http://nursingpub.com/nursing-care-for-seizures
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.
