Headache and seizures

Under supervision of
Dr/Doha seliem
GA17
Faculty of Nursing
2022_2023
Outlines
Introduction
Pathophysiology
Causes
Types
Sign and symptoms
Complications
Treatment
Nursing care plan
Prevention
First aid
References
 Headache
Introduction of a headache
A headache is a pain in your head or face that’s often described as a pressure that’s
throbbing, constant, sharp or dull. Headaches are a very common condition that
most people will experience many times during their lives. Headaches can differ
greatly in regard to pain type, severity, location and frequency. Headaches are a
very common condition that most people will experience many times during their
lives. They’re the most common form of pain and are a major reason cited for days
missed at work or school, as well as visits to healthcare providers. While most
headaches aren’t dangerous, certain types can be a sign of a more serious condition
Pathophysiology
Headaches are estimated to affect over 90% of the general population at some time
in their lives1 and may be encountered by physicians in a wide variety of clinical
settings. The overwhelming majority of recurrent headaches occur in the context of
what are known as primary headache disorders, in which no identifiable underlying
cause can be found. Some headaches, however, classified as secondary headache
disorders, are symptomatic of an underlying abnormality that may include anything
from transient viral illness, to intracranial tumor, aneurysm, or drug withdrawal for
differential diagnosis of secondary headache disorder. Prevalence studies indicate
that a benign process, such as a mild febrile illness or alcohol withdrawal, usually
causes secondary headaches and that the lifetime prevalence of headache resulting
from more ominous intracranial structural lesions is less than 2%.3 Head pain
occurs when nociceptive neurons within the trigeminal, vagus, or glossopharyngeal
cranial nerves or within the upper cervical roots become depolarized. Information
from procedures involving intracerebral electrode implantation suggests that
direct electrical or mechanical activation of areas within the brain involved in pain
processing may also cause head pain.4 The causes of head pain vary widely and
include not only direct mechanical, chemical, or inflammatory stimulation of pain-
generating structures but also less well-characterized events that occur in primary
headache disorders. Once initiated, the transmission and processing of the painful
information is likely to be quite similar regardless of the inciting cause. In this
chapter, we first review the anatomy involved in generating generic head pain and
then discuss current theories of the pathophysiology of the major
primary headache disorders, including migraine, cluster headache, and tension-type
headache.
Causes
Headache pain results from signals interacting among your brain, blood vessels
and surrounding nerves. During a headache, multiple mechanisms activate specific
nerves that affect muscles and blood vessels. These nerves send pain signals to
your brain, causing a headache.
The most common reasons are:
having a cold or flu
Stress
drinking too much alcohol
bad posture
eyesight problems
not eating regular meals
not drinking enough fluids (dehydration)
taking too many painkillers
having your period or during menopause
Most headaches aren't the result of a serious illness, but some may result from a
life-threatening condition requiring emergency care
Types
Types of headache include:
1) Tension-type headaches (most common type of headache).
2) Migraine headaches.
3) Cluster headaches.
4) New daily persistent headaches (NDPH).
5) spinal headache.
6) sinus headache.
7) medication overuse headache.
1_tension-type headache (TTH):
Is generally a mild to moderate pain that' often described as feeling like a tight
band around the head .A tension-type headache is the most common type of
headache.
2_migraineheadache: is usually a moderate or severe headache felt as a throbbing
pain on1side of the head. Many people also have symptoms such as Feeling sick ,
being sick and increased sensitivity to light or sound.
3_Clusterheadache: are excruciating attacks of pain in one side of the head ,often
felt around the eye.
4_Newdailypersistentheadache (NDPH): is a rare disorder that happens
un predictably and for unknown reasons. People with NDPH have a headache that
won’t stop and doesn’t get better with common treatments .For some people, the
headache can last years or never goes away.
5)Spinal headache: Are caused by leak age of spinal fluid through A puncture hole
in them embrane (duramater) that surrounds the spinal cord. This leakage
decreases the pressure xerted by the spinal fluid on the brain and spinal cord,
which leads to a headache.
6)Sinus headache: are headaches that may feel like an infection in the
sinuses(sinusitis).
