually get quite a work up to figure out what the underlying cause was and what actually happen to them, leading to detailed history and its importance. So again, one of the first questions we ask is "Has your child ever done this before?" "How long did it happen?" and "Are they on any medications?" Especially "Are they on any antiepileptic medications?" If they are, "Have they had any recent dosing changes or have they had any recent growth?" Because sometimes kids who are on antiepileptic medications just outgrow their seizure medicine and they just require a slightly higher dose so they start having seizures again. Another thing that can trigger seizures and does so pretty often is just being sick. If somebody has epilepsy or a seizure disorder and they are prone to having seizures any way, then whether they're on medications or not, if they get sick especially if they have a fever that can cause their seizure threshold to lower. So basically they're more prone to have one. Alright, part of the diagnosis for seizure or the type of seizure it is is using labs and radiography to figure out "Are there any kind of electrolyte imbalances? Or "Is there any type of trauma or visibly damaged or abnormal tissue in the brain that might be causing the seizure?" Some electrolyte imbalances or the major one that can cause seizures is hyponatremia or low sodium. You may see this especially in infants who might be given formula if that's overdiluted or that's diluted at all. Formula should never be diluted any more than on the directions. So sometimes especially in low resource areas, parents won't realize the dangers of doing that. They might dilute their formula with more water, with extra water in an effort to save money, but it's one thing that we've seen as a cause for some infant seizures. This is electroencephalogram or EEG. This s something, don't worry you don't have to know how to work it but as a nurse you're going to see this if you take care of children. A nurse's role for an EEG is basically monitoring the child just like you would any other patient and knowing what to do if you or the family member in the room notes seizure activity. The main things you have to do is there's always a button to press so that it can be captured in some way in the recording of the brain activity. And also, the child has to stay in a view of a camera that's monitoring them the whole time. Sometimes EEGs are done just really quickly like in emergency department and they don't take very long and other EEGs are done over a whole span of time like 12 hours. Safety is a key priority to consider when caring for a child with seizures or with suspected seizures. Some of the precautions that you're going to want to take are patting their side rails in some way, being familiar with the medicines given to stop seizures in your institution as well as to treat them, make sure that your safety equipment in the room as well as the portable safety equipment is functioning and nearby. So, that would especially include the ambu bag, oxygen, and suction equipment because you may need to take the child to x-ray or CT scan or some other place in the hospital for some kind of diagnostic procedure. Always make sure these equipment goes with you and a nurse should also go with the child. Finally, the medications in general in a general sense that are given to these children, so I'm speaking from a hospital emergency department perspective but this covers pretty much everything that would need to be done even if they came to a doctor's office for a seizure. So, rescue medications are generally benzodiazepines and those meds will stop a seizure usually with a dose, sometimes it takes 2, and the reason why we want to sometimes stop seizures is because if a seizure goes on too long it can basically cause a lack of adequate oxygenation to the brain because during a seizure the person is not breathing regularly and the airway needs to be protected so we often, if they keep having a seizure activity or if they do it repeatedly while they're in the hospital, we often give them a rescue medication to stop it quickly. Then, antiepileptic medications are given to help prevent additional ones. If they're in the hospital, they will usually get a loading dose of some sort of antiepileptic medication in order to bring their blood level up to a certain level so that they will not continue to have seizure activity in the hospital and then if they are thought to have some kind of seizure disorder that's going to continue for some reason, if they are thought to have epilepsy, they'll be sent home on a prescription. A lot of kids come to the hospital who have a history of epilepsy and just require an adjustment in their dosing and they would still be treated the same way if they have seizure activity in the hospital. Finally, oxygen may be needed just like for any other urgent situation.

    06:25 They may need it usually just temporarily while they're having a seizure or maybe for a slight time afterwards while they're in that postictal state because after having a seizure, generally the person is not quite as alert, they're usually breathing a little bit shallow. So they just may need a little bit of temporary oxygen support. This is the NCSBN Clinical Judgment Measurement Model. It's the framework being used now for many next gen NCLEX items and case studies. You may hear about it in nursing school and you may see test questions framed using this. So we're going to start going over some of the content from this lecture and tying it to the first 2 steps of this model. Recognizing cues and analyzing cues. In order to recognize and analyze cues in a child who's having a seizure or who has had a seizure, you need to first be able to identify seizure activity in the neonate to the adult basically because child seizures present very similar or the same as adult seizures. So in the neonate and young infant, seizure activity can be very very subtle and sometimes limited just to the face or the head. Basically abnormal eye movements or lip smacking can both be pretty common signs and symptoms of seizures in neonates and young infants. The older the infant, the more likely their seizure is going to be more obvious and the activity will be similar to that of adult seizure. And those common activities that occur, the involuntary activities that occur with seizures include tonic movements or stiffening; clonic movements or shaking and jerking; atonic or akinetic movement which is basically lack of movement, it's kind of dropping and stiffening; and absence seizures or not really movement at all, just kind of staring off and not focusing but kind of looking off in one direction for a while and kind of being out of it but not completely losing control not dropping to the ground. Finally, in order to identify cues and analyze cues in children who have seizures or may have had a seizure, you have to be really familiar with what questions to ask as part of the history taking because this can really help identify when a seizure has happened and when it has not if there's any question and often there is a question as to what has actually happened. So, thank you for joining me for this lecture and I will see you next time.

    About the Lecture

    The lecture Pediatric Seizures: Diagnosis and Treatment (Nursing) by Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN is from the course Neurologic Disorders – Pediatric Nursing.

    Included Quiz Questions

    1. Syncopal episodes can often be mistaken for seizures.
    2. Illness is a common trigger for seizures.
    3. Hyponatremia can cause seizures.
    4. Children usually remain on the same dose of anti-seizure medication until adulthood.
    5. Treatment is the same whether or not the child has a history of seizures.
    1. “The camera can record any seizures my child has even if my child isn’t in view.”
    2. “I need to press the button if I think my child is having a seizure.”
    3. “I can’t remove any stickers on my child’s head until the test is over.”
    4. “My child is having this test done because of their seizure history.”
    1. Ensure the side rails are padded.
    2. Ensure suctioning equipment is present and functional.
    3. Ensure oxygen equipment is present and functional.
    4. Place the bed in the Trendelenburg position.
    5. Ensure a bite block is present at the bedside.
    1. Benzodiazepines
    2. Anti-epileptics
    3. Oxygen therapy
    4. Opioid agonists

    Author of lecture Pediatric Seizures: Diagnosis and Treatment (Nursing)

     Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

    Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

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