Status Epilapticus
Status Asthamaticus
Group members Shazia,valentina,varda, uzma
At SNC Lahore
Presentation Plan
Subject: ACCN Class PRN BSN Topic: Status Epilapticus and Date: 01-06-2017 Status Asthmaticus
Mentor: Tanzeel Ul Rahman
Sr No Objectives Content Time Strategies/Discussion Evaluation
1
Explore status epilepticus
Status Asthamaticus
Definition
Difference R/T epilapsy
and asthama
5
Multimedia Discussion
Question &
Answers
2
Its pathophysiology
Etiology and pathogenesis,
10
Multimedia Discussion
Question &
Answers
3
Clinical manifestation
Sign and symptoms
5
Multimedia Discussion
Question &
Answers
4
Medical Management
Surgical management
Initial Management
10
Multimedia Discussion
Question &
Answers
5
Explanation of Nursing
diagnosis and
Management
Nursing diagnosis and
Management
10
Multimedia Discussion
Question &
Answers
Learning Outcomes/Objectives
What is status epilepticus and Status Asthamaticus
Pathophysiology
Etiology
Pathogenesis
Clinical Manifestations
o
Signs
o
Symptoms
Medical Management
Surgical Management
Status Epilepticus
Status Epilepticus
It is defined as continuous clinical and electrographic seizures activity. A seizure
that longer than 5 minutes, or having more than 1 seizure with in a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus. This definition used a 30 minute time limit.
Convulsions may involve jerking motions, grunting sound, drooling and rapid eye
movements . The seizures can either be of the tonic-clonic types with regular
pattern of contraction and extension of the arms and legs or type that do not involve contractions such as absence seizures or complex partial seizures.
EPILEPSY: A group of syndrome characterized by paroxysmal transient disturbances
of brain function its causes seizure or fits.
Status epilepticus accounts for 1-8% of all hospital admissions for epilepsy.
Physiological A seizure involves abnormal electrical activity in the brain affecting both the mind and the body. This is a medical emergency that may lead to
Pathophysiology
Status epilepticus-common etiology
Status epilepticus may occur in those with a history of
epilepsy only
25%
as well as those with an underlying problem of the
brain
. These
underlying problems include
Trauma
Infections
Stroke, including hemorrhagic
Alcohol withdrawal
Anoxic brain injury
Metabolic disturbances (such as affected liver and kidney)
Metabolic derangements(shock)
o
Hypoxia, Hypoglycemia ,Hyponetremia, hypomagnesaemia
Conti…
Head Injuries Meningitis Deliriumme
Intoxication or adverse reactions to
Drugs
o
Antibiotics ( pencilline's ,isoniazid)
o
Anasthetics, norcotics (halothane ,cocain, ketamine)
o
Psychopharmaceuticals (antidepresent , antipsychotics , antidepresent
Insufficient dosage or sudden withdrawal of a medication (especially anticonvulsants) Dieting or fasting while on an anticonvulsant
A new medication that reduces the effectiveness of the anticonvulsant its half life
leading to decrease blood concentration.
Pathogenesis
Message from body carried by neuron
Control discharge or electrochemical energy
Impulses occur in bursts whenever a cell has a task to perform
If EC discharge is un control or abnormal
A person said to having an epileptic syndrome
If prolong epileptic seizures
Pathogenesis
Many neurons fire in a synchronous pattern, resulting in a transient
physiologic disturbance .
The risk of cell injury depends also on the overall pathophysiologic profile,
including the presence of alterations resulting from SE and occurring independent of SE.
On neurophysiologic grounds. we divide SE into "spike-wave" and
"nonspike-wave" forms. Spike-wave "absence" status epilepticus carries a low risk of epileptic brain damage, and therapy should be adjusted accordingly. All
nonspike-wave SE has a theoretical basis for epileptic brain damage, but the actual risk is variable.
There is a significant known risk of cell injury during generalized convulsive SE,
Clinical Manifestation (Signs and symptoms)
Non-Convulsive SE
convulsive SE
IN convulsive status epilepticus
Unusual behavior leads to
Confusion and stiff body with
eyes rolled upward and dilated
pupils and Muscle spasms is
major sign.
Difficulty speaking
Falling
Unusual noises
Loss of bowel or bladder
control
Clenched teeth
Irregular breathing
A "daydreaming" look
This is an extended seizure with no
physical convulsions. Symptoms of status
epilepticus without outward physical signs
are unresponsiveness, confusion or
agitation, and confirmed by EEG
Convulsive SE
Increased CO
Increased BP
Increased BS
Increased Lactate levels
Decomposition-Failure of Homeostatic failure
Reduced CO- Levels/BS/Lactate/Oxygen levels leads
to:
1.
Cardiorespiratory collapse
2.
Electrolyte Imbalance
3.
Hyperthermia
Diagnostic criteria
Routine labs( lactic acidosis)
ABG’s(acidosis)
CT Scan brain
MRI
EEG
First Aid for Seizures:
If you see someone having a seizure, take the following
steps
Time the seizure with your watch.
Clear the area of anything hard or sharp.
Loosen anything at the neck that may impair breathing.
Turn the person onto his or her side.
Put something soft beneath the head.
Do not place anything inside the mouth.
