Seizure Management
Seizures are paroxysmal events associated with abnormal electrical discharges of neurons in the brain. Partial seizures are usually unilateral, involving a localized or focal area of the brain. Generalized seizures involve the entire brain. (See Differentiating among seizure types, page 642.) When a patient has a generalized seizure, nursing care aims to protect him from injury and prevent serious complications. Appropriate care also includes observation of seizure characteristics to help determine the area of the brain involved.
Patients considered at risk for seizures are those with a history of seizures and those with conditions that predispose them to seizures. These conditions include metabolic abnormalities, such as hypocalcemia and pyridoxine deficiency; brain tumors or other space-occupying lesions; infections, such as meningitis, encephalitis, and brain abscess; traumatic injury, especially if the dura mater was penetrated; ingestion of toxins, such as mercury, lead, or carbon monoxide; genetic abnormalities, such as tuberous sclerosis and phenylketonuria; perinatal injuries; and stroke. Patients at risk for seizures need precautionary measures to help prevent injury if a seizure occurs. (See Precautions for generalized seizures, page 643.)
Equipment
Oral airway ▪ suction equipment ▪ side rail pads ▪ seizure activity record ▪ IV catheter insertion equipment ▪ normal saline solution ▪ oxygen ▪ endotracheal intubation equipment.
Implementation
If you are with a patient when he experiences an aura, help him into bed, raise the side rails, and adjust the bed flat. If he’s away from his room, lower him to the floor and place a pillow, blanket, or other soft material under his head to keep it from hitting the floor.
Provide privacy, if possible.
Stay with the patient during the seizure, and be ready to intervene if complications such as airway obstruction develop.1 If necessary, have another staff member obtain the appropriate equipment and notify the doctor of the obstruction.
Nursing Alert
Depending on your facility’s policy, if the patient is in the beginning of the tonic phase of the seizure, you may insert an oral airway so his tongue doesn’t block his airway. If an oral airway isn’t available, don’t try to hold the patient’s mouth open or place your hands inside because you may be bitten. After the patient’s jaw becomes rigid, don’t force an airway into place because you may break his teeth or cause another injury. Turn the patient on his side to allow secretions to drain and the tongue to fall forward. Never force any objects into the patient’s mouth unless his airway is compromised.
Move hard or sharp objects out of the patient’s way and loosen his clothing.
Don’t forcibly restrain the patient or restrict his movements during the seizure because the force of the patient’s movements against restraints could cause muscle strain or even joint dislocation.
Continually assess the patient during the seizure. Observe the earliest signs and symptom, such as head or eye deviation, as well as how the seizure progresses, what form it takes, and how long it lasts. Your description may help determine the seizure’s type and cause.1
If this is the patient’s first seizure, notify the doctor immediately. If the patient has had seizures before, notify the doctor only if the seizure activity is prolonged or if the patient fails to regain consciousness. (See Understanding status epilepticus.)
If ordered, establish an IV catheter and infuse normal saline solution at a keep-vein-open rate.
If the seizure is prolonged and the patient becomes hypoxemic, administer oxygen as ordered. Some patients may require endotracheal intubation.
For a patient known to be diabetic, administer 50 mL of dextrose 50% in water by IV push as ordered. For a patient known to be an alcoholic, a 100-mg bolus of thiamine may be ordered to stop the seizure.
After the seizure, turn the patient on his side and apply suction if necessary to facilitate drainage of secretions and maintain a patent airway. Insert an oral airway if needed.
Check for injuries.
Reorient and reassure the patient as necessary.
Place side rail pads on the bed in case the patient experiences another seizure.
After the seizure, monitor vital signs and mental status every 15 to 20 minutes for 2 hours or according to your facility policy.
Ask the patient about his aura and activities preceding the seizure. The type of aura (auditory, visual, olfactory, gustatory, or somatic) helps pinpoint the site in the brain where the seizure originated.
Document the event.5
Understanding Status Epilepticus
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