05.03 Seizure Assessment

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Outline

Overview

  1. Assess for risk before, safety during, and changes in level of consciousness afterwards.

Nursing Points

Assessment

  1. Before Seizure
    1. Risk Factors
    2. Assess for medication compliance
    3. Assess for Aura
      1. Sensation that warns of impending seizure
      2. Different for every patient
        1. See colors
        2. Smell metal
        3. Feel tingly
  2. Assess and Document
    1. Type
    2. Onset
    3. Duration
    4. Complications
      1. Biting tongue
      2. Aspiration
      3. Injury
  3. Postictal State – period after seizure
    1. Memory loss
    2. Sleepiness
    3. Impaired speech
    4. Disorientation
    5. Agitation

Transcript

As a nurse, there are things you will need to assess for the patient before, during, and after a seizure. Let’s look at them closer.

The first thing we need to assess is whether the patient is at risk for seizures. We talked in the Causes lesson about what sorts of things can cause seizures. So if you get report and find out your patient had a stroke and now has a sodium level of 165, you know there’s some definite risk there, right? We’ll also assess for medication noncompliance – not having these meds at a therapeutic level can cause breakthrough seizures and even status epilepticus. And then, if this patient has a seizure disorder or has them often, they may be able to sense if one is coming because they get an aura. Auras are different for each patient, some will see lights or shapes like what you see here. Other patients will taste metal or feel tingly. Either way, if the patient has an aura, they can warn you that the seizure is coming.

Once a patient begins having a seizure, our number one priority is safety. That means protecting their airway, and keeping them free of injury. Many patients who have seizures may have difficulty breathing or could potentially aspirate during the seizure. We will talk about nursing interventions specifically in the nursing care lesson, however, part of your assessments during a seizure are to make sure that we prevent or quickly identify and treat these complications. We also want to make note of what time the seizure started and how long it lasts, as well as any events that occurred leading up to the seizure. This will help us to identify the cause and potentially reverse it.

After a generalized seizure, patients will enter what’s known as the postictal phase or the postictal state. Now, this typically doesn’t happen with focal seizures, although some patients may feel a bit dizzy afterwards. In the postictal phase, patients will be very drowsy, they may even take a few minutes to regain any sort of consciousness. They will not remember the seizure or what just happened. They tend to be disoriented and sometimes agitated because they’re confused and scared. Sometimes we even see slurred speech. This is one of the easiest ways to know if a patient had a true generalized seizure. If they wake up immediately and say “wow, I just had a seizure, that was a bad one!”….then there’s a possibility they could have been faking. Of course, patients don’t read the textbooks, right? But 99% of the time, patients enter this drowsy, disoriented postictal phase for a brief period of time after a generalized seizure. So we want to assess their level of consciousness and continue to keep them safe.

So let’s recap – before a patient even has a seizure, we want to assess risk factors, compliance with medications, and whether the patient might experience auras. During the seizure, we are focused on assessing for airway protection, breathing, and safety, as well as considering the events leading up to the seizure to determine the possible cause. And afterwards, we expect this postictal drowsy, confused phase, so we want to assess their LOC and maintain their safety.

So those are the major assessments for patients before, during, and after a seizure. Keep working through this module to learn about therapeutic management and specific nursing care for these patients. You guys are awesome! Let us know if you have any questions. Happy Nursing!