tonic - clonic seizures marco, carmela dawn m

8/2/2019 Tonic - Clonic Seizures Marco, Carmela Dawn M.

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Tonic Clonic SeizuresMarco, Carmela Dawn M.

BSN II - 3


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Tonic Clonic Seizures Also known as Grand mal Seizure Generalized seizures consisting of

four stages:1. Prodromal Period2. Aura3. Tonic- Clonic Stage4.

Postictal Stage Not all four stages occur with every

seizure


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Tonic Clonic Seizures


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Four Stages:I. Prodromal Period1. Prodromal Period Manifestations:

Drowsiness

DizzinessMalaiseLack of coordinationTension

Parents may observe simply that the child is not himselfSchool- Age ChildrenMay able to predict from vague preliminary feelings whenthey are going to have seizure


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Four Stages:II. Aura2. Aura May reflect the portion of the brain in which

seizure originates Manifestations:

Smelling unpleasant odors Denotes activity in medial portion of the temporal lobe

Seeing flashing lights Suggests occipital area

Repeated hallucinations Arise from the temporal lobe

Numbness of the an extremity

Relates to the opposite parietal lobe


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Cheshire- cat grin Relates to the frontal lobe

Young Children Unable to describe or understand an aura

Expected Actions During Onset: May scream in fright Run to their parents

Note exactly what symptoms the child experiencesduring the onset It may help to localize the involvement of brain portion

Four Stages:II. Aura


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3. Tonic Clonic Stage Tonic Stage

It lasts only about 20 seconds Manifestations:

All muscles of the body contract Child falls on the ground Extremities stiffen Face distorts May experience hypoxia and become cyanotic

Due to contraction of respiratory muscles

Four Stages:III. Tonic Clonic Stage


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Collection of saliva in the mouth Due to contraction of the throat and prevent

swallowing Child might bite the tongue

Due to contraction of the jaw Guttural Cry

Due to initially contraction of the chest muscle and airpushed through the glottis

Clonic Stage It usually lasts about 20-30 seconds Manifestations:

Quick, Jerky Motions Muscles of the bod ra idl contract and relax



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May blow bubbles or foamy saliva Incontinent of stool and urine

If the child bite his tongue when his jaw spasmed shut Presence of blood in the mouth



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Tonic Clonic Seizures Seizures may occur at night When the child wake up in the morning

expect: Blood on the pillow

Due to bitten tongue

Bed wet with urine Persistent Bedwetting

Considered possibility of nocturnal seizures

Abnormal EEG patterns


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Therapeutic Management: Daily administration of Anticonvulsant

Valproic Acid (Depakene) Care should be taken when giving this medication to very

young children and clients with liver disorders Due to hepatoxicity for possible adverse reaction

Carbamazepine (Tergetol)

Used to control this type of seizure that have not respondedto other anticonvulsant therapy Avoid drinking grapefruit juice

May cause toxicity


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Therapeutic Management: Phenobarbital

Inexpensive anticonvulsant that lowers the seizure threshold Drowsiness and Sleepiness

Phenytoin Sodium (Dilantin) To prevent this type of seizure Non-toxic side effects

Painless Hypertrophy of the gums Unless the gum hypertrophy is extensive, it is not sufficient reason

to discontinue the medication.

Prescription of Ketogenic Diet High in fat and low in proteinand carbohydrate To causes an increased level of ketones

Decrease tonic- clonic seizure activity


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tonic - clonic seizures marco, carmela dawn m

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