7)Medication over use headaches or rebound headache: are caused by regular,
long-term use of medication to treat headaches, such as migraines .Pain reliever
soffer relief or occasional headaches .But if you take them more than a couple of
days a week ,they may trigger medication over use headache.
Sign and symptoms
-Weakness.
-Dizziness.
-Sudden loss of balance or falling.
-Numbness or tingling.
-Paralysis. Speech difficulties.
-Mental confusion.
-Seizures.
-Personality changes inappropriate behavior.
-Throbbing pain , usually on one side of the head (unilateral)
-Nausea
-Confusion
-Blurred Vision
-Fatigue
-Muscle tension
-Increase sensitivity to light, sound, and odors.
-blood pressure changes
Complications
Complications of headache include:-
1)Sleeplessness
2)Depression,anxiety.
3)Numbness.
4)Vertigo.
5)Difficulity in breathing.
6)Stomach ulcer ,nausea,vomiting(due to uses of many medications).
Rare Complications of headache include:-
7)Status migrainosus.
8)Migrainous infarction.
9)Persistentaura without infraction(PMA).
10)MigraineassociatedSeizure.
Treatment
• Treatment of Tension headache:-
1. use painkillers like paracetamol, aspirin and ibuprofen –
paracetamol is the first choice of painkiller if you're pregnant, and
children under 16 should not take aspirin
2. try doing activities to help you relax like exercise, yoga and massage
3. try changing your sleeping habits if sleep problems like insomnia
may be causing headaches.
4. try using a low, firm pillow and heat or cold packs if you have neck
pain and headaches
5. try to stay at home and avoid contact with other people if you have a
high temperature or you do not feel well enough to do your normal
activities.
5. try to stay at home and avoid contact with other people if you have a
high temperature or you do not feel well enough to do your normal
activities.
• Treatment of migraine headache:-
1. Rest in a quiet, dark room
2. Hot or cold compresses to your head or neck
3. Massage and small amounts of caffeine
4. Over-the-counter medications such as ibuprofen (Advil, Motrin IB,
others), acetaminophen (Tylenol, others) and aspirin
5. Prescription medications including triptans, such as sumatriptan
(Imitrex) and zolmitriptan (Zomig)
6. Preventive medications such as metoprolol (Lopressor), propranolol
(Innopran, Inderal, others), amitriptyline, divalproex (Depakote),
topiramate (Qudexy XR, Trokendi XR ,Topamax) or erenumab-aooe
(Aimovig).
• Treatment of cluster headache :-
1)- Acute treatment :-
• Oxygen. Briefly inhaling pure oxygen through a mask provides
dramatic relief for most who use it. The effects of this safe, inexpensive
procedure can be felt within 15 minutes.
• Triptans. The injectable form of sumatriptan (Imitrex), which is
commonly used to treat migraine, is also an effective treatment for acute
cluster headache.
• Local anesthetics. The numbing effect of local anesthetics, such as
lidocaine, may be effective against cluster headache pain in some people
when given through the nose (intranasal).
• Octreotide. Octreotide (Sandostatin), an injectable synthetic version
of the brain hormone somatostatin, is an effective treatment for cluster
headache for some people. But overall, it's less effective and acts less
quickly to relieve pain than triptans.
2)- Preventive treatment :-
• Calcium channel blockers .
• Corticosteroids .
• Lithium carbonate .
• Noninvasive vagus nerve stimulation (VNS).
• Nerve block.
3)- Potential future treatments :-
• Occipital nerve stimulation.
• Deep brain stimulation.
4)- clinical trails :-
• Lifestyle and home remedies .
1. Stick to a regular sleep schedule.
2. Avoid alcohol.
• Alternative medicine .
• Coping and support .
5)- Surgery .
• Treatment of sinus headache :-
1. Apply a warm compress to painful areas of the face.
2. Use a decongestant to reduce sinus swelling and allow mucus to
drain.
3. Try a saline nasal spray or drops to thin mucus.
4. Use a vaporizer or inhale steam from a pan of boiled water. Warm,
moist air may help relieve sinus congestion.
• Treatment of (NDPH):-
NDPH is often a difficult condition to treat. Some cases of this condition
are easier to treat, especially those with migraine-like symptoms. Tension
headache cases are more likely to resist treatment. Time is also a factor,
as NDPH is more likely to respond to treatment when treated earlier
rather than years after symptoms begin.
