Lesson plan

Subject : Medical Surgical Nursing

Topic : Epilepsy

Name of the subject: MEDICAL SURGICAL NURSING -I

Name of the teacher: JITENDRA BARDE
Name of the topic: Epilepsy
Placement of student: GNM II year
Method of teaching: Lecture cum discussion
Date:
Venue: GNM II ND year Lecture hall
Duration:1 hr
Instructional aids : chart, black board
No of the student :
No of present student :
Previous knowledge of student : Students have basic knowledge about epilepsy.
General objectives:
At the end of the class the students will gain deep knowledge about epilepsy.
Specific objectives:
At the end of the class students should be able to,
 define epilepsy
 describe types
 list down the etiological factors
 describe the pathophysiology
 list down the clinical manifestations
 list down the diagnostic evaluations
 explain the management

TIME OBJECTIVES CONTENTS AV TEACHER/ EVALUATIO

 LEARNER
AIDS N
ACTIVITIES
EPILEPSY:
Black Lecture and
1 min Introduce the Introduction: board & discussion
topic chalk
The epilepsies are a symptom complex of several disorders of brain
function characterized by recurring seizures.
Seizure is a paroxysmal, uncontrolled electrical discharge of neurons in
the brain that interrupts normal function.
1 min Define epilepsy Black Lecture and What is
Definition: board & discussion epilepsy?
Epilepsy is a condition in which a person has spontaneously recurring chalk

seizure caused by a chronic underlying condition.

5 min Explain about Anatomy & physiology: Lecture and

anatomy & Black discussion Explain about
Anatomy:
physiology of board & the anatomy &
nerve cells The nervous system consists of a vast number of cells called neurons, chalk physiology of
nerve cells?
supported by a special type of connective tissue, neuroglia. Each
neurons consists of a cell body end its process. On e axon and many
dendrites.
Physiology:
The physiological units of nervous system are nerve impulses , or
action potentials, which are skin to tiny electrical charges. In effect the
strength of the impulse is maintained through out the length of the
neurons.
5 min Properties of neurons: Lecture and
discussion
 irritability Black
 conductivity board &
chalk
irritability is the ability to initiate nerve impulse in response to stimuli
from,
 outside the body
 inside the body

conductivity means the ability to transmit an impulse

5 min Explain the types Types: Lecture and

of seizures? discussion What are the
It is mainly divided into two,
types of
1. generalized seizures Black epilepsy?
board &
2. partial seizures
chalk

1)Generalized seizures:
They are characterized by bilateral synchronous epileptic discharges in
the brain from the onset of the seizure, it is divided into,
a) Tonic clonic seizures
b) Typical absence epileptic seizures
c) Atypical absence seizures
d) Myclonic seizures
e) Akinetic epileptic seizures
 a)Tonic clonic seizures:
It is characterized by loss of consciousness and falling to ground If the
patient is upright , followed by stiffening of the body.
b)Typical absence epileptic seizures:
It usually occurs only in children which characterized by brief starring
spell that last only a few seconds
c)Atypical absence seizures:
it is characterized by starring spell accompanied by other signs and
symptoms including brief warnings
d)Myoclonic Seizures:
it is characterized by sudden, excessive jerk of the body or extremities.
e)Akinetic seizures:
it is characterized by loss of tone, astatic (loss of balance) and arrest of
movement.
2)Partial seizures:
Partial seizures may be confined to one side of brain end remain partial
List down the
1 min incidence or focal in neturs.
Lecture and
Incidence: discussion
 The prevalence of epilepsy is 5 to 10 per 1000 persons.
 It is higher in undeveloped countries
 It occurs before the age of 20years in greater than 75% of
patients.
 List down the Black
3 min etiology board &
Etiology: chalk Lecture and
discussion
 Severe birth injury
 Congenital defects involving CNS
 Infections
 Inborn errors of metabolism
 Trauma
What are the
 Genetic factors etiological
factors?
 Brain tumors
Black
 Vascular disease board &
chalk
 Cerebrovascular lesions
 Metastatic brain tumors
 Idiopathic
 Genetic pre disposition
Explain about
5 min pathophysiology?
Pathophysiology:
Lecture and
Messages from the body are carried by the nerve cells of the brain by discussion
means of electrochemical energy. These impulses occur in bursts
whenever a nerve cell has a test to perform.
Due to etiological factors
↓
The nerve cells or groups of cells continues firing after a task is
finished Explain about
↓ pathophysiolog
 Unwanted electrochemical discharges forms y?
↓ Black
board &
Resultant dysfunction ranges from mild to incapacitating and often
chalk
cause unconsciousness
↓
When these uncontrolled, abnormal discharges occur repeatedly a
person is said to have epilepsy.

