Seizure types
Classification affects observation and teaching.
During and after a seizure
Safety and observation are the nurse's main jobs.
| After the seizure | Rationale |
|---|---|
| Assess airway, breathing, oxygen saturation; suction if needed | Secretions and depressed consciousness |
| Keep side-lying; reorient gently | Postictal confusion and drowsiness are expected |
| Check for injury (tongue, head, limbs) | Falls and convulsive movements |
| Document onset, duration, movements, eyes, incontinence, and recovery | Helps classify the seizure |
Seizure precautions per policy: bed low, side rails padded if used, suction and oxygen at the bedside.
Status epilepticus
Prolonged seizures can cause brain injury and must be stopped quickly.
| Time | Treatment (as ordered) |
|---|---|
| 0–5 min | Airway, oxygen, glucose check, IV access, monitor |
| 5 min or more | Benzodiazepine: IV lorazepam, IM midazolam, or rectal diazepam |
| If seizures continue | Second-line IV drug: fosphenytoin, levetiracetam, or valproate |
| Refractory | Anesthetic agents with intubation in intensive care |
Check glucose early; hypoglycemia is a treatable cause of seizures.
Antiseizure medications and teaching
Monitoring and teaching prevent toxicity and breakthrough seizures.
- Febrile seizures: common between about 6 months and 5 years; most last under 15 minutes and resolve without lasting harm. Teach parents seizure first aid and when to call emergency services.
- Avoid triggers where known: sleep deprivation, alcohol, missed doses, flashing lights in photosensitive epilepsy.
NGN-style case
Timing decides the action.
functions Clinical judgment case — the seizure that will not stop
A client's generalized tonic-clonic seizure has lasted 6 minutes. SpO₂ is 88%. There is IV access. What should the nurse anticipate first?
- Recognize cues: seizure longer than 5 minutes; hypoxemia.
- Analyze: status epilepticus.
- Support airway with oxygen and side-lying position; call the rapid response team.
- Give IV lorazepam as ordered; prepare a second-line drug if seizures continue; check glucose.
Answer. Treat as status epilepticus: oxygen and airway support, call for help, and give an IV benzodiazepine as ordered.