I was given an opportunity to create a learning presentation for nurses in a place that I work part time about seizures. This topic is exciting to tackle as I have seen seizures and nurses sometimes tend to be overwhelmed.

I hope you will enjoy the lesson that I presented.

SEUZURES

Objectives:

1.  Define a seizure

2.  Differentiate a seizure from epilepsy

3.  Be able to differentiate types of seizures

4.  Review Causes of Seizures

5.  Review nursing responsibilities and priorities during a seizure

What is a seizure?

A seizure is an episode of abnormal electrical activity in the brain. A seizure, just like headache, is a symptom rather than a disease.

What is epilepsy?

Epilepsy is a diagnosis given when a person has two or more unprovoked seizures.

Difference between seizure and epilepsy:

All people with epilepsy have seizures but not all people with seizures have epilepsy. A seizure is a symptom of an underlying condition. Epilepsy is a clinical diagnosis assigned to a patient having more than two unprovoked seizures.

Types of Seizures:

There are two main categories of seizures: –

1.      Generalized Seizures

a.       Tonic Clonic Seizures (Grand mal)

b.      Absence Seizures (Petit mal)

2.      Partial Seizures.

a.       Simple partial

b.      Complex partial

Tonic Clonic Seizures (Grand mal)

Signs and symptoms:

1.      Sudden loss of consciousness

2.      Muscle rigidity and stiffening

3.      Jerking movements

4.      Shrill cry

5.      Incontinence

6.      Apnea (pt may turn blue)

7.      Dilated Pupils

Absence seizures

Signs and symptoms

1.      Sudden behavioral arrest

2.      Staring

3.      Unresponsiveness

4.      Only last for 1-15 seconds

Simple partial seizures:

Signs and symptoms

1.      No alteration or loss of consciousness

2.      There could subjective symptoms reported by the patients in absence of objective signs (smell, sound, taste or visual perception)

3.      Pt remains awake and aware, sometimes unable to communicate until the seizure is over

Complex Partial Seizures:

Signs and symptoms

1.      Alteration of consciousness (Not complete loss of consciousness)

2.      Automatisms: Simple repetitive uncontrollable actions performed during the seizure.

a.       Lip smacking

b.      Chewing

c.       Picking at clothes, etc

3.      Patient has no awareness of what they are doing

4.      Patient cannot remember what happened

5.      This is the most common seizure by those diagnosed with epilepsy.

Causes of seizures:

1.      Trauma

2.      Drug overdose

3.      Alcohol or drug withdrawal

4.      Non-compliance of anti-epileptic medications

5.       Stroke

6.      Febrile

7.      Intracranial processes and increase in intracranial pressure. E.g. tumors. A seizure occurring in an adult without any obvious underlying cause like alcohol, etc should be evaluated for brain cancer.

8.      Infections. E.g. Meningitis

9.      Metabolic and electrolyte imbalance. E.g. Uremia and Hyponatremia

Nursing Responsibilities and Priorities During Seizures.

What Do I do?

1.      Remain calm. This is your strength during any medical emergency. Make it an active process and tell your self: “I need to remain calm to help the situation and avoid causing errors, accidents or downright malpractice”.

2.      Mark the seizure start time.

3.      If a patient is standing, lay them to the ground and roll them to the side

4.      If the patient is in bed, roll them to the side;

5.      The patient can never swallow their tongue. Never place anything in patient mouth or try to open their mouth. This can compromise the airway or cause more harm to the patient.

6.      Never hold the patient down or try to stop their movements. This can cause injury to the patient. Instead, protect the patient from hitting hard surfaces with soft puddings like pillows.

Priorities

ABC assessments

1.      By rolling the patient to the sides, you may achieve a patent airway.

2.      Administer 100% oxygen

3.      Check oxygen saturation. It may be below 90 due to apnea. The patient may turn blue on the lips and fingers. Do not panic!

4.      Patient will have oral secretions. Suction at bedside to keep the airway patent.

5.      If help is available, establish an IV- line for possible IV medication administration if the seizure continues for a long time (Status epilepticus). You do not have to have a physician order to start an IV line in this case.

Safety:

1.      Do not run or panic. You may become a victim of the circumstance.

2.      Put the side rails up to prevent falls

3.      Pad the bed of any patient expected to get seizures. Injuries caused by unpadded bed can count against you.

4.      Your drug of choice during seizure is Ativan IV push.

Test.

1.      You are taking care of a patient with history of seizures. A nursing assistance calls you to the room and you find the patient having seizures. You should do all of the following except.

a.       Remain calm

b.      Roll the patient to the side

c.       Ask the nursing assistant to hold down the patient while you try to open their mouth

d.      Monitor oxygen saturation

2.      You are passing medication in a psychiatric unit and Mr. Crazy is sited quietly staring at you. You notice Mr. Crazy smacking his lips and making repetitive hands movements as if he is wiping the table. This goes on for a while and then stops. Mr Crazy cannot remember anything about the occurrence. What type of seizures did Mr. Crazy has?

a.       Simple partial seizures

b.      Grand mal Seizures

c.       Complex partial seizures

d.      Alcohol seizures.

