Status Epilapticus & Status Asthmaticus.pptx

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(1)Management of Status Epilepticus and Status Asthmaticus Presented by: Post RN 1st Year Rukhsana Asghar Shukriya Liaquat.

(2) PRESENTATION TEACHING / LESSON PLAN Subject : .10Topic: Teacher:. ADVANCE CONCEPT IN NURSING Class: Post RN BSN Status epliapticus & Status asthamaticus Date: 18.10.2018 Tanzeel ul Rehman Venue: Class Room. SR.no. Objective. Name. Time. 1.. Describe status epilapticus.nursing and medical mangement. Ruksana Asghar. 15 mins. 2.. Describe status asthamaticus.nurisng and medical mangement. Shukria Liaqat. 15 mins. 3. Question and answer session. 5 mins.

(3) Learning Objectives ●At the End of this presentation the student will be able to ●Define Status Epilepticus and Status Asthmaticus ●Decsribe Pathophysiology of Status Epilepticus and Status Asthmaticus ●Enlist Clinical manifestation ●Brief Diagnostic workup ●Enumerate Aims of management ●Describe Medical management ●Describe Surgical management ●Describe Nursing management.

(4) Status Epilepticus ●Definition by Clark And Prout: Maximal development of epilepsy in which seizures are so frequent that coma exhaustion are continuous between seizures.. ●Status epilepticus is said to occur when a seizure lasts too long or when seizures occur close together and the person doesn't recover between seizures.

(5) Causes ● Truma ● Infection ● Stroke ● Head injury ● Sleep deprivation ● Alcohol withdrawal ● Meningitis.

(6) Pathophysiology ●Unclear ●A seizure occurs when a portion of brain becomes overly excited or when nerves in the brain begin to fire together in an abnormal fashion. ●The pathophysiology of seizures results from an abrupt imbalance between the forces that excite and inhibit the nerve cells such that the excitatory forces take precedence..

(7) Pathophysiology.

(8) Clinical Manifestation ●Stiff body with eye rolled upward and dilated pupils ●Difficulty in speaking ●Clenched teeth ●Irregular breathing ●Increased CO2 ●Increased BP ●Increased Lactate level ●Cardiorespiratory collapse.

(9) Clinical Manifestation ●Hyperthermia ●Raised ICP and Cerebral oedema ●Jerking motions ●Grunting sounds ●Drooling ●Tonic-clonic types of seizures ●Contraction and extension of arms and legs ●Absence Seizures or complex partial seizures.

(10) Tonic Clonic Seizure.

(11) Approach: Diagnostic workup All patients • Obtain IV access • Monitor vital signs (ABC). • Head CT (appropriate for most cases) • Labs: blood glucose, CBC, renal function tests, Calcium, Magnesium, electrolytes, AED levels. • cEEG monitoring (preferably) Consider based on clinical presentation • Brain MRI • Lumbar puncture • Toxicology panel (i.e. isoniazid, TCAs, theophylline, cocaine, sympathomimetics, organophosphates, cyclosporine) • Other relevant investigations as per need.

(12) EEG in Status Epilepticus.

(13) Aims of management of status Epilepticus 1.Termination of status Epilepticus 2.Prevention of seizures recurrence 3.Management of precipitating cause 4.Management of.

(14) Medical Management ●Airway and oxygenation (ETT, ventilator) ●Anti-epileptic medication ●Sedative drugs ●IV Fluids ( 5 % dextrose if hypoglycemic) ●Monitor frequently S/E and glucose ●Continue monitor neurologic sign.

(15) Surgical management ●Lobectomy ●A corpus callosotomy ●A hemisepherectomy ●Vegal nerve stimulation.

(16) Nursing Management ❑The nursing goal is to prevent injury to the patient. This includes not only physical support but psychological support as well. ❑Provide privacy, ease the patient on the floor, if possible to protect the head with a pad to prevent injury. ❑Place the patient on one side with head flexed forward and loosen the tight clothes..

(17) ❑Place padded tongue blade between the teeth. ❑Clear airway ❑Oxygen therapy ❑Telemetery ❑IV access ❑Administred medication ❑Protective measures.

(18) Complications ●Hypertension, Cardiac Arrest, Arrhythmias ●Apnea, Respiratory failure ,Aspiration pneumonia ●Fever ●Hyperkalemia, Hyperglycemia then hypoglycemia ●Decreased cognitive functions ●Vertebral and other fractures.

(19) Nursing diagnosis ● Risk for injury ● Ineffective air way clearance ● Risk for ineffective cerebral tissue perfusion..

(20) Status Asthmaticus ●Status asthmaticus is an older, less precise term for what’s now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn’t improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours..

(21) Causes ● Allergens ● Air pollution ● Respiratory infection ● Physical and mental stress ● Climate.

(22) Pathophysiology of Status Asthmaticus.

(23) Clinical Manifestation ●Shortness of breath ●Can’t speak in full sentences ●Feel breathless even when you lie down ●Chest feels tight ●Bluish tint to your lips ●Feel agitated, confused, or can’t concentrate ●Hunched shoulders, strained abdominal and neck muscles ●Feel that you need to sit or stand up to breathe more easily.

(24) Diagnosing Status Asthmaticus Status asthmaticus is diagnosed through a series of assessments and medical treatment. ●Decreased level of consciousness ●Use of accessory muscles when breathing ●Increased respiratory rate ●Wheezing when breathing in and out (can also be a sign of other health conditions) ●Increased fatigue ●Increased heart rate ●Inflammation of the airway ●Decreased level of oxygen ●Decreased peak expiratory flow.

(25) Aims of management of status Asthmaicus 1.Termination of status Ashmaticus 2.Prevention of attacks recurrence 3.Management of precipitating cause 4.Management of.

(26) Medical Management The first line of treatment of status asthmaticus starts with ●Beta-antagonists, ●Corticosteroids, ●Theophylline. ●Other medications that can used to treat status asthmaticus are anticholinergics (decrease mucus production), sedatives (calms anxiety), and anesthetics (relaxes smooth muscle)..

(27) Nursing Management ❑The nursing goal is to prevent injury to the patient. This includes not only physical support but psychological support as well. ❑Provide privacy, ease the patient on the floor, if possible to keep patient breathing normally..

(28) Complications ●Pneumonia (infection of the lungs) ●Collapse of part or all of the lung ●Respiratory failure, where the levels of oxygen in the blood become dangerously low, or the levels of carbon dioxide become dangerously high ●Status asthmaticus (severe asthma attacks that do not respond to treatment) ●Fatigue.

(29) Complications ●Underperformance or absence from work ●Inability to exercise, leading to other health problems such as high blood pressure or weight gain ●Permanent problems with your lungs ●Repeated visits to hospital ●Psychological problems including stress, anxiety and depression ●Learning problems in children.

(30) Nursing Diagnosis ● Activity intolerance ● Ineffective breating pattern ● Health seaking behaviours”prvention of asthma.

(31) Refrences ●Textbook of medical surgical nursing (Brunner and suddarth,s) ●www.medscape.com ●Brophy, et al NCC 2012 ●Textbook of medical surgical nursing ●NHS Choices, UK (Asthma - Living with), Healthline (Complications of asthma).

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