Medications are usually the main way to treat NDPH. However, finding a
medication that can treat this condition is often difficult. Some examples
of possible medication types include:-
1. Antidepressants. Medications like amitriptyline, nortriptyline and

venlafaxine, which also treat pain disorders, can sometimes help NDPH.
2. Antiseizure medications. Some examples include gabapentin or
topiramate.
3. Botulinum toxin injections (commonly known by the brand name
Botox). This drug blocks nerve signals, including pain signals. Other
types of nerve blocks can also help.
4. Medications used to prevent migraines. Examples include beta-
blockers like propranolol and angiotensin-II receptor blockers like
candesartan.
5. Experimental anesthetic/antidepressants. Ketamine, a powerful
anesthetic that also sees experimental use in treating resistant depression,
can sometimes help NDPH
Nursing Management
Acute Pain Assessment
1. Assess the patient’s pain experience.
Pain is subjective and must be assessed meticulously based on its characteristics,
onset, frequency, intensity, and quality. A detailed pain assessment can help
determine the type of headache and develop the most appropriate treatment
regimen.
2. Assess and monitor vital signs.
Vital signs may be altered during a patient’s pain episode. Fluctuations can indicate
whether the patient’s condition is improving or worsening
Nursing Diagnosis: Acute Pain
Related to:
Pressure, throbbing, or aching to the temples, eyes, sinuses, or base of the skull
Migraine episode
As evidenced by:
Guarding or protective behavior
Restlessness
Positioning to ease pain
Increased heart rate
Facial grimace
Reports of pain
Flat affect
Loss of appetite
Expected Outcomes:
The patient will report a reduction in pain using the numeric pain scale
The patient will be able to complete daily tasks without disruption due to pain
Acute Pain Interventions
1. Administer pain medications as indicated.
OTC medications specific to migraines are available. Prescription-strength
medication such as Fioricet may be required. Pain medications should be
administered before the onset of the pain or during the prodrome phase when
symptoms such as irritability or difficulty concentrating begin.
2. Teach patients non-pharmacologic pain management. Non pharmacologic pain
management techniques like relaxation, cool compresses, darkness, and massage
can help with pain relief. Moreover, these do not have any side effects or risk of
dependence.
3. Schedule activities during the peak effects of pain relievers.
Headache pain can be debilitating and prevent the patient from working, caring for
family, and ADLs. Schedule nursing tasks and patient care when pain is most
controlled.
4. Identify precipitating factors.
Migraine headaches can have triggers such as stress, missed meals, too much
caffeine or caffeine withdrawal, weather changes, exhaustion, exposure to smoke
or strong odors, and more.
Helping the patient identify specific instances of migraine occurrences can
decrease episodes.
impaired Comfort Care Plan
Impaired Comfort Assessment
1. Assess the effect of impaired comfort on lifestyle.
Assess how the patient’s impaired comfort affects their ability to form
relationships, maintain a career,and reach goals. This can direct interventions.
2. Assess current coping strategies.
Determine what the patient currently does to increase comfort. Does the patient
have a support system, religious beliefs, or even negative coping behaviors? The
patient may need redirection or additional resources.
3. Assess the patient’s goals for comfort.
Before interventions can be implemented and evaluated, the nurse must determine
what the patient’s comfort goals are and what is important to their daily level of
functioning.
Nursing Diagnosis: Impaired Comfort
Related to:
Headache and migraine pain
Anxiety and worry
Inadequate sleep
Lack of support systems
Associated symptoms such as nausea/vomiting, dizziness, etc.
As evidenced by:
Expressed pain, anxiety, or worry
Lack of sleep or restlessness
Fatigue
Difficulty relaxing
Irritability
Expected Outcomes:
The patient will verbalize an improved sense of emotional relief and comfort
The patient will participate in strategies and interventions to improve spiritual and
psychological
comfort
Impaired Comfort Interventions
1. Administer medications as indicated.
Pain medications can initially assist with pain that is causing impaired comfort.
Additional medications such as antiemetics to help with nausea or antihistamines
for dizziness and sleep aids can all improve comfort.
