Table of Contents:

1. Pathophysiology & Assessment 4. Chronic Seizure Management

Seizures
1. Pathophysiology & Assessment
Seizure: Abnormal electrical activity
TABLE 1. SEIZURE ASSESSMENT
in the brain  Changes in behavior,
movement, sensation, and/or level of
Seizure Phase Description
consciousness
y Caused by epilepsy (recurrent
seizures) or underlying factors like Aural phase
Aura: Sensory change before seizures (e.g., strange
ICP (head injury), hyponatremia, (before seizure) sensations, smell) experienced by some clients

Neurologic
alcohol withdrawal, or fever
y Two main types of seizures: Ictal phase Tonic-Clonic (Grand Mal)
y Generalized: Affects entire brain (during seizure) y Loss of consciousness
and includes tonic-clonic (grand y Stiffening (tonic)
mal) and absence y Jerking (clonic)
y Focal (partial): Affects one y Cyanosis may occur.
specific area of the brain Absence
Assessment findings y Brief loss of awareness (staring) or “zones out”
y Vary depending on the seizure type Focal aware (simple partial)
(TABLE 1) y No loss of awareness
Diagnostics y Localized twitching may occur.
y Electroencephalogram (EEG): Focal impaired awareness (complex partial)
Identifies abnormal electrical brain y Altered awareness
activity y Repetitive movements (lip smacking)
y Metabolic panel (CMP, BMP):
Identifies possible causes (e.g.,
Postictal phase y Confusion, drowsiness, headache,
hypoglycemia, hyponatremia)
(after seizure) muscle soreness
y CT or MRI scan: Identifies
structural abnormalities

During seizure:
2. Acute Seizure Interventions
Place pillow under client’s head to prevent injury.
y #1 priority = prevent injury and maintain a
Place client in side-lying position to protect
patent airway. airway in case vomiting occurs.

Implement seizure precautions for at-risk clients y Do not restrain client; loosen tight clothing.
(alcohol withdrawal, hyponatremia) (FIGURE 1): y Remove objects around the client that could
y Pad and raise side rails. cause injury (bedside table).
y Keep suction and airway equipment at the bedside.
Never place anything in the client’s mouth
because it can cause aspiration.

Time seizure: Seizures lasting >5 min =
status epilepticus (medical emergency).

 Seizure precautions: Implement seizure  Safety during seizures: During seizures, time the
precautions for at-risk clients, including padding event, remove objects around the client, place
side rails and keeping suction equipment at the client in a side-lying position, and do not
the bedside. place objects in the client’s mouth.

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2. Acute Seizure Interventions, Continued
y After seizure:

Suction airway to remove FIGURE 1. SEIZURE PRECAUTIONS
secretions and prevent aspiration.
y Maintain client in side-lying
recovery position.
y Perform neurological assess-
ment (LOC).
y Check vitals and assess for injuries.
y Reorient client; promote rest.

3. Status Epilepticus
Status epilepticus is a life-threatening
emergency that occurs when seizures last
>5 min or if consecutive seizures occur

Neurologic
without regaining consciousness.
y Requires immediate intervention to
prevent hypoxia, hypoglycemia, and
hyperthermia.
Interventions

#1 priority = maintain airway patency.
y Prepare for possible intubation. 4. Chronic Seizure Management
y Administer oxygen via facemask to prevent hypoxia. y Medication adherence
y Closely monitor vital signs (heart rate, y Antiepileptic medications are used to prevent
oxygen saturation). seizures (TABLE 2).
y Administer medications to stop the seizure (TABLE 2):
Clients should not abruptly stop taking

First = IV benzodiazepines (diazepam, antiseizure medications, as this may trigger
lorazepam); repeat doses may be needed until status epilepticus.
seizure stops.
Regular blood draws are required to assess
y For clients without IV access, rectal drug levels.
anticonvulsants may be used. y Trigger management

Second = long-acting IV anticonvulsants y Avoid triggers like flashing lights, sleep
(phenytoin, fosphenytoin) deprivation, stress, and alcohol.
y Check blood glucose levels and administer IV y Encourage a consistent sleep schedule to
dextrose as needed;metabolic activity during fatigue-related seizures.
status epilepticus can cause hypoglycemia. y Promote stress reduction techniques like
relaxation exercises.

 Status epilepticus: Status epilepticus is a medical emergency defined as seizures lasting >5 minutes.
Priority interventions include maintaining airway patency and stopping the seizure with IV benzodiazepines
like lorazepam.

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4. Chronic Seizure Management, Continued 5. Anticonvulsant Medications

Safety promotion
y Wear a medical alert bracelet for rapid TABLE 2. ANTIEPILEPTIC DRUGS AT A GLANCE
identification in emergencies.
y Shower instead of taking tub baths to prevent Medication Considerations
drowning if a seizure occurs.

Never leave children alone while bathing. Benzodiazepines: y Risk for respiratory
y Avoid high-risk activities like swimming alone. Treatment depression: Avoid
y Children should wear helmets when for acute combining with other CNS
participating in sports. seizures (rescue depressants (opioids).
y Instruct family members on: medications)
y Appropriate actions during seizures (stay calm, lorazepam
protect the head, time the seizure) diazepam

When to seek emergency care (seizures lasting
>5 min, multiple seizures, or respiratory distress)

Neurologic
Anticonvulsants:
Risk for Stevens-Johnson
y Dietary considerations
Long-term Syndrome: Immediately
y For refractory seizures (drug-resistant), a
management notify HCP if rash occurs.
ketogenic diet (high-fat, low-carbohydrate) may
be prescribed. phenytoin Phenytoin
valproic acid y Only dilute with normal
carbamazepine saline.

Monitor therapeutic drug
levels.
y Can cause gingival
hyperplasia; teach good
oral care.
Valproic acid
y Monitor liver function and
platelet count.
Carbamazepine
y Avoid grapefruit juice as
it drug levels.

 Home safety: Wear a medical alert bracelet,  Antiepileptic safety: Clients taking antiepileptics
shower instead of tub bathing, and avoid should immediately report a rash due to the risk
swimming alone. of Stevens-Johnson Syndrome (SJS).

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  What two seizure precautions should be  Clients with a seizure history should wear a
implemented for at-risk clients? ______ for rapid identification, take ____ instead
of baths, and avoid swimming alone.
 What three interventions should the nurse
take during a seizure? What action should the  Why should clients taking antiepileptics report
nurse avoid? the appearance of a rash immediately?

 Status epilepticus is a medical emergency

Neurologic
Do not place objects in client’s mouth 3. 5; benzodiazepines 4. medical alert bracelet, showers 5. Risk of SJS
Answers: 1. Pad side rails and have suction equipment at bedside 2. Time the seizure, remove objects around client, place client in side-lying position;

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Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (Eds.). McKinney, E., Mau, K., Murray, S., James, S., Nelson, K., Ashwill,
(2023). Lewis’s medical-surgical nursing: Assessment and J., & Caroll, J. (2022). Maternal-child nursing (6th ed.).
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Hockenberry, M., Duffy, E.A., & Gibbs, K. (2024). Wong’s nursing Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
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