Seizure or fainting?? Assessment question

besaangel, ASN, BSN, MSN, CNA, RN, APRN, NP · Oct 7, 2013

I was called down to a classroom for a 17 y/o student who had lost consciousness in her 1st period class - she had fallen out of her chair and hit her head on the floor too. The student stated they thought she may have had a seizure. no hx of prior seizures or of fainting. Student reports an aura before incident. She did not eat breakfast, had worked out before school, and reports feeling shaky and "weird" right before. Hearing did not change, did not see spots. She ate a granola bar a couple mins before it happening d/t "feeling weird" and had been about to ask to go to the nurse. She had acute memory loss before and after the incident and couldn't remember what happened - one minute she was at the computer, the next on the floor feeling scared, head hurting, crying. States she has a vague memory of feeling like she had moved, which is why she thought she had a seizure. Teacher came down to get me in a panic thinking she had had a seizure. VS normal, all neuro checks normal, behavior normal within 5 mins after incident (when i got down there). And fyi probably not pregnant (she's in a lesbian relationship). Was okay down in my office. Dad came and picked up.
My health aide and the student's mom seem to think she just fainted because of working out/not eating. Teachers and student thought it might have been a seizure. I have no idea really. Dad was taking her to the dr but mom said she didn't think she really had to go.
Is there any way to assess to clue you in on if someone had a seizure or "just" fainted?

I havent started Clinical's but I have a few friends who get the "silent" seizures. The biggest clue IMHO is that they have a blank stare while it happens, are unusually unresponsive during this time although it seems they are "normal", most do not convulse and there is usually a drop in Bp right before. If she has a history of seizures then that's a clue. They also tend to ask if they had a seizure.

Once again, only exp has taught me that the added stress could have triggered it. But I am not a nurse and have no proof so I am just speculating based on my exp. she can see a neurologist so they can test this assumption. All the best

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fetch, BSN, RN · Oct 7, 2013

It sounds like everything you assessed could go either way. The best thing for the student is to see a doctor about it, monitor for any future episodes, and make sure she knows to eat before working out next time.

NutmeggeRN, BSN · Oct 7, 2013

It could be any number of things: syncopal epeisode, extreme reaction to menses, dehydration, new onset of epilepsy. She definitely needs to be followed up. Most likely I would have called EMS due to the unknown etiology and the hit to the head as well as the ? seizure activity (reported movement). Not my (or your) place to whether or not a seizure. That is what the follow up is for.

momRNmy · Oct 15, 2013

Hypoglycemia is the first thing that popped in my mind. Not only did the student not eat breakfast, but she also worked out, further depleting her blood glucose. Was she diaphoretic? The fact that she felt the urge to eat something 2/2 not feeling normal just prior to the episode could be a major cue in diagnosing an episode of low blood sugar. If a seizure is suspected, a finger stick is one of the first things to assess as a seizure or altered mental status is a common finding in blood sugars below 30. And the fact that she wasn't necessarily postictal when you arrived might only be related to the rise in blood glucose following the granola bar. Does your school have a glucometer on hand? If not, it might be something to consider. In the meantime, definitely reiterating the importance of eating to your students is definitely an important nursing intervention:)

Nurse ABC · Oct 16, 2013

Definately sounds like fainting. I would've called the parent and said do you want me to call EMS or do you want to take her to the ER? Most likely hypoglycemia. We have spare glucometers but we are only allowed to use them on diabetics who have a dr's order for blood glucose testing so be careful who you stick! Seizures can be tricky but what besangel said is what can happen but not always. Fainting they come too pretty quickly and are more with it. Seizures they are usually zapped and sort of out of it and very sleepy for a while afterwards but to different degrees depending on the kid and type of seizure and not always. It's not up to you to diagnose what's going on anyway, you're job is to determine if the student can stay in school, needs to go home, or see dr. Leave the diagnosing up to the dr's.

RNlove17 · Oct 22, 2013

I don't have anything to finger stick with! The only supplies I even have are for a student with Type I and they're his personal supply. There have been multiple times where I have wanted to test a kid but can't. Also I have no standing orders to do it. So juice and crackers and see how they do, then call mom/dad who can take them home or to the dr if they choose. That's a frustrating part of school nursing - if at the hospital I could easily test people like that, not so in the schools. And when I followed up the next day, apparently the doctors weren't sure what happened either, so she remains a mystery. I do think it was probably hypoglycemia but just my hypothesis.

KelRN215, BSN, RN · Oct 24, 2013

There's no way to tell if you didn't witness it. It sounds more like syncope related to hypoglycemia to me. I was a neuro nurse first. What did the teacher witness that led her to believe this may have been a seizure? The child needs to see a neurologist and have an EEG.