A. DEFINITIONS
Epilepsy is a symptom or manifestation of excessive loss of electrical charge on the central nervous system neuronal cells that can lead to loss of awareness, involuntary movements, abnormal sensory phenomena, increased autonomic activity and other physical disorders.
Epilepsy is a symptom or manifestation of excessive loss of electrical charge on the central nervous system neuronal cells that can lead to loss of awareness, involuntary movements, abnormal sensory phenomena, increased autonomic activity and other physical disorders.
B. ETIOLOGY
1. Idiopathic.
2. Acquerit: brain damage, drug toxicity,
metabolic bacteria.
- Birth trauma
- Trauma to the head
- A brain tumor
- stroke
- cerebral edema
- hypoxia
- poisoning
- metabolic disorders
- infections.
C. PATHOPHYSIOLOGY
According to the investigators that most of
the rise of epilepsy comes from a collection of abnormal neuronal cells in the
brain, which releases excessive charge and hypersinkron. Groups of
abnormal neuronal cells, which is also known as epileptic focus underpins all
types of epilepsy, both the public and the focal (partial). Remove the
electrical charge can then be spread through physiological pathways involving
anatomical and surrounding suburbs or more distant regions of the
brain. Not all neurons in the central nervous system arousal can trigger
epilepsy clinic, although he pulled off excess electric
charge. Diserebellum neurons in the lower brain stem and spinal cord,
although they can release excess electrical charge, but their positions are not
able to trigger arousal causes epilepsy. It is not yet revealed exactly
what triggers the mechanisms of neuronal cells to release both sync and charge
excessive (mechanism of epilepsy).
Generally Pathology:
nerve cell biochemical phenomenon that marks
epilepsy:
1. The instability of the nerve cell
membrane.
2. Neurons hypersensitif the threshold
decreases.
3.Polarization abnormal.
4. Ion imbalance.
D. CLASSIFICATION
AND CLINICAL
1. Common epilepsy.
-
Grand mal.
- Petit
mal.
-
Infantile spasm.
2. Epilepsy Type Focal / Partial.
-
Focal motor.
-
Focal sensory.
-
Psychomotor.
Symptoms:
1. General resurrection:
-
Tonic: 20-60 sec. à muscle contractions, leg and elbow flexion,
neck and back arched,
screaming
epilepsy (aura).
-
clonic: spasmus 40 sec. à flexi alternate relaxation,
hypertension, midriasis, tachycardia,
hyperhidrosis
, hypersalivasi.
-
Post-Attack: muscle activity stalled client senses weakness, muscle
pain and
headache clients
sleep 1-2 hours.
2. Partial Type:
-
Simple: there is no disturbance of consciousness.
-
Komplex: impaired consciousness.
Ad:
1. Grand mal (tonic clonic):
-
Characterized by aura: the sensation of hearing or sight.
-
Lost consciousness.
-
epileptic cry.
-
increased muscle tone stance flexion / extension. À
-
Jolt, clonic seizures.
-
The tongue may bite, hypertension, tachicardi, sweating, dilated pupils and
hypersalivasi.
-
After the attack patient to sleep 1-2 hours.
-
Patient forgotten, sleepy and confused.
2. Petit mal:
-
Missing consciousness briefly.
-
Clients look bemused.
-
What he did stop.
-
Client staggered but did not fall.
3. Infantile spasm:
- There
was aged 3 months - 2 years.
-
Seizures flexor on ektremitas and head.
-
just a few fetik recurrent seizures.
-
Most of the clients are mentally retarded.
4. Focal motor:
Lesions
in the frontal lobe.
5. Focal Sensory:
lesion
in the parietal lobe.
6. Focal Psychomotor:
temporal
lobe dysfunction
E. DIAGNOSTIC EXAMINATION
Laboratory
tests: § routine blood examination, blood banks and other appropriate
indications such as blood sugar, electrolytes. Examination of
cerebrospinal fluid (if necessary) to determine the pressure, color, clarity,
bleeding, number of cells, cell counts, protein content, sugar and other tests
NaCl on the indication.
EEG:
An EEG is useful for
the diagnosis of epilepsy. There are abnormalities in the form
epilepsiform epileptiform discharges or activity), such as spike sharp wave,
spike and wave, and so on. EEG recordings can determine the focus and the
type of epilepsy is focal, multifocal, cortical or subcortical, and so
on. Should be performed at regular intervals (approximately 8-12% of
patients with epilepsy have a normal EEG recordings).
Radiological Examination:
Photos skull to skull
abnormalities, bone destruction, abnormal calcification intrakranium,
exaltation sign of ICTs such as widening sutures, erosion sidelines tursika and
so on. Pneumoensefalografi and ventrikulografi to see a picture of the
ventricles, sisterna, sub arachnoid cavity and brain
imaging. Arteriography to see the blood vessels in the brain: cerebral
vascular anomalies, obstruction, neoplasm / hematome / abscess.
