A registered nurse (RN), licensed practical nurse (LPN), or unlicensed assistive personnel (UAP) may institute seizure precautions. An RN is responsible for closely monitoring the child’s respiratory, circulatory, and neurologic status, assessing the cause of a seizure, determining and implementing measures to prevent and manage seizure activity, and documenting seizure activity. The RN also calculates weight-appropriate dosages for emergency seizure medications.
Seizure precautions are implemented for children with
Known seizure disorder
History of seizure in the last 6 months (Chart 99-1)
New onset of seizures
Known risk for seizures from head trauma, severe electrolyte imbalance, or drug overdose
Seizure precautions are implemented for the first 24 hours post procedure or post surgery on all children with a past history of seizures if the current surgery requires the use of general anesthesia, narcotics, or bowel-cleansing preparations.
Most breakthrough seizures occur as a result of missed seizure medications. Therefore, children whose diet status is nothing by mouth (NPO) should have the order written as “NPO, except for seizure medications.” If the prescriber prefers nothing to be administered by mouth, the IV route should be ordered for medications.
Bed pads
Bedside oxygen delivery equipment, including oxygen source, flowmeter, and bag-mask (size appropriate) (see Chapter 80)
Suction apparatus and suction catheters
Pulse oximeter (see Chapter 94)
Cardiac/apnea monitor (see Chapter 24)
Seizure record
Vital sign equipment (e.g., stethoscope, thermometer, blood pressure cuff) (see Chapters 119, 120, 122, and 123)
Blood glucose monitor equipment (as ordered) (see Chapter 20)
Completed emergency medication list
Assess the child’s perinatal development and birth history.
Assess the child’s seizure history, including the following:
Type of seizures (obtain detailed description)
Typical frequency of seizures
Description of events before, during, and after seizure activity (i.e., Does the child experience long periods of apnea during or after the seizure? Does the child’s face change in color?)
Typical length of seizure events and at what point the seizure is treated
Auras that the child experiences before seizures
Assess the child’s and family’s understanding of seizures; address any concerns or questions.
Assess the child’s and family’s understanding of current antiepileptic medications, including purpose, side effects, and importance of adherence to medication regimen; address any concerns or questions.
Assess understanding of daily antiepileptic medications versus “rescue” medications to stop a seizure
Explain to the child and family why seizure precautions are necessary, using developmentally appropriate language (e.g., “The pad on the railing is soft, so you won’t hurt yourself if you bump it”).
Instruct the child and family to inform the nursing staff if the child senses an aura or exhibits any seizure activity.
CHART 99-1 Seizure: The Risk of Recurrence
The highest recurrence risk after the first unprovoked seizure is in the first year at approximately 40%.
The rate of recurrence decreases dramatically beyond the first seizure-free year after a first unprovoked seizure. The probability for recurrent seizures in children with a first unprovoked seizure plateaus at approximately 60% after 2-3 years.
The recurrence rate at 2 years varies by neurologic history. Only about one third of the children with previously normal cognition and motor function and no prior neurologic injury will have had a seizure recurrence after 2 years. However, in children with previously abnormal cognition or motor function, it is found that about two thirds of them will have had a seizure recurrence after 2 years.
Almost 90% of children whose seizures recur do so within 2 years of the initial event.
The initial assessment and history for a first unprovoked seizure are crucial in determining baseline functioning and the diagnostic modalities selected. Focal onset seizures and seizures associated with new persistent focal deficits are more likely to be caused by intracranial lesions (tumor, stroke, abscess, and vascular malformation).
PROCEDURERoom Preparation
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KidKare If available, use colorfully decorated, child-friendly pads to help decrease the child’s anxiety.
Emergency intubation may be necessary after a seizure to maintain the child’s airway.
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