This NCLEX study guide is aimed at nursing students for them to better understand seizures. This includes the definition of seizures, types, stages, medical management, and nursing interventions.
What Are Seizures?
Seizures happen when there is abnormal neuronal activity. It occurs suddenly and causes a disturbance within the brain. It may be caused by severe conditions like high fever, hypoglycemia, and other diseases that affect the nervous system. However, the seizures will stop once the condition is treated.
Epilepsy is a recurring seizure attack. It can be caused by chronic conditions like stroke and congenital brain defects. Seizures can happen to both children and adults. It can affect both sides or a specific side of the brain. The localized seizure is called a partial or focal seizure, while a generalized seizure affects the whole brain.
Types of Seizures
Generalized Seizure: Affects both sides of the brain
Tonic-clonic (Grand-Mal)
- Most common type
- May experience a warning sign before seizure attack (AURA, will be discussed below)
- At risk for injury because they tend to lose consciousness
- Experiences both tonic and clonic phase
- Tonic phase – body stiffening (may bite tongue and cheek), breathing stops (may show cyanosis)
- Clonic phase – recurrent jerking of extremities
- Attacks do not last more than three minutes
- immediate treatment needed if seizure duration is more than five minutes and happening one after another
- Post Ictus: patient can’t remember what happened, will feel exhausted, and muscle soreness that can last for hours or days
Absence Seizure (Petit-Mal)
- Commonly seen in pediatric patients
- The most common sign is a staring-like state
- The child will look like he is daydreaming but cannot snap out of it
- Attacks are short, only lasts for seconds
- Post Ictus: does not remember being spaced out
Atonic
- Drop-attacks
- Without muscle tone
- The patient suddenly drops or goes limp and falls
- They are more at risk for a head injury
- Not aware during the attack
- Post Ictus: recovers immediately and regains consciousness
Myoclonic
- A quick episode of muscle jerking
- The patient is conscious and usually aware
- It only lasts for a few seconds
Focal or Partial: only affects a specific site of the brain
Focal Onset Awareness
- Simple partial
- The patient is aware of their surrounding
- The symptom of the patient will depend on which part of the brain is affected
- It can be called an aura (happens before focal impaired awareness seizure)
Focal Impaired Awareness
- Motor symptoms
- Alters awareness of the patient
- Affect the temporal lobe most of the time
- Automatisms
- The patient is unaware of the action that they are doing
Stages of a Seizure Experience
Prodromal
- A period where symptoms start to appear before the seizure attack
- It may start days prior
- The mood change is the most common symptom
- The patient may feel depressed, have trouble sleeping, angry, anxious
- May also experience some urinary and gastrointestinal issues
Aura
- It is not present in all of the types of seizures
- It happens at the beginning of the focal or tonic-clonic seizure
- The patient may experience aura within seconds or minutes before the seizure attack
- It gives the patient awareness and preparedness for the seizure before it happens
- As a nurse present before the attack, lay your patient down on their side with a pillow under their head
- Symptoms vary in each patient. Here is the most common aura:
- deja vu feeling
- sudden weird taste or smell
- anxiety
- hallucination
- altered vision
- inability to speak
- dizziness
Ictus
- means seizure
- the actual duration of the seizure
- lasts between one to three minutes
- STATUS EPILEPTICUS – back-to-back seizures with a duration of more than five minutes. Status Epilepticus does not stop on its own and needs immediate medical attention.
Post Ictus
- the time where the brain rests after the episode
- may last from hours to a day (tonic-clonic)
- may be immediate for some patients
- patients will feel exhausted, confused, sleepy, or headaches
Nursing Interventions for Seizures
Before the seizure
The first thing to do is to assess risk factors for the seizure and then initiate a seizure precaution.
- Have oxygen and suction ready at the patient’s bedside
- IV access for anti-seizure medication if the patient needs it
- Pillow under the patient’s head
- Pad the side rails of the bed
- The bed should be in the lowest position
- Take away items that can cause injury to the patient
- eyeglasses
- tight clothing
Ask the patient for the history of seizure, what kind of seizure, and duration.
***if the patient can identify if they are experiencing a prodrome or aura, assist the patient in preparing for the coming seizure by laying them down on their side***
During a seizure
If the patient is standing up or sitting down, protect them by doing these:
- Let the patient lie down gently on his side. This will help the saliva or blood to drain from the mouth and will prevent the tongue from blocking the airways
- AVOID restraining the patient and do not hold them down
- Protect the patient’s head and extremities by placing a pillow or foam on their bedsides
- Do not place anything inside the patient’s mouth
- Remove items that can impede breathing or may break
What are the important questions you should be asking yourself while your patient is having a seizure?
- How long was the seizure?
- Take note of the time it started, and it stopped
- If it took longer than five minutes, another seizure may occur
- Modify the attending physician for status epilepticus
- What did the patient’s behavior before and during the seizure happen?
- Did the patient become confused or cried out loud?
- Was there any jerking or stiffness of the extremities?
- Describe the seizure in its every detail to help diagnose the right type of seizure the patient experienced
- Did the patient experience incontinence?
- Check if the patient passes urine or stool.
- Check oxygen saturation if the patient is showing cyanosis
After the seizure
The nurse’s role during post ictus is to check how the patient behaves after the attack.
- Check if there is any injury that they may have gotten during the seizure
- Maintain proper oxygenation
- Let them rest and sleep if they’re exhausted
- Clean the patient if there’s incontinence
- Document and report it to the MD
- Assess vitals and neurological status (reflexes, pupils, consciousness)
Medications for Seizure
The medication given to the patient is depending on the seizure type.
Barbiturates: Phenobarbital
- For tonic-clonic, focal, or status epilepticus
- Stimulates GABA receptors
- Side effects are ataxia and drowsiness
- May cause hypotension and respiratory depression
- 15-40 mcg/mL
Hydantoins: Phenytoin
- For tonic-clonic or focal seizures
- May cause gingival hyperplasia, bone marrow suppression
- Not given with antacids and milk
- 10-20 mcg/mL
Benzodiazepines
- for absence, focal, or tonic-clonic seizures
- A common side effect is drowsiness
Valproates
- all types of seizures