2. Establish a reliable and trusting relationship with the patient.
A trusting relationship encourages open and honest communication. Building a
rapport can increase adherence to the treatment plan.
3. Minimize noise and stimuli. Dim lighting in a cool and quiet room can induce
comfort. Speak calmly and quietly to the patient when required.
4. Consider therapy consults. Outward stress and personal issues can trigger
headaches and prevent feelings of comfort. Encourage or
provide opportunities to work with a counselor that may be able to develop coping
strategies to control emotional stress.
Deficient Knowledge Care Plan
Deficient Knowledge Assessment
1. Assess the patient’s ability to learn.
Assess the patient’s ability to learn and determine possible barriers to learning to
formulate an appropriate teaching plan.
2. Assess the patient’s willingness to learn.
Learning readiness is essential to patient education as it will determine how likely
a person will seek out knowledge and participate in the learning process.
3. Acknowledge any cultural differences.
Acknowledging any cultural differences will establish rapport with the patient and
improve therapeutic communication with the patient.
Nursing Diagnosis: Deficient Knowledge
Related to:
Inadequate access to resources
Inadequate awareness of resources
Lack of information
Inadequate participation in care planning
Lack of interest/motivation
Misinformation
As evidenced by:
Inaccurate follow-through of instructions
Inaccurate statements about a topic
Poor control of symptoms
Expected Outcomes:
The patient will verbalize understanding their disease process by exhibiting
adherence to the treatment regimen The patient will seek information on adjunctive
treatment and lifestyle changes to improve healt
Deficient Knowledge Interventions
1. Educate on different treatment options.
Migraine treatments continue to improve. Other than analgesics, antidepressants,
anti-seizure drugs,
blood pressure medications, vitamins, and even Botox injections are used to treat
migraines.
2. Provide accurate information and dispel myths.
There is still much to learn about headaches and migraines. Provide accurate
information
from reputable
sources that the patient is able to understand.
3. Encourage a headache diary.
Have the patient keep a diary surrounding headaches and migraine episodes. This
information can help
with understanding possible triggers and changes to make in diet or lifestyle.
4. Consider resources.
Headaches and migraines can feel isolating. If the patient does not already see a
neurologist, this
specialist can offer expert treatment. Support groups may also help with feeling
understood
by others by sharing similar experiences.
Evaluation
The evaluation of headache begins with ruling out a health or life threatening
cause.if concern is identified , the workup must progress rapidly.Headache is
classically defined as primary or secondary .if suspicion is alleviated , reasonable
approach involves determining whether symptoms are related to a benign
secondary headache disorder versus a primary headache disorder . Headaches may
resolve without further need for treatment if a secondary cause of headache can be
identified and eliminated. Alternatively ,if symptoms appear to be related to a
primary headache disorder , establishing a correct diagnosis is vital subsequently
developing a treatment plan.
Prevention of Headaches
The following steps may prevent symptoms of headaches:
Maintaining a regular sleep schedule. Getting too little sleep and oversleeping can
trigger headaches, as can getting up and going to bed at inconsistent times. Go to
bed and get up about the same time
every day. Yes, even weekends. Watching what you eat and drink — and when.
Don’t skip or delay meals. And drink plenty of water. Also avoid foods that can
trigger headaches. This is particularly true if you suffer
migraine headaches.
Common food and beverage triggers include caffeine, monosodium glutamate
(MSG), aged cheese, sausage, red wine and other alcoholic beverages.
Controlling stress. Learn techniques to help you relax and reduce emotional stress,
which may be caused by overwork, job loss, financial difficulties or family
problems. Stress can cause muscles to tense up and trigger
headaches. Stress relief techniques include deep breathing, visualization,
progressive relaxation and biofeedback. Stress may cause you to clench your jaw
or grind your teeth, even while sleeping. Exercising regularly. Exercising 30
minutes at least three days a week is good for your overall health,
and can help prevent migraines and tension headaches. Low-impact aerobic
exercise prevents tension as it strengthens your muscles and keeps them flexible.
Also good for muscle flexibility and stress
relief: stretching,
tai chi and yoga.
Choosing your sports wisely. Activities that involve running, jumping or sudden
starts, stops
and
direction changes can jar your neck and head, leading to tight muscles and
headache pain.