F.COMPLICATIONS
Brain damage and
mental retardation due hypoksia may arise from recurrent seizures. May present
state of depression and anxiety.
G. MANAGEMENT:
a. Causal
Treatment:
It was investigated
whether the patient is still suffering from the active disease, such as
cerebral tumor, chronic dural sub hematome. If yes, need to be treated
first.
b. Rumat
Treatment:
Patients epilepsy are
given anticonvulsant drugs rumat. In clinical child neurologist Faculty of
medicine-RSCM Jakarta, treatment is usually continued until 3 years free of
attack, then the medicine is gradually reduced and terminated within 6
months. In general, duration of treatment ranged from 2-4 years free of
attacks. During the treatment of the symptoms of intoxication should be
checked periodically and laboratory examinations. drugs used for epilepsy
that can be applied to all forms of seizures:
- Phenobarbital, the
dose of 3-8 mg / kg bw / day.
- Diazepam, dose 0.2
-0.5 mg / kg bw / day.
- Diamox
(asetazolamid), 10-90 mg / kg bw / day.
- Dilantin
(Difenilhidantoin), the dose of 5-10 mg / kg bw / day.
- Mysolin (Primidion),
doses of 12-25 mg / kg bw / day.
When suffering from
infantile spasms are given:
- Prednisone dose is
2-3 mg / kg bw / day.
- Dexametasone, doses
of 0.2 to 0.3 mg / kg bw / day.
- Adrenokortikotropin,
a dose of 2 - 4 mg / kg bw / day
Nursing:
The problem of
patients who need to be aware of is the risk of danger due to rise of epilepsy,
impaired sense of security and comfort, the risk of psychosocial disorders,
lack of parental knowledge about the disease.
H. NURSING CARE CONCEPTS
1. PATIENT
ASSESSMENT DATA BASE.
ACTIVITY / REST
Symptoms: Fatigue,
general weakness. limitations in activities / work caused by self /
significant other.
Alerts: Changes in
muscle tone / muscle strength. involuntary movement / contraction of
muscle or group of muscles.
CIRCULATION
Symptoms : ictal:
hypertension, increased pulse, cyanosis.
Postiktal: normal
vital signs or depression with decreased pulse and respiration.
EGO INTEGRITY
Symptoms: Stressor
external / internal related to the condition and / or treatment. sensitive
excitatory; feeling hopeless / no helpless. Change in touch.
Alerts: Widening the
range of emotional responses.
ELIMINATION
Symptoms: episodic
incontinence.
Alerts: ictal:
increased pressure bladder and sphincter tone.
Postiktal: muscle
relaxation resulting in incontinence (both urinary / fecal).
FOOD / FLUID
Symptoms: Sensitivity
to food, nausea / vomiting associated with seizure activity.
Alerts: soft tissue
damage / gear (injury during a seizure). gingival hyperplasia (Dilantin
side effects long term use).
NEUROSENSORI
Symptoms: headache
history, activity of repeated seizures, fainting , dizziness. History of
head trauma, cerebral anoxia and infection. presence of an aura (visual
stimulation, auditory, area hallucinogenic).
Postiktal: weakness,
muscle pain, area parestese / paralysis.
Alerts:
Characteristics of seizures: Generalized seizures. partial seizures
(complex). partial seizures ( simple).
PAIN / CONVENIENCE
Symptoms: Headache,
muscle aches / back postiktal period. abnormal paroxysmal pain during the
ictal phase.
Alerts: attitude /
behavior cautious. Changes in muscle tone. restless behavior /
distraction.
BREATH
Symptoms: ictal phase:
teeth shut, cyanosis, decreased breathing / fast; increased mucous secretion.
Postiktal Phase:
apnea.
SECURITY
Symptoms: History of
falls / trauma, fractures. presence of allergies.
Alerts: Trauma to the
soft tissue / ecchymosis. decrease in strength / overall muscle tone.
SOCIAL INTERACTION
Symptom: Problems in
interpersonal relationships within the family or social
environment. Restrictions / avoidance of social contact.
AWARENESS / EDUCATION
Symptoms: A history of
epilepsy in the family. Usage / drug dependence (including alcohol).
PRIORITY NURSING
1. Prevent /
control seizure activity.
2. Protect the
patient from injury.
3. Maintain
airway.
4. Increasing
positive self esteem.
5. Provide
information about disease process, prognosis, and treatment needs.
PURPOSE REPATRIATION
1. Controlled
seizures.
2. Complications
/ injuries can be prevented.
3. Able to show
the image of the body.
4. An
understanding of the disease process, prognosis and treatment needs.
2. NURSING
DIAGNOSIS THAT MAY ARISE:
High risk of trauma /
respiratory cessation associated with changes in consciousness; weakness;
losing big or small muscle coordination.
ACTION PLAN /
INTERVENTION:
- Dig with clients
various stimulation can trigger seizures.
Rational: alcohol, various drugs and other
stimulation (such as lack of sleep, the lights were too
bright, watching TV too long) can increase
brain activity, which in turn increase the risk of
seizures.
