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Outline
Pathophysiology
Seizures are a very complex neurological issue. Here is the definition from Medscape of a seizure: “a seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation” (source). Basically, abnormal electrical discharges are occurring in the brain. There are different kinds of seizures (epileptic, focal-onset, general-onset).
Etiology
The exact cause of a seizure can be extremely difficult to pinpoint. John Hopkins Epilepsy Center divides seizures into two categories: provoked and unprovoked.
The etiology of provoked seizures can include: trauma, drugs or alcohol, tumors, medications, drug withdrawal, progressive brain disease, and more.
The etiology of unprovoked (or “natural”) seizures can include: fever, infection, metabolic issues, genetics, Alzheimer’s disease, and more. (Source link listed below)
Desired Outcome
Stop any current seizure activity as soon as possible, minimize damage, and prevent it from occurring in the future.
Seizures Nursing Care Plan
Subjective Data:
- Loss of awareness
- Confusion
- Pt may report aura before seizure
- A postictal state (drowsiness, nausea, vomiting, headache)
Objective Data:
- Rhythmic twitching
- Stiff contraction
- Loss of consciousness
- Staring off blankly
- Repetitive behavior (lip smacking, laughing)
Nursing Interventions and Rationales
- Initiate seizure precautions for patients at-risk for seizures.
- Suction set up and working
- Ambu-bag in room
- Padding side rails
- All side rails up
Seizures frequently happen without warning, therefore we must ensure safety in case it occurs. Once one begins, it’s too late to try to implement the safety precautions
- Maintain airway
During a seizure, the patient may not be able to maintain their own airway, or they may not be able to handle their oral secretions and aspirate.
- Maintain safety during any seizure activity
- Turn pt to side
- NOTHING in mouth
- Do NOT restrain
- Patients may be vomit during a seizure, therefore turning them to their side can help to prevent aspiration (in addition to having suction available).
- Putting things in the mouth can cause the patient injury as they tend to clench their teeth during seizures
- Restraining the patient may cause injury because of the unpredictable muscle movements
- Assess, monitor and document seizure activity
It is essential to know the precipitating factors, what actually happened during the seizure (rhythmic twitching and specific location) and the specific timing (30 seconds vs. 2 minutes vs. 6 minutes) – you must be as specific as possible to enable the medical team to make appropriate clinical decisions.
- Administer antiepileptics (PRN and scheduled) medications per orders
Many patients with seizures, or who are at-risk will have schedule antiepileptic medications. They must receive these promptly, as ordered. Also be aware of your PRN antiepileptics and when to administer them (typically for seizures lasting longer than 2 minutes)
- Reevaluate any medications that may lower the seizure threshold (some antibiotics, antidepressants, narcotics, and many more may do this)
We want to do all we can to prevent seizures from occurring, therefore the healthcare team must evaluate meds that may increase the seizure risk and closely look at them to decide if the benefit is worth the risk, or if an alternative is available that does not lower the seizure threshold
- Educate patient and family on hospital procedures, and when to notify staff
Some patients with a history of seizures can tell when one is coming on, which is helpful to communicate to the nurse. Also, it’s helpful to let them know what you as the nurse will do when/if a seizure occurs so that they are prepared mentally and emotionally, as it can be somewhat scary for families to witness and patients to experience.
- Provide emotional support
Seizures are serious and upsetting to witness. The more empathy and support you can provide patients and loved ones, the better.
- Help the patient develop a seizure action plan for after discharge
The patient and family need to know what to do should a seizure occur at home. Not all seizures are emergencies. They should know what to do to keep the patient safe and when to call 911:
- Cyanosis or not breathing
- Back to back seizures
- Seizure lasting > 5 minutes
References
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