What are the major assessments that the nurse should make during seizure activity?

Before a nurse can track seizures, she should understand what to look for during the observation and assessment. A seizure is usually broken down to four major phases that is

• Prodrome, which is the feelings or behaviors that happen a few days or hours before a seizure (Lezak, 2014).
• Aura: the actual commencement of the seizure, which might be perceived as a warning.
• Ictus: the seizure episode
• Postictal: The period of recovering after the seizure (Lezak, 2014).

When observing a seizure a nurse should note everything that occurs in every stage of the seizure before, during, as well as after the event. The nurse should note down what the patient was doing during the time of the episode (Lezak, 2014). She should note any behavior or mood change days or hours before the event and note any possible aura or warning prior to the seizure (Louis et al, 2015). The nurse should note any factors or patterns that may make the episode more likely to happen:

• Time of the month or day,
• For females, the nurse should note the menstrual cycle date of the patient, and any other hormonal or birth control treatment if pregnant (Lezak, 2014).
• Use of alcohol, tobacco or other drug use
• Inadequate sleep, irregular sleeping or any other sleep complication
• Not eating frequently and bother by certain foods
• Change in drug doses, late or missed medicine,
• During or after physical exercise
• After or during fast breathing
• Other diseases or infection
• Emotional worry, stress, excitement
• Sounds, bright sunlight, flashing lights

During the episodes or the event, the nurse needs to note changes such as:

• Confusion, alertness, awareness
• Thinking, perceptions, emotions, remembering
• Ability to understand and talk—clear speech, unable to speak, respond with just noises or few words (Lezak, 2014).
• Felling, smelling, tasting, hearing, seeing
• Facial expression—drooling, eye rolling or blinking, twitching, staring
• Muscle tone—the body, becomes limp or stiff,
• Movement—twitching or jerking movements, head or body falls or turns to one side, unable to move.
• Loss of bowel or bladder control
• Skin color, breathing, sweating
• Running, wandering, walking
• Repeated or automatic movements—swallowing, chewing, lips macking, rubbing hands, undressing or dressing, tapping feet, picking at clothes

The nurse should also note the body part involved by identifying where the symptoms began, whether it spread to other body areas or stayed in that part, and the part of the body that was involved (Lezak, 2014). The nurse should also note what occurs after the episode whether the patient could remember what transpires, respond to touch or voice, need to sleep or tire, numb or weak in any body part, could communicate or talk, and other symptoms such as pain, upset stomach, or headache.

The nurse should also record the duration in which the seizure lasted, the length of aura, and length of postictal or recovery period.

For seizures diagnose in summary, the most critical data derived from the patient history which normally must be provided by the patient and the observer include previous seizures, the description of the seizure event, stroke and other risk factors linked to epilepsy, current medication, and other medical conditions.

Why is the EEG a priority study for patients with seizure disorders?

Electroencephalography (EEG) is a critical diagnostic test especially in assessing a possible epileptic condition.  It can offer support for epilepsy diagnosis as well as helps in classifying the underlying epileptic syndrome (Ullsperger & Debener, 2015).  Unlike MEG, which mainly detects magnetic field linked to the activity of the neuron. EEG detects the electric fields that the neurons in the brain produce (Ullsperger & Debener, 2015). EEG is essential, noninvasive, bedside diagnostic procedure, especially for quick differentiating the etiology as well as therapeutical efficacy in patients who are critically ill, and with ranging brain injuries and altered consciousness states. It is vital to distinguish artifact from pathophysiologic EEG changes, which would hint epileptiform, encephalopathy activity or seizures. There are specific patterns relative to deepening encephalopathy and coma patterns which have prognostic and diagnostic significance (Ullsperger & Debener, 2015).

Epileptiform patterns such as periodic lateralized, generalized periodic,  and independent periodic epileptiform discharges present certain challenges since there is a gray zone between the evolving patterns and interictal patterns  of non-conclusive seizures. EEG this present the only medical procedure to diagnosing non-conclusive status epilepticus, manifesting generalized slow waves in idiopathic generalized epilepsy or sharp waves or regional spikes in for focal epilepsy. Besides, it the most widely used test globally to confirm death caused by brain injury or complication. Alongside polysomnography, EEG can be employed to show cyclic variations as well as pathological alterations during sleep as well as their link to body motility, dreaming, and eye movement (Ullsperger & Debener, 2015).

References

Lezak, M. D. (2014). Neuropsychological assessment. Oxford: Oxford University Press.

Louis, E. K. S., O’Brien, T. J., & Ficker, D. M. (2015). Epilepsy and the interictal state: Co-morbidities and quality of life.

Ullsperger, M., & Debener, S. (2015). Simultaneous EEG and fMRI: Recording, analysis, and application. Oxford: Oxford University Press.