Pathophysiology: This can be caused by many problems but seizures happen because there is an abnormal electrical activity happening in the brain. This causes the seizure. It can be brought on for many reasons such as meningitis, brain injury, or high blood pressure.
- Top priorities
- Airway protection
- Medication compliance
- Give all medications on time
- Seizure precautions if at risk
- Verify order of PRN Ativan dosing and ensure that medication is readily available
- Maintain patent airway
- Turn client to side in case of vomit
- Have O2 and suction equipment available
- DO NOT force anything into the mouth during the seizure (including bite block)
- Protect from injury
- Bed to the lowest position
- Padded side rails
- Loosen restrictive clothing
- DO NOT try to restrain client
- Notify MD of type, onset, duration
- Maintain patent airway
- Keep safe while Postictal
- Preceding events
- Type & Duration
- Postictal events
- Educate patient and family on importance of medication compliance
- Educate family on care & safety during seizure
- Educate family on when to call 911
- Help patient develop plan of action for when they get an aura
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell
Okay, so now that we know what seizures are, what causes them, and how we assess and treat them medically, let’s talk nursing care. A lot of this we probably already mentioned or is going to be common sense based on what we’ve talked about, but we’re bringing it full circle here.
So…before a patient has a seizure we’re focused on two things – PREVENTION and PROTECTION. So one big thing we need to do is make sure we’re giving their medications as scheduled and on time. They have relatively narrow therapeutic windows so this becomes really important. If we know the patient is at risk, we put them on seizure precautions. So…what are seizure precautions – well, we put the bed in the lowest position, we pad the side rails with pillows, blankets, or they even make pads specifically designed for this. And we always keep suction and oxygen at the bedside just in case. Also – it’s important that you have a standing order for PRN Ativan if you know your patient is at risk for seizures. This will save precious time trying to call the doctor for the order and waiting for pharmacy to approve it.
When the patient does have a seizure, you want to turn them to their side and have suction ready in case they vomit, we need to prevent aspiration. Make sure you call for help because you won’t be able to do everything by yourself. If you can, monitor their SpO2 levels and give oxygen as needed. We’ll use a mask and just hold it near their face – we shouldn’t be trying to forcefully hold their head to apply a nasal cannula or put the elastic around. As long as they’re breathing, just having the mask by their face will help. We do NOT put ANYTHING in their mouth. In the old days they used to try to put a bite block in to prevent patients from biting their tongues, but now it shows it just does more harm than good. So we’re confident they have a patient airway, and we also want to protect them from injury. We want to put the bed low and pad the side rails if it isn’t already. When patients are seizing, they can have big clonic jerks and could hit the side rails. If they have on restricting clothing like a tight jacket, we’ll loosen it so that it doesn’t get pulled too tight and we do NOT restrain the patient. We simply protect their head, protect their airway, and wait for it to be over. Now, while all of this is happening – someone needs to call the provider and someone needs to get and push the Ativan – usually I will call the charge nurse to help me. Don’t try to handle this on your own if you don’t have to.
Once the seizure is over and the patient is stable, we need to continue paying attention to safety. Remember they’re going to be delirious and may only be semi-conscious. So we need to monitor their LOC and oxygenation until they’re fully awake again. As far as documentation, you’ll document the onset and duration times as well as any events leading up to the seizure. Maybe they had just had a large bowel movement or drank a cold glass of ice water. We’ll document what type of seizure it was – so tonic, tonic clonic, absence, etc. Then we want to document vitals and any events that happen during the postictal phase. Did you apply oxygen? Suction their mouth? Did they vomit? All of that needs to be documented. Then, of course, if you gave any medications.
The most important things for patient education, if you haven’t picked up on it already, are medication compliance and safety during seizures. We can help them set up a pill organizer and get a calendar to remember their pills. We also want to make sure they have an action plan as a family for their seizures and know when to call 911. For someone who has seizures regularly, not every seizure is an emergency. If they begin to turn blue or have excessive vomiting, or if it lasts longer than 5 minutes with no relief with medications, they need to call 911. If they begin having back-to-back seizures or are injured during it, that would also be a reason to call for help.
Of course our top priorities are intracranial regulation – remember something is going on in their brain that is causing this seizure to happen – and safety. Think airway protection and injury prevention.
So again, before a seizure we’re focused on prevention and protection. During a seizure we’re worried about airway protection and injury prevention while we work to stop the seizure. Afterwards we continue to focus on safety and we document everything in detail. Then make sure your patient is educated about medication compliance and that they have a seizure action plan for when they go home.
So that wraps it up for seizures, we hope you guys will feel comfortable and ready when you have a patient who has a seizure. Make sure you check out the care plan and case study attached to this lesson to learn more. Let us know if you have any questions! Now, go out and be your best selves today! And, as always, happy nursing!