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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.
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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.