Headache/seizure

• Triggers for headache: foods(chocolate, caffeine, MSG), changes in hormone levels, changes in patterns(weather, sleep, meal), stress, intense activity, bright lights, odors
• Headache: common reasons why children miss school, visit their physician and receive subsequent referrals to neurologists
• Headache: can result from sinusitis or eye strain or more serious conditions like brain tumours, acute meningitis, or increased ICP
• Headache: a child may have primary headache disorder that is exasperated by the frequent use of medication
• ketogenic diets are recommended for people with reoccurring migraines
• Febrile seizures: some kids of lower threshold, others are higher
• Febrile seizures: commonly reported in about 2-5% of children between the ages of 6 months and 5 years
• Febrile seizures: result of a viral infection, usually short lives- under 15 minutes, not repeated in 24 hours
• Febrile seizures: more commonly seen in boys and where there is a family history of febrile seizures
• Febrile seizures: complications are rare but include: status epilepticus, motor coordination deficits, intellectual disability, and behavioural problems
• status epilepticus: long period of seizure activity that is hard to stop, longer than 5 minutes
• febrile seizures nursing management: determine cause and treatment of fever, provide education and support, reassure about benign nature of them, discuss how to control fever, keep safety during seizure, medication if needed
• febrile seizures nursing management: reinforce that recurrent seizure activity will require medical attention
• seizure disorders: caused by disorders originating outside of the brain(high fever, infection, head trauma, hypoxia, toxins, or cardiac arrhythmias)
• seizure disorders nursing management:

  • relieving anxiety
  • managing treatment
  • providing support
  • providing education
  • low stimulating environment
• common seizure triggers: missing medication, lack of sleep, missing meals, hormonal changes, stress, illness, fever, flickering lights, alcohol withdrawal, street drugs
• generalized seizures: widespread electrical activity in the left and right hemispheres of the brain
• generalized seizures: experience aura(partial seizure preceding a generalized seizure), often a warning signs
• aura- see spiders, flashing lights, smells, impending doom feeling
• generalized seizures: may or may not be convulsive, often experience postictal state
• postictal state: sleeping, difficult to rowse, brain fatigue
• epilepsy: generalized seizure condition which seizures are triggered recurrently from within the brain
• epilepsy: fewer than 1/3 of seizures in children are caused by epilepsy, prognosis is good, many children outgrow symptoms but some will have persistent seizures
• Generalized seizures: absence

  • blank state lasting <10 sec
  • starts and stops abruptly
  • may experience several hundred a day
• generalized seizures: Tonic-clonic

  • tonic: crying out, groan, falls
  • clonic: convulsions, jerking, twitching of the muscles
  • may be inconvenient
  • may turn grey/blue
  • lats 1-3 minutes
• generalized seizures: myoclonic

  • involves the motor cortex of the brain
  • sudden brief massive muscle jerks, may or may not lose consciousness
• generalized seizures: atonic

  • sudden loss of muscle tone
  • in children may be as small as a drop of the head
  • regain consciousness within a few seconds to a minute
• partial seizures: occurs when seizure activity is limited to a part of one brain hemisphere, site or focus in the brain where seizure begins
• partial seizures: after seizure there is a period of confusion
• Complex partial seizure: does not involve convulsions but impairs consciousness, person will no longer respond to questions, lasts about two to four minutes
• simple partial seizures:

  • remains aware but cannot control function or behaviour
  • can experience aura
  • lasts seconds to minutes
• complex partial seizures:

  • altered awareness, automatisms
  • stops and has blank look or empty stare
  • the child will appear unaware of the environment and may seem dazed
• automatisms: pull at nothing, pick skin, scratch
• seizure precautions: padding of side rails and other hard objects, side rails raised when in bed, oxygen and suction at bedside, supervision, protective helmet, medical bracelet
• nursing management of seizures: more likely to have hypoxia symptoms, call for help, prevent injuries, monitor vitals and neurological status, establish IV access, administer med to prevent/reduce seizures, provide education and support
• seizure airway management:

  • respiratory depression or apnea may occur
  • suction excess secretions
  • administer oxygen