Page 187 - Encyclopedia of Nursing Research

154 n EPiLEPSY

of respiratory placements. Finally, measur-
ing and recording of the insertion length EpilEpsy
E was helpful, especially if correct placement
of the tube in the stomach was verified by
radiograph at the time of insertion, as the Epilepsy refers to a chronic condition char-
length of tube extending from the nares or acterized by recurrent seizures. A seizure is
mouth can then be compared with this mea- a temporary alteration in functioning caused
sured length before each feeding or medi- by an abnormal discharge of neurons in the
cation instillation to detect slippage of the central nervous system (Holmes, 1987). The
tube in or out. This method will not detect exact nature of the seizure depends on the
tubes that have migrated internally dur- function of the brain cells that are affected
ing severe coughing, nasotracheal suction- by the abnormal discharge. Seizures are clas-
ing, retching, or vomiting with no slippage sified into two major types: partial and gen-
(Ellett, 2006). eralized. Partial seizures, which occur when
in summary, although estimates of tube the electrical discharge remains in a circum-
placement errors vary, there is no doubt scribed area of the brain, can be broken down
that they are common and high placements further into elementary or complex divisions.
(esophagus or GEJ) can lead to serious com- With elementary partial seizures, the person’s
plications. The direct NEX distance, the consciousness is not impaired. With complex
insertion-length predictor currently used in partial seizures, there is some impairment of
practice, has been found to be inaccurate in consciousness. in some persons with partial
both adults and children. Both the Hanson seizures, the abnormal discharge spreads
(1979) method and the Ellett et al. (2005) throughout the brain and is referred to as a
regression equation using gender, weight, partial seizure with secondary generaliza-
and NU have been found to be more accu- tion. Generalized seizures occur when the
rate in adults for placing NG/OG tubes in discharge affects both brain hemispheres and
the stomach on insertion. Both NEMU in results in a loss of consciousness. The two
children of any size or ARHB in all chil- most common types of generalized seizures
dren except infants <44.5 cm in length have are generalized tonic clonic and absence. in
been found to be more accurate insertion- generalized tonic clonic seizures, the per-
length predictors for placing NG/OG tubes son typically stiffens all over in the tonic
in the stomach on insertion. Verifying cor- phase, has jerking movements of the arms
rect placement of the NG/OG tube by radio- and legs in the clonic phase, and is inconti-
graph on initial insertion and whenever the nent of urine. After the seizure, the person
tube is changed is recommended in children is commonly sleepy. in absence seizures,
(Ellett et al., 2005; Ellett et al., submitted; there are a few seconds of loss of conscious-
Ellett, Cohen, et al., in preparation). Because ness. The person generally stares blankly
none of the bedside methods are sufficiently and sometimes rotates the eyes upward. An
accurate when used alone, a combination of absence seizure begins and ends abruptly
assessing whether the tube insertion length (Dreifuss & Nordli, 2001). Epilepsy affects
has changed and assessing the color (gastric more than 2 million persons in the United
fluid is usually white, tan, colorless, or green) States. The cumulative incidence to age 80
and consistency (gastric fluid is usually years is 1.3% to 3.1%. incidence rates are high-
cloudy) of tube aspirate along with pH test- est among those younger than 20 years and
ing for interim monitoring of NG/OG tube older than 60 years. The trend is for the fre-
location is recommended. quency of epilepsy to be decreasing in chil-
dren and to be increasing in the elderly. Rates
Marsha L. Ellett are slightly higher for men than for women.