- Maintain soft pads on the bed barrier attached to low bed position.
- Maintain soft pads on the bed barrier attached to low bed position.
Rational: reducing trauma during seizures
(often / common) occurs during the patient is in bed.
- Stay with the patient in a long long time / after a seizure.
- Stay with the patient in a long long time / after a seizure.
Rational: improving patient safety.
- Record the type of seizure
activity (such as the location / length of motor activity, loss of
consciousness, incontinence, etc.) and how
many times occurs (frequency / recurrence).
Rational: help to localize the brain areas affected.
Rational: help to localize the brain areas affected.
High risk of airway
clearance / ineffective breathing pattern related to neuromuscular damage;
obstruction trakeobronkial.
PLAN ACTION /
INTERVENTION:
- Encourage clients to
clear the mouth of objects / substances specified / dentures or other device
if the aura phase occurs and to avoid jaw
shut if seizures occur without marked
symptoms.
Rational: reducing the
risk of aspiration or the entry of foreign objects into the
pharynx.
- Place the patient on
his side, flat surface, tilt the head during a seizure.
Rational: increasing flow
(drainage) secretions , to prevent the tongue falling and block the
airway.
- Take your clothes on the neck / chest and
abdomen.
Rational: to
facilitate efforts to breathe / chest expansion.
- Enter spatel tongue
/ artificial airway or the rolls soft materials according to
indications.
Rational: if put in
early to open the jaw, the tool to prevent biting tongue during
inhalation and facilitate mucus or ante up
the breathing if necessary.
- Do exploitation as indicated.
Rational: reducing the
risk of aspiration or asphyxia.
- Collaboration in the
provision of supplemental oxygen.
Rational: can lower
cerebral hypoxia as a result of decreased circulation or oxygen secondary to
vascular spasm during a seizure.
Disorders esteem /
self-identity related § uncontrolled perceptions; stigma-related
condition; characterized by: fear of rejection, changes in perception of self,
less follow / did not participate in the therapy.
PLAN ACTION /
INTERVENTION:
- Discuss feelings
about the patient diagnostics, self-perception of the treatment
does. Advise to
express his feelings.
Rational: reactions
have varied between individuals and the knowledge / experience with state of
the disease early will affect the acceptance
of the rules of treatment.
- Identify /
anticipate possible reactions on the state of the disease.
Rational: provides an
opportunity to respond to the problem-solving process and provide control
measures to the situation at hand.
- Dig with patients
about the success that has been obtained or will be achieved next and
Strength
Rational: focus on the
positive asfek can help to eliminate the feelings of failure or self-
awareness and establish patient began
receiving handling of the disease.
- Discuss referral to
psychotherapy with patients or people nearby.
Rational: seizures
have a huge effect on self esteem and patient / significant other may feel
guilty
over the acceptance of her limitations and
stigma society. Counseling can help overcome the feeling of
self-consciousness.
Lack of knowledge
(learning needs), on the conditions and rules of treatment is associated with
less exposure, incorrect interpretation of the information, less menginat,
characterized by: lack of following the rules of medicine, questions, less
control seizure activity.
ACTION PLAN /
INTERVENTION:
- Explain again about
the pathophysiology / prognosis of the disease and the need for treatment /
handling within a period of time in
accordance with procedures.
Rational: provides an
opportunity to clarify misperceptions and circumstances existing disease as
something that can be handled in the normal
way of life.
- Review the drugs are
obtained, it is important take medication as directed, and do not stop the
medication without medical supervision. Includes
instructions for dose reduction.
Rational: lack of
understanding of the drugs obtained is the cause of the seizures were
continuously without stopping.
- Instruct patient to
wear a bracelet / some kind of clue that tells you is that people with
epilepsy.
Rational: speed
handling and determine diagnosis in an emergency.
- Discuss the benefits
of good general health, such as adequate diet, adequate rest, adequate
exercise and avoid the dangers of alcohol,
caffeine and drugs that can stimulate seizures.
Rational: moderate and
regular activity can help menuurnkan / controlling the predisposing factors
that increase the feeling healthy and good coping skills and self-esteem.
Risk of impaired
growth and development related to brain cell damage and secondary to epileptic
seizure activity.
PLAN ACTION /
INTERVENTION:
- Teach parents about
the developmental tasks according to age group.
Rational: provides an
overview of patterns of child development according to the development in
his age group.
- Observation and give
children the opportunity to meet age-appropriate developmental tasks.
Rational: determine
the extent of the child's development can be achieved and compared with
patterns development of appropriate developmental age group.
REFERENCES
Doengoes, Marylin,
1999. Nursing care plan, EGC, Jakarta.
Elizabeth,
J.Corwin. , 2001. Pathophysiology Handbook. Matter
I. Publisher: EGC, Jakarta.
Mansjoer,
Arif. et al, 2000.Capita Selekta Medicine. Media Auskulapius, Jakarta
Ngastiyah,
1997. Child Care Hospital. EGC, Jakarta
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