Skill 66

Seizure Precautions

The two basic types of seizures are partial (simple and complex) and generalized. In a simple seizure a patient does not lose consciousness. In a partial complex seizure a patient loses consciousness. Generalized seizures affect the whole brain and cause both nonconvulsive and convulsive seizures. Status epilepticus, characterized by prolonged seizures lasting more than 10 minutes or a series of seizures that occur in rapid succession over 30 minutes, is a medical emergency (Eliahu et al., 2008).

Your role as a nurse is to protect patients who have a seizure disorder from harm. The most immediate risks from a generalized seizure are traumatic injury and choking, requiring you to protect the patient physically and assist with airway management as needed. A generalized seizure lasts from 1 to 2 minutes. A cry, loss of consciousness, tonicity (muscle rigidity), clonicity (rhythmic muscle jerking), and incontinence are all characteristics. Following the seizure there is a postictal phase, which lasts for up to an hour.

During a seizure perform interventions to keep the patient’s airway open. Insert a bite block or an oral airway only when there is clear access for insertion, possibly after the seizure resolves and there is a need for airway support.

Delegation Considerations

The skill of assessing a patient on seizure precautions cannot be delegated to nursing assistive personnel (NAP). However, the skills for making a patient’s environment safe can be delegated. The nurse directs NAP by:

▪ Explaining the patient’s prior seizure history and factors that may trigger a seizure.

▪ Instructing to inform the registered nurse immediately when seizure activity develops.

▪ Explaining how to protect the patient in the event of a seizure.

▪ Emphasizing not to try to restrain the patient or place anything in the patient’s mouth during a seizure.