Call Area Emergency Number, if a seizure lasts more than
MEDICAL MANAGEMENT
Emergency/inpatient management includes basic life support (0-10 minutes) and
pharmacological management (10-60 minutes).
Airway & Oxygenation is established (pass ETT if unconscious , if need ventilate)
Anti epileptic medication(keep seizure free)
Anti sedative drugs
IV Fluid ( 5% dextrose if hypoglycemic)
Thiamaine 100mg proior to dextrose
Monitor frequently S\E & Glucose
Continue monitor neurologic sign
Drugs used in pharmacological management are Injectibale lorazepam, midazolam,
Surgical management
Common surgical procedure for treatment of seizure is cortical exicision i.e lobectomy
When temporal lobe epilepsy, then resection of the antero-medial temporal lobe called
mesial temporal lobectomy
If scar tissue or other focal epileptogenic area exists the identified lesion
(lesionectomy) can be removed
A corpus callosotomy has been helpful in patients with tonic clonic seizures
A hemispherectomy is reserved for selected catastrophic infant and early childhood
epilepsies
Other therapies
Vagal nerve stimulation
An electrode is surgically placed around the left vagus nerve in the neck. It is
Nursing Diagnosis
Nursing Diagnosis
Risk for Trauma
Risk for Suffocation
Risk factors may include
Weakness, balancing difficulties; reduced muscle, hand or eye coordination
Poor vision
Reduced sensation
Cognitive limitations or altered consciousness
Loss of large or small muscle coordination
Emotional difficulties
Possibly evidenced by
Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has
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. Loosen constrictive clothing.
If aura precedes the seizure, place padded tongue blade between the teeth
Do not attempt to pry open jaws that are clenched in a spasm to insert
anything
Clear airway
Oxygen therapy
Telemetry
Iv access
Instruct about medications such as anti epileptic
Classification
Systemic
Complications
Cardiac
Hypertension, tachycardia (reversing after 30 minutes),arrhythmias,
cardiac arrest
Pulmonary
Apnea, respiratory failure, hypoxia, neurogenic pulmonary edema,
aspiration pneumonia
Autonomic
Fever, sweating, hyper secretion (including tracheobronchial),vomiting
Metabolic
Hyperkalemia, hyperglycemia then hypoglycemia, volume depletion,
venous stasis, possible thrombosis
Cerebral
Neuronal damage similar to that of hypoxia, hyperthermia : cortical layers 3 and
5, cerebellum, and hippocampus
Cerebral edema, raised intracranial pressure
Cortical vein thrombosis
Neurologic squeals
Increased seizure
frequency
, recurrent status epilepticus
Decreased cognitive function (controversial)
ANATOMICAL OVERVIEW OF RESPIRATORY SYSTEM
Upper Respiratory Tract Lower Respiratory Tract
Nose
Para nasal sinuses
Pharynx
Tonsils
Larynx
Trachea
Lungs
o
Pleura
o
Media sternum
o
Bronchi &
bronchioles
FUNCTION OF RESPIRATORY SYSTEM
Oxygen transport
Respiration
Ventilation
Pulmonary perfusion & diffusion
Status Asthamaticus
Asthama
A respiratory
condition marked by
attacks of spasm in
the bronchi of the
lungs , causing
difficulty in breathing
are often due to
allergic reaction or
others forms of
hypersensitivity.
Status Asthamaticus
A prolonged sever attack of
asthma that is unresponsive to
initial stander therapy, is
characterized especially by
dispend, dry cough , wheezing &
hypoxemia that may lead to
PATHOPHYSIOLOGY
Irritant or terrors Inflamed bronchial mucosa Decrease diameter of the bronchi
Decrease PaO2 & PCO2
SIGN & SYMPTOMS OF STATUS
ASTHMATICUS
Labored
breathing &
wheezing
Prolonged
exhalation
Respiratory
failure
Obstruction
worsens
Engorged
Causes of status Asthamaticus
Air pollution
Allergens
climate
Respiratory
Infection
Physical and
ASSESSMENT & DIAGNOSIS
Respiratory assessment
Routine labs ( CBC basophils increase)
MEDICAL MANAGMENT
Short acting beta2 aderenegenic agonist (rapid relief
bronchospasm)
Corticosteroids(
reduce inflammation)
Oxygen therapy(to treat cyanosis, dyspnea & hypoxemia)
IV fluid and hydration
Sedative are contraindicated
Muscle relaxation (magnesium sulphate & a calcium
antagonist)
Treat respiratory acidosis ( use Bipap , may need mechanical
NURSING DIAGNOSIS
Impaired gas exchange
related to ventilation perfusion inadiquality
Ineffective airway clearance
related to increase mucous production
or ineffective cough
Ineffective breathing pattern
related to shortness of breath
Self care deficits
related to fatigue secondary to increase work of
breathing
NURSING MANAGMENT
Asses the airway & patient response to treatment
Telemetry until the sever exercitation resolve
IV access (3 to 4L\ day
Patients room should be quite & free from
irritant.
COMPLICATIONS
Pneumonia
Atelectasis
Sever dehydration
Airway obstruction
References
Text book of medical surgical nursing ( Brunner & suddarth,s)
www.medscape.com
http://emedicine.medscape.com/article/2129484-treatment
http://
www.epilepsy.com/information/professionals/resource-library/tables/compli
cations-status-epilepticus