3.      The drug of choice during a seizure activity is_____________.

a.       Methadone IV Push

b.      Morphine IV Push

c.       Lorazepam IV Push

d.      Dilantin IV Push

4.      The following are causes of seizures expect?

a.       Alcohol or drug withdrawal

b.      Infections like meningitis

c.       Toothache

d.      Trauma

5.      What is the first thing you should do as soon as notice a patient is having grand mal seizures?

a.       Note the time the seizure started

b.      Run down the hall and get the crash cart

c.       Administer IV Ativan per PRN orders

d.      Call 911

6.      What is the therapeutic level for dilantin that you must monitor on patients taking this medication? (Nurses only)

a.       1-5 ug/ml

b.      5-10 ug/ml

c.       10-20 ug/ml

a.       20-40 ug/ml

All patients with epilepsy have _______________ but not all patients with _________ have epilepsy.

Updates on Nursing Care of Patient with Seizure & Epilepsy:

Assessment

Risk Factors

◯ Genetic predisposition – Absence seizures are more common in children and tend to occur in families.

◯ Acute febrile state – particularly among infants and children younger than the age of 2 years

◯ Head trauma – May be early or late onset (up to 9 months) and incidence is increased when the head trauma includes a skull fracture.

◯ Cerebral edema – especially when it occurs acutely and seizure activity tends to disappear when the edema is successfully treated

◯ Abrupt cessation of antiepileptic drugs (AEDs) – as a rebound activity

◯ Infection – if intracranial, a result of increased intracranial pressure; if systemic, a result of the persistent febrile state

◯ Metabolic disorder – a result of insufficient or excessive chemicals within the brain such as occurs with hypoglycemia or hyponatremia

◯ Exposure to toxins – especially those associated with pesticides, carbon monoxide, and lead poisoning

◯ Brain tumor – if benign, seizures caused by the increased bulk associated with the tumor; if malignant, associated with the ability of the brain tissue to function

◯ Hypoxia – results in a decreased oxygen level of the brain; necessary for neuronal activity

◯ Acute drug and alcohol withdrawal – dehydration that accompanies withdrawal, creating a toxic level of the drug in the body

◯ Fluid and electrolyte imbalances – results in abnormal levels of nutrients required for neuronal function

Subjective and Objective Data

Generalized seizure

•  A generalized seizure is also called a tonic-clonic seizure (previously referred to as a grand mal seizure).
• It may begin with an aura (alteration in vision, smell, hearing, or emotional feeling).
• A generalized seizure begins for only a few seconds with a tonic episode (stiffening of muscles) and loss of consciousness.
• A 1- to 2-min clonic episode (rhythmic jerking of the extremities) follows the tonic episode.
• Breathing may stop during the tonic phase and become irregular during the clonic phase.
• Cyanosis can accompany breathing irregularities.
• Biting of the cheek or tongue can occur during clonic phase.
• Incontinence can also accompany a seizure.
• During the postictal phase, a period of confusion and sleepiness follows the seizure.
• Tonic seizure
  • During a seizure, only the tonic phase is experienced.
  • The seizure usually lasts 30 seconds to several minutes.
  • A loss of consciousness occurs.
  • This type of seizure is much less common than a tonic-clonic seizure.
• Clonic seizure
  • Only the clonic phase is experienced.
  • The seizure lasts several minutes.
  • During this type of seizure, the muscles contract and relax.
  • This type of seizure is much less common than a tonic-clonic seizure.
• Absence seizure
  • Absence seizures are most common in children.
  • The seizure consists of a loss of consciousness lasting a few seconds.
  • This type of seizure is associated with blank staring.
  • Seizure activity also may include unconscious, involuntary behavior associated with eye fluttering, smacking of the lips, and picking at clothes called automatisms.
  • Baseline neurological function is resumed after seizures, with no apparent sequelae.
• Myoclonic seizure
  • Myoclonic seizures consist of brief jerking or stiffening of the extremities, which may be symmetrical or asymmetrical.
  • This type of seizure lasts for seconds.
• Atonic or akinetic seizure
  • Atonic or akinetic seizures are characterized by a few seconds in which muscle tone is lost.
  • The seizure is followed by a period of confusion.
  • The loss of muscle tone frequently results in falling.
• Partial or focal/local seizure
  • Complex partial seizure
    •  Complex partial seizures have associated automatisms (behaviors that the client is unaware of, such as lip smacking or picking at clothes).
    • The seizure can cause a loss of consciousness for several minutes.
    • Amnesia may occur immediately prior to and after the seizure.
  • Simple partial seizures
    • Consciousness is maintained throughout simple partial seizures.
    • Seizure activity may consist of unusual sensations, a sense of déjà vu, autonomic abnormalities, such as changes in heart rate and abnormal flushing, unilateral abnormal extremity movements, pain or offensive smell.

 During a seizure:

• Protect the client’s privacy and the client from injury (move furniture away, hold head in lap if on the floor).
• Position client to provide a patent airway.
• Be prepared to suction oral secretions.
• Turn the client to the side to decrease the risk of aspiration.
• Loosen restrictive clothing.
• Do not attempt to restrain the client.
• Do not attempt to open jaw or insert airway during seizure activity (may damage teeth, lips, and tongue). Do not use padded tongue blades.
• Document onset and duration of seizure and client findings/observations prior to, during, and following the seizure (level of consciousness, apnea, cyanosis, motor activity, incontinence).

Post seizure:

• The postictal phase of the seizure episode.
• Maintain the client in a side-lying position to prevent aspiration and to facilitate drainage of oral secretions.
• Check vital signs.
• Assess for injuries.
• Perform neurological checks.
• Allow the client to rest if necessary.
• Reorient and calm the client (may be agitated or confused).
• Institute seizure precautions including placing the bed in the lowest position and padding the side rails to prevent future injury.
• Determine if client experienced an aura, which can possibly indicate the origin of seizure in the brain.
• Try to determine possible trigger (fatigue).