What should a nurse do during a seizure?
Seizures occur when there is an uncontrolled burst of electrical activity in the brain that results in abnormalities in muscle control, sensations, and consciousness. Seizures can occur due to an array of conditions such as high fever, alcohol withdrawal, hyperglycemia/hypoglycemia, or brain tumors. These are one-time occurrences related to a specific cause. Show
Epilepsy is diagnosed when there are two or more unprovoked seizures. Epilepsy can occur at any age and is usually attributed to genetics, prenatal or perinatal causes resulting in brain damage, brain malformations, severe head injuries, and infections in the brain. There are different types of epilepsy with their own manifestations. There is no cure for epilepsy, though some children may outgrow the disorder and others may become seizure-free after years of treatment. The Nursing ProcessNurses may care for patients experiencing acute seizures in relation to a larger condition or traumatic injury or a patient who has had epilepsy for many years. In both instances, maintaining safety in the event of a seizure is the first priority. When learning a patient has a history or current diagnosis of seizures, seizure precautions should be implemented (bed in the lowest position, padded side rails). Long-term control of seizures requires education and strict adherence to a treatment plan which the nurse can encourage and support. Nursing Care Plans Related to SeizuresRisk For Injury Care PlanSeizures can result in a loss of awareness, consciousness, and voluntary control of the body increasing the risk of falls, injury, and trauma. Nursing Diagnosis: Risk For Injury Related to:
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not occurred yet and the goal of nursing interventions is aimed at prevention. Expected Outcomes:
Risk For Injury Assessment1. Explore seizure patterns. 2. Assess availability of family/caregiver. Risk For Injury Interventions1. Ensure a patent airway. 2. Remove hazardous items. 3. Do not restrain, monitor closely. 4. Instruct on activities that require additional precautions. 5. Encourage a medical alert bracelet or identification. Deficient Knowledge Care PlanA lack of knowledge regarding triggers, treatment, and prevention predisposes the patient to poor seizure control. Nursing Diagnosis: Deficient Knowledge Related to:
As evidenced by:
Expected Outcomes:
Deficient Knowledge Assessment1. Assess the patient’s knowledge of their seizure. 2. Assess the patient’s adherence to activity limitations. 3. Review adherence to medications. Deficient Knowledge Interventions1. Instruct on keeping a seizure diary. 2. Review potential triggers. 3. Help the patient to recognize warning signs. 4. Provide an action plan. Caregiver Role Strain Care PlanCaregiver role strain can result from caring for a child or family member struggling with epilepsy or as a caregiver who personally has epilepsy and is experiencing difficulty in juggling responsibilities with their disorder. What are the nursing care of patient during a seizure?Maintain in lying position, flat surface; turn head to side during seizure activity; loosen clothing from neck or chest and abdominal areas; suction as needed; supervise supplemental oxygen or bag ventilation as needed postictally.
What are the priorities of care for a patient during and after a seizure?The priorities when caring for a patient who is seizing are to maintain a patent airway, protect the patient from injury, provide care during and following the seizure and documenting the event in the health record. to pre-seizure level of consciousness.
What is the first action when a patient is having a seizure?Place something soft under their head and loosen any tight clothing. Reassure the person until they recover. Time the seizure, if you can. Gently roll the person onto their side after the jerking stops.
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