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SEIZURE DISORDERS Seizures (convulsions) are the result of uncontrolled electrical discharges from the nerve cells of the cerebral cortex and are characterized by sudden, brief attacks of altered consciousness, motor activity, and/or sensory phenomena. Seizures can be associated with a variety of cerebral or systemic disorders as a focal or generalized disturbance of cortical function. Sensory symptoms arise from the parietal lobe; motor symptoms arise from the frontal lobe. The phases of seizure activity are prodromal, aural, ictal, and postictal. The prodromal phase involves mood or behavior changes that may precede a seizure by hours or days. The aura is a premonition of impending seizure activity and may be visual, auditory, or gustatory. The ictal stage is characterized by seizure activity, usually musculoskeletal. The postictal stage is a period of confusion/somnolence/irritability that occurs after the seizure. The main causes for seizures can be divided into six categories: Toxic agents: Poisons, alcohol, overdoses of prescription/nonprescription drugs (with drugs the leading cause). Chemical imbalances: Hyperkalemia, hypoglycemia, and acidosis. Fever: Acute infections, heatstroke. Cerebral pathology: Resulting from head injury, infections, hypoxia, expanding brain lesions, increased intracranial pressure. Eclampsia: Prenatal hypertension/toxemia of pregnancy. Idiopathic: Unknown origin. Seizures can be divided into two major classifications (generalized and partial). Generalized seizure types include tonic-clonic, myoclonic, clonic, tonic, atonic, and absence seizures. Partial (focal) seizures are the most common type and are categorized as either (1) simple (partial motor, partial sensory) or (2) complex. CARE SETTING Community; however, may require brief inpatient care on a medical or subacute unit for stabilization/treatment of status epilepticus. RELATED CONCERNS Cerebrovascular accident (CVA)/stroke Craniocerebral trauma (acute rehabilitative phase) Psychosocial aspects of care Substance dependence/abuse rehabilitation Patient Assessment Database ACTIVITY/REST May report: Fatigue, general weakness Limitation of activities/occupation imposed by self/significant other (SO)/healthcare provider or others May exhibit: Altered muscle tone/strength Involuntary movement/contractions of muscles or muscle groups (generalized tonic-clonic seizures) CIRCULATION May exhibit: Ictal: Hypertension, increased pulse, cyanosis Postictal: Vital signs normal or depressed with decreased pulse and respiration EGO INTEGRITY May report: Internal/external stressors related to condition and/or treatment Irritability; sense of helplessness/hopelessness Changes in relationships May exhibit: Wide range of emotional responses ELIMINATION May report: Episodic incontinence
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May exhibit: Ictal: Increased bladder pressure and sphincter tone Postictal : Muscles relaxed, resulting in incontinence (urinary/fecal) FOOD/FLUID May report: Food sensitivity nausea/vomiting correlating with seizure activity May exhibit:
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