You may need to take
 Seizures
Seizures are a very common problem that accompany the humanity since its origin.
Seizures are more common than you might think. Seizures can happen after a
stroke, a closed head injury, an infection such as meningitis or another illness.
Many times, though, the cause of a seizure is unknown.
Most seizure disorders can be controlled with medication, but management of
seizures can still have a significant impact on your daily life. Seizures An
abnormal electrical discharge in the brain that interrupt normal function. Seizures
are episodes of abnormal motor, sensory, autonomic, or psychic activity (or a
combination of these) resulting from sudden excessive discharge from cerebral
neurons.
What is a seizures?
A seizure can be defined as abnormal, uncontrolled electrical activity in brain cells.
Nerve cells transmit signals to and from the brain in two ways by— Altering the
concentrations of salts (sodium, potassium, calcium) within the cell Releasing
chemicals called neurotransmitters (gamma aminobutyric acid).
Causes of seizures
Nerve cells (neurones)in the Brain send and receive that disrupts in these
communications pathway and biochemical changes in the Brain and increase level
of norepinephrine , dopamine , and serotonin
The Most common cause seizures is epilepsy , But different between one person to
another Sometimes seizures may caused by:
• Caungenital abnormalities such as; Head truma and head injury during labor
• Brain tumors
• Metabolic disorders such as (hypoglycemia hyponatremia hypernatremia)
• CNs infections ; meningitis , brain access
• intracranial hemorrhage
Others causes
• Lack of sleep
• illegal drugs and alcohol such as cocaine and nicotine
• COVID-19 virus infection
• fever (Febrile seizures)
What are the types of seizures?
Seizures are classified into two groups.
• Generalized seizures
• Focal seizures
1) Generalized seizures :-
Seizures that appear to involve all areas of the brain are called generalized seizures.
Types of generalized seizures:-
• Absence seizures. Absence seizures, previously known as petit mal seizures,
often occur in children and are characterized by staring into space or by subtle
body movements, such as eye blinking or lip smacking. They usually last for five
to 10 seconds but may happen up to hundreds of times per day.
These seizures may occur in clusters and cause a brief loss of awareness.
• Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures
usually affect muscles in your back, arms and legs and may cause you to lose
consciousness and fall to the ground.
• Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of
muscle control, which may cause you to suddenly collapse, fall down or drop your
head.
• Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking
muscle movements. These seizures usually affect the neck, face and arms on both
sides of the body.
• Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or
twitches of your arms and legs. There is often no loss of consciousness.
• Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal
seizures, are the most dramatic type of epileptic seizure and can cause an abrupt
loss of consciousness, body stiffening and
shaking, and sometimes loss of bladder control or biting your tongue. They may
last for several minutes.
2) Focal seizures:-
Focal seizures result from abnormal electrical activity in one area of your brain.
Focal seizures can occur with or without loss of consciousness:
Types of focal seizures:-
• Focal seizures with impaired awareness. These seizures involve a change or loss
of consciousness or awareness that feels like being in a dream. You may seem
awake, but you stare into space and do not respond normally to your environment
or you perform repetitive movements. These may include hand rubbing, mouth
movements, repeating certain words or walking in circles. You may not remember
the seizure or even know that it occurred.
• Focal seizures without loss of consciousness. These seizures may alter emotions
or change the way things look, smell, feel, taste or sound, but you don’t lose
consciousness. You may suddenly feel angry, joyful or sad. Some people have
nausea or unusual feelings that are difficult to describe. These seizures
may also result in difficulty speaking, involuntary jerking of a body part, such as
an arm or a leg, and spontaneous sensory symptoms such as tingling, dizziness and
seeing flashing lights.
• Simple focal seizures affect a small part of the brain. These seizures can cause
twitching or a change in sensation, such as a strange taste or smell.
• Complex focal seizures can make a person with epilepsy confused or dazed. The
person will be unable to respond to questions or direction for up to a few minutes.
• Secondary generalized seizures begin in one part of the brain, but then spread to
both sides of the brain. In other words, the person first has a focal seizure, followed
by a generalized seizure.