Clinical manifestations:
In adults:
 Loss of consciousness
 Fear
 Anger
 Elation
List down the
3 min clinical features  Irritability Lecture and
 Jerky alternation of muscle relaxation and contraction discussion

 Contraction of diaphragm and chest muscles Black

 Tongue is often chewed incontinence of urine and stool board &
chalk
 Headache
 Person may talk unintelligibly may be dizzy , sounds, odours or
tastes are experienced.
What are the
clinical
In children: features?
 Numbness
 Tingling
  Parasthesia
 Pallor
 Sweating
 Flushing
 Papillary dilation

Diagnostic evaluation:
In adult:
 History collection
 Physical examination
 Electro encephalogram (EEG)
 Complete blood count
 CT scan
 MRI scan
List down the  Cerebral angiography
3 min diagnostic
evaluation  Single photon emission computed tomography (SPECT) Lecture and
 Magnetic resonance spectroscopy (MRS) discussion

 Positron emission tomography (PET)

 Urinalysis Black
board &
 Liver and kidney function test chalk
 Serum chemistries

Which are the

 In children: diagnostic
evaluation?
 EEG
 MRI
 Lumbar procedure
 Polygraph equipment
To monitor physiological data such as respiratory effort, eye
5 min Explain about the movements, heart rate and systemic , blood pressure. Lecture and
complications discussion
Complications:
 Status epileptics :It is a state of continuous seizure activity or a
condition in which seizures recur in lipid succession without
return to consciousness between seizures.
 Severe injury
 Death from trauma

15 Explain about Management: Lecture and

min management discussion
The management of epilepsy to meet the needs of each patient and not
just to manage and to prevent seizure.
Pharmacological management:
Epileptic disorder are treated primarily with ant seizure drugs.
 Aim
To prevent epilepsy because cure is not possible.
In adults:
 Eg: clonazepam
  Carhanzepine Black
board &
 Primidone
chalk
 Phenytoin
 Fethamate
 Phenobarbital What are the
complications?
In children:
Epileptic drugs:
 Carbamazepine-5-25mg/kg/day
 Phenytoin -5-7mg/kg/day
Black
 Valporic acid – 10-30mg/kg/day
board &
 Phenobarbital – 3-5mg/kg/day chalk
 Ethosunimide-15-40mg/kg/jday
Explain about
the
Surgical management: management
There are 3 types of surgical interventions are in children. of epilepsy?

1)Resective Surgery: In this the focal area of the seizures activity is

excised.
2)Callostomy: Include the separation of the connection between the two
hemispheres of the brain and is used in some generalized seizures.
3)Vagus nerve stimulation:- It uses an implantable device that reduces
seizure in individuals who have not had effective control with drug
therapy.
In adult:
 1) Cerebral resection Lecture and
Black discussion
2) Temporal lobectomy
board &
10 Explain about 3) Vagus nerve stimulation chalk
min nursing
management Nursing management:
 Assess the condition of the patient
 Help in taking medication
 Exercise I moderation in a temperature controlled
environment to avoid excessive heat.
 Keep a “drug and seizure chart”
 Assess for trauma to mouth
 Provide teaching to patient and family
Nursing diagnosis:
1.Ineffective breathing pattern related to neuromuscular impairment
Interventions:
 Loosen constricting to clothing to avoid restricting breathing
 Assess breathing pattern
 Provide manual ventilation
 Inset oral airway
2.Risk for injury related to epileptic activity and impaired physical
mobility.
Interventions:
 Assess for trauma to mouth
 Assess for weakness
  Refrain from moving or restraining patient during a seizure
 Assist in determining whether operation of a motor vehicle is
appropriate for patient
3.Ineffective coping related to perceived loss of control and denial of
diagnosis
Interventions:
 Explore nurons for denial to determine extend of problem and to
plan appropriate interventions.
 Implement and individualize teaching plan about causes and
mechanisms of seizures.
4.Ineffective therapeutic regimen management related to lack of
knowledge about management of epileptic disorder
Interventions:

 Provide teaching to patient and family about seizure activity and

therapeutic management
Conclusion:
Students are able to tell about definition, etiology, types,
pathophysiology, clinical manifestations, diagnostic evaluation and
management of epilepsy.
 Chalk board summary:
Number of students:
Number of students
present
Topic : Epilepsy
 Definition of epilepsy
 Types
 Etiology
 Pathophysiolgy
 Clinical manifestations
 Diagnostic evaluations
 Complication
 Management
Reference:
teachers reference:
1. Lewis mantic Sharon, Heitkemper Melean marc, aret and dirksen ruff shannow, “MEDICAL
SURGICAL NURSING”,6th edition , Elsevier publications , new delhi,
page no-1555-15561.
2. Suddarths and Brunners ,TEXT BOOK OF MEDICAL SURGICAL9th edition, lippincott
publications , Philadelphia,
page no 1739-1744.
3. Wilson and ross , “ANATOMY AND PHYSIOLGY IN HELATH & ILLNESS”, 9th edition, Churchill
livingstdne publications , London,
page no 139-141.