Convulsive Disorders

Caring for a patient with convulsive disorders can be a challenging role. A good foundation must be inculcated in order to provide a competent nursing care plan. In this article, two convulsive disorders are discussed.

A. Convulsion – Involuntary contraction of muscles resulting from abnormal cerebral stimulation.

Types of Convulsion:

  • a. Clonic – Involuntary contraction and relaxation of opposing muscle groups, producing jerky convulsive movements.
  • b. Tonic – Persistent contraction of a muscle or sets of muscles due to muscular shrinkage
  • c. Tetanic- Any form of spasms characterized by tetanus without loss of consciousness
  • d. Epileptiform – Any convulsion with loss of consciousness

B. Epilepsy – Symptom complex characterized by attacks of unconsciousness that may or may not be associated with convulsions, sensory phenomenon or abnormalities in behaviour.

Causative Factors:

  1. Birth Trauma
  2. Head Trauma
  3. Brain Tumor
  4. Meningitis, encephalitis or brain abscess
  5. Metabolic Disorders such as hypoglycaemia or phenylketonuria
  6. Cerebrovascular disorder

Most of the cases of epilepsy are idiopathic or no known pathology. Epilepsy is elicited when the nerve cell impulses kept on firing causing a constant jerky movement. These erratic movements are called seizures.

Types of Epilepsy:

  1. Grand Mal – The patient loss his or her consciousness. Before the patient losses consciousness, an aura or warning sensation can be described either in a form of dizziness or numbness. The muscles tend to elicit an tonic-clonic contraction.
  2. Petit Mal – As the name implies, momentary loss of consciousness can be observed.
  3. Status Epilepticus – A dangerous form of epilepsy which can eventually lead to death due to continuous major convulsion
  4. Jacksonian Epilepsy – A certain body part or group of body parts contracts locally.

Nursing Management:

  1. Provide a padded tongue depressor at the bedside in order to prevent injury to the tongue as well as on the mouth. However, do not attempt to apply the tongue depressor by force when the jaws a clenched.
  2.  Document the occurrence of each seizure. Record the progress of symptoms which can be observed during the seizure. These are the pointers in the documentation:
    • The initial movement and stiffness as well as the position of the eyeballs
    • Type of movement as well as the body parts involved
    • Pupil size
    • Urine incontinence or involuntary passage of feces
    • Duration of each attack
    • The period of being in the unconscious state
    • Paralysis after the attack
  3. Provide a safe environment for the patient. This may mean providing support to the patient during seizures. Loosen the clothing of the patient when epilepsy occurs.
  4. Prevent aspiration by turning the patient on his side.
  5. Provide soft pads or sheets on the head area of the patient as he or she may elicit head banging during the attack.
  6. Reassure the patient after the attack was finished that everything is under control.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

What Do You Think?