Signs and Symptoms of seizure
You can experience both focal and generalized seizures simultaneously, or one can
happen before the other. The symptoms can last anywhere from a few seconds to
several minutes per episode. Sometimes symptoms occur before the seizure takes
place. These can include:
• a sudden feeling of fear or anxiousness
• a feeling of being sick to your stomach
• dizziness
• a change in vision
• a jerky movement of the arms and legs that may cause you to drop things
• an out-of-body sensation
• a headache
• deja vu
Signs that indicate a seizure is in progress include:
• losing consciousness, followed by confusion
• having uncontrollable muscle spasms
• drooling or frothing at the mouth
• falling
• having a strange taste in your mouth
• clenching your teeth biting your tongue
• having sudden, rapid eye movements
• making unusual noises, such as grunting
• losing control of bladder or bowel function
• having sudden mood changes
Complications of seizures:-
A seizure can sometimes lead to circumstances that are dangerous for you or
others. You might be at risk of:
• Falling. If you fall during a seizure, you can injure your head or break a bone.
• Drowning. If you have a seizure while swimming or bathing, you’re at risk of
accidental drowning.
• Car accidents. A seizure that causes loss of either awareness or control can be
dangerous if you’re driving a car or operating other equipment.
• Pregnancy complications. Seizures during pregnancy pose dangers to both mother
and baby, and certain anti-epileptic medications increase the risk of birth defects. If
you have epilepsy and plan to
 become pregnant, work with your doctor so that he or
she can adjust your medications and
monitor
your pregnancy, as needed.
• Emotional health issues. People with seizures are more likely to have
psychological
problems, such as
depression and anxiety. Problems may be a result of difficulties dealing with the
condition
itself as well
as medication side effects.
• Medication Side Effects Like most drugs, epilepsy medications can come. with a
variety of
side effects.
One of the most common side effects is drowsiness, which can negatively affect
daily life.
Other
potential side effects include rash or severe bruising, nausea, and fever. In some
rare cases,
epilepsy
medication may actually cause more frequent seizures. Alternate treatments may
be
available. Speak
with your doctor about adjusting your medication plan if symptoms make life
difficult for you.
Treatment
can help most people with epilepsy have fewer seizures, or stop having seizures
completely.
Treatments include:
• medicines called anti-epileptic drugs (AEDs)
• surgery to remove a small part of the brain that's causing the seizures.
• a procedure to put a small electrical device inside the body that can help control
seizures.
• a special diet (ketogenic diet) that can help control seizures.
• Some people need treatment for life. But you might be able to stop if your
seizures
disappear over time.
• You may not need any treatment if you know your seizure triggers and are able to
avoid
them.
• Talk to your specialist about the treatments available and which might be best for
you.
Nursing Management
Nursing care for a child with seizure disorder include the following:
Nursing Assessment Nursing assessment includes:
• History. The diagnosis of epileptic seizures is made by analyzing the patient’s
detailed
clinical history and by
performing ancillary tests for confirmation; someone who has observed the
patient’s
repeated events is
usually the best person to provide an accurate history; however, the patient also
provides
invaluable details
about auras, preservation of consciousness, and postictal states.
• Physical exam. A physical examination helps in the diagnosis of specific epileptic
syndromes that cause
abnormal findings, such as dermatologic abnormalities (e.g., neurocutaneous
syndromes
such as SturgeWeber, tuberous sclerosis, and others); also, patients who for years
have had
intractable generalized tonicclonic seizures are likely to have suffered injuries
requiring stitches
Nursing Diagnosis Based on the
assessment data, the major
nursing diagnoses are:
• Risk for trauma or suffocation related to loss of large or small muscle
coordination.
• Risk for ineffective airway clearance related to neuromuscular impairment.
• Situational low self-esteem related to stigma associated with the condition.
• Deficient knowledge related to information misinterpretation
• Risk for injury related to weakness, balancing difficulties, cognitive limitations or
altered
consciousness.
Nursing Care Planning and Goals
The major nursing goals for a child with seizure disorder are:
• The patient or caregiver will verbalize understanding of factors that contribute to
the possibility of trauma and or suffocation and take steps to correct the situation.
• The patient or caregiver will identify actions or measures to take when seizure
activity occurs.
• The patient or caregiver will identify and correct potential risk factors in the
environment.
• The patient or caregiver will demonstrate behaviors, lifestyle changes to reduce
risk factorsand protect self from injury.
• The patient or caregiver will modify the environment as indicated to enhance
safety.
• The patient or caregiver will maintain treatment regimen to control or eliminate
seizure activity.
• The patient or caregiver will recognize the need for assistance to prevent
accidents or injuries.
• The patient will maintain effective respiratory pattern with airway patent or
aspiration prevented.
• The patient or caregiver will demonstrate behaviors to restore positive self-
esteem.
• The patient or caregiver will participate in treatment regimen or activities to
correct factors
that
precipitated a crisis.
• The patient or caregiver will verbalize understanding of the disorder and various
stimuli that
may
increase potentiate seizure activity.
Nursing Interventions
Nursing interventions for a child with seizure disorder include the following:
• Prevent trauma/injury. Teach SO to determine and familiarize warning signs and
how to care for patient during and after seizure attack; avoid using thermometers
that can cause breakage; use tympanic thermometer when necessary to take
temperature; uphold strict bedrest if prodromal signs or aura experienced; turn
head to side and suction airway as indicated; support head, place on soft
area, or assist to floor if out of bed; do not attempt to restrain; monitor and
document AED drug
levels, corresponding side effects, and frequency of seizure activity.
• Promote airway clearance. Maintain in lying position, flat surface; turn head to
side during
seizure
activity; loosen clothing from neck or chest and abdominal areas; suction as
needed;
supervise
supplemental oxygen or bag ventilation as needed postictally.
• Improve self-esteem. Determine individual situation related to low self-esteem in
the
present
circumstances; refrain from over protecting the patient; encourage activities,
providing
supervision
and monitoring when indicated; know the attitudes or capabilities of SO; help an
individual
realize that
his or her feelings are normal; however, guilt and blame are not helpful.
• Enforce education about the disease. Review pathology and prognosis of
condition and
lifelong need
for treatments as indicated; discuss patient’s particular trigger factors (flashing
lights,
hyperventilation, loud noises,video games, TV viewing); know and instill the
importance of
good oral
hygiene and regular dental care; review medication regimen, necessity of taking
drugs as
ordered, and
not discontinuing therapy without physician supervision; include directions for
missed dose.
Evaluation
Goals are met as evidenced by:
• The patient or caregiver verbalized understanding of factors that contribute to the
possibility
of trauma and or
suffocation and take steps to correct the situation.
• The patient or caregiver identified actions or measures to take when seizure
activity occurs.
• The patient or caregiver identified and corrected potential risk factors in the
environment.
• The patient or caregiver demonstrated behaviors, lifestyle changes to reduce risk
factors
and protect self from
injury.
• The patient or caregiver modified environment as indicated to enhance safety.
• The patient or caregiver maintained treatment regimen to control or eliminate
seizure
activity The patient or
caregiver recognized the need for assistance to prevent accidents or injuries.
• The patient maintained effective respiratory pattern with airway patent or
aspiration
prevented.
• The patient or caregiver demonstrated behaviors to restore positive self-esteem.
• The patient or caregiver participated in treatment regimen or activities to correct
factors that
precipitated a
crisis.
• The patient or caregiver verbalized understanding of the disorder and various
stimuli that
may increase
potentiate seizure activity.
Documentation
Guidelines Documentation in a child with seizure disorder include:
• Individual findings, including factors affecting, interactions, nature of social
exchanges,
specifics of individual
behavior.
• Cultural and religious beliefs, and expectations.
 • Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward the desired outcome.
Seizure Prevention Tips
Here are some tips that may help reduce your risk of having an epilepsy seizure:
• Get plenty of sleep each night — set a regular sleep schedule, and stick to it.
• Learn stress management and relaxation techniques.
• Avoid drugs and alcohol.
• Take all of your medications as prescribed by your doctor.
• Avoid bright, flashing lights and other visual stimuli.
• Eat a healthy diet.
Until more is known about the causes of epilepsy and how it can be prevented,
your best bet
to prevent seizures
associated with epilepsy is to avoid the things that can trigger your seizures. This
can make
a measurable difference in
the number of seizures you have.
What is the First aids of seizures?
● Epileptic seizure first aid
If you are with someone having a tonic-clonic seizure (where the body stiffens,
followed by
general muscle
jerking), try to :
● Stay calm and remain with the person.
● If they have food or fluid in their mouth, rollthem onto their side immediately.
● .Keep them safe and protect them from injury
● Place something soft under their head and loosen any tight clothing.
● Reassure the person until they recover.
 ● Time the seizure, if you can.
● Gently roll the person onto their side after the jerking stops.
● Do not put anything into their mouth or restrain or move the person, unless they
are
in
danger.
● If a person having a seizure is in a wheelchair
● If a person has a seizure when they are in a wheelchair, car seat or stroller:
● Leave the person seated with the seatbelt on (unless it is causing injury).
● Put the wheelchair brakes on
If it’s a tilt wheelchair, tilt the seat and lock in position.
● Support their head until the seizure has ended
● Lean the person slightly to one side to aid drainage of any fluid in the mouth.
● After the seizure, if the person is having trouble breathing or they need to sleep,
take
them
out of the chair and put them in the recovery position.
● If their breathing difficulties continue, call an ambulance and closely monitor the
person. Be
prepared to perform CPR if they stop
breathing.
● Seizures in water
● If a seizure occurs in water:
● Support the person's head so their face is out of the water.
● Tilt their head back to ensure a clear airway.
● If the person is in a pool, remove them from the water when the
jerkingstops.Note: In
the
rare circumstance the jerking does not stop, seek help from others if possible, and
remove
the person from the water at the shallowest end of the pool.
● If the person is in the surf, remove them from the water immediately
Flotation devices may be useful when removing someone from water.
● Seek help if possible.
● Once out of the water:
Call triple zero (000) for an ambulance immediately. (Do this even if the person is
breathing,
)as they may have inhaled water
Place the person on their side
Check to see if they are breathing
If they are not breathing, or they are not breathing normally, reposition the person
onto their
back and begin the appropriate from of cpr.
References and Sources
1. Al Sawaf A, Arya K, Murr N. Seizure Precautions.
[Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing;
2022 Jan-. Available from:
https://www.ncbi.nlm.nih. gov/books/NBK536958/
2. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse's Pocket Guide
Diagnoses, Prioritized Interventions,
and Rationales (11th ed.). F. A. Davis Company.
3. Evaluation of a First-Time Seizure. (n.d.). Johns Hopkins Medicine. Retrieved
February
28, 2022, from
https://www.hopkinsmedi cine.org/health/conditions-and
diseases/epilepsy/evaluat ion-of-a-firsttime-seizure
4. First Aid for Seizures. (2015, August 10). Cleveland Clinic. Retrieved February
28, 2022,
from
https://my.clevelandclinic. org/health/articles/6998 seizures-first-aid
5. Schachter, S. C. (2021, July 22). Learn / Triggers of Seizures. Epilepsy
Foundation.
Retrieved February 28, 2022, from
https://www.epilepsy.com /learn/triggers-seizures
6. Service Coordination/Case Management Programs.
(n.d.). Epilepsy Foundation. Retrieved February 28, 2022, from
https://www.epilepsy.com
/local/northeastern-new
york/programs/service coordinationcase management-programs
7. https://www.webmd.com/migraines-headaches/migraines-headaches-basics
8. https://pubmed.ncbi.nlm.nih.gov/33974014/
9. https://www.who.int/news-room/fact-sheets/detail/headache-disorders
10. https://pubmed.ncbi.nlm.nih.gov/20875042/
11. The global burden of headache: a documentation of headache prevalence and
disability
worldwide.
Stovner Lj, Hagen K, Jensen R, et al. Cephalalgia. 2007;27:193–210. [PubMed]
[Google
Scholar]
12. Prevalence of headache and migraine in children and adolescents: a systematic
review
of population-based
studies. Abu-Arafeh I, Razak S, Sivaraman B, Graham C.
https://pubmed.ncbi.nlm.nih.gov/20875042/ Dev Med
Child Neurol. 2010;52:1088–1097. [PubMed] [Google Scholar]
13. Clinical profile of primary headache disorders in Kano, North western Nigeria.
Owolabi
LF, Gwaram
B. https://www.ajol.info/index.php/jmt/article/view/80367 J Med Trop.
2012;14:109–115.[Google Scholar].