Seizure | Nursing Diagnosis, Care Plans, and More

Approximately 1 in every 100 US adults has had at least one unprovoked seizure in their lifetime or was diagnosed with epilepsy. A seizure occurs when there is abnormal electrical activity in the brain and can cause physical symptoms and changes in awareness, behavior, and emotions, depending on which part of the brain is affected.

While most seizures don't cause severe or long-term side effects, it's important to note that untreated seizures can be life-threatening. Therefore, seizure care must be swift, accurate, and safety-focused. 

As a nurse, you must develop a seizure nursing diagnosis care plan tailored to your patient's specific needs to address and prevent seizure activity. In addition, the care plan should educate patients on what to do before and after a seizure, how to minimize triggers and cover all prescribed medical modalities. This guide will teach you some seizure nursing diagnoses and interventions you can include in your care plans for patients with seizures.

Signs and Symptoms of Seizure

The first step healthcare providers take to diagnose a seizure disorder is identifying the signs and symptoms. Depending on the situation, many patients will experience seizures at home and may even seek emergent medical care. Others will be in a care setting when the seizure happens. 

In both of the above scenarios, it's critical the physician and other healthcare providers receive an accurate description of what happened during the seizure activity to make the diagnosis. This information must often come from family, friends, or other witnesses because the patient might not remember anything from a few minutes before the seizure begins until a short time after it stops. 

Signs of seizures can include:

• Loss of consciousness
• Uncontrollable movements, such as jerking or shaking
• Confusion
• Dazed expressions on the face
• Difficulty breathing
• Bladder incontinence

It's critical to know that the symptoms may vary from seizure to seizure in the same patient and from one type to another. Because of this, be sure to report any symptoms consistent with a seizure for further diagnosis by a physician. 

Types of Seizures

Understanding the pathophysiology of seizures is crucial to care. It's helpful to be familiar with the different types of seizures when making a seizure nursing diagnosis care plan. Furthermore, understanding the different seizure types will help you identify seizure triggers and have a better chance of preventing a seizure from happening. 

Below are the most common seizure types.

Generalized Seizure

This seizure type affects both sides of the brain and is mainly characterized by loss of consciousness or convulsions. There are two types of generalized seizures: tonic-clonic (formerly known as grand mal or convulsive) and absence (formerly known as petit mal).

A person with a tonic-clonic seizure may suddenly fall, and their body stiffens. Jerking motions follow in rapid succession. Finally, the individual may lose consciousness or cry out. They may experience confusion or altered consciousness for up to 30 minutes following the seizure. This period is called a postictal state. 

A person with an absence seizure may experience staring spells and small muscle twitches, such as rapid blinking, lip smacking, or eyelid fluttering. They may or may not lose consciousness or awareness. This type of seizure can be mistaken for daydreaming because the seizure activity is short, usually lasting 15 seconds or less. Absence seizures resolve independently, but the patient might not remember what happened during that period. 

Focal Seizure

A focal seizure, also called a partial seizure, affects one part of the brain and tends to be less severe than a generalized seizure. Where in the brain the seizure happens dictates the symptoms, so it's critical to know that two patients having a focal seizure may have seizures that look quite different.

There are three categories of focal seizures:

• Simple focal seizure -  the patient experiences momentary changes in motor or sensory functions, such as losing their sense of smell or taste without loss of consciousness
• Complex focal seizure - the patient experiences repetitive movements known as automatisms and impaired consciousness and may or may not remember details of the seizure
• Secondary generalized seizure - the patient experiences a seizure that begins in one part of the brain but moves to another, eventually turning into a generalized seizure 

At-Risk Populations

Anyone, regardless of gender and age, can develop seizures. Nonetheless, some individuals are more prone to them than others.

For example, pediatric patients and people over 55 are at an increased risk of seizure disorders. Other groups that may be at a high risk of seizures include individuals with:

• A brain tumor
• A brain injury related to head trauma
• Certain genetic conditions or neurological disorders
• A family history of seizure disorders
• Dementia
• A history of prolonged drug use
• A history of stroke
• Acute infection and high fever

Changes inside or outside the body often trigger seizures. Therefore, it's essential to know the most common triggers to reduce the likelihood of a patient with a seizure disorder having another seizure. 

Common triggers include:

• Dehydration
• Fevers, especially in pediatric patients
• Sleep deprivation
• Menstrual cycle
• Loud music
• Flickering lights
• Severe hypoglycemia

Treatments

There is a range of seizure treatment options based on seizure type. Below is an overview of the most common treatments. Of course, treatments must be individualized to the patient and the underlying cause of the seizure disorder to be most effective.

Medication

Anti-seizure medications are the first line of seizure treatment and can help control seizure activity. These include benzodiazepines and antiepileptic drugs, which either stop the seizure from occurring or decrease its duration and severity. However, as with any medications, drugs to treat seizures can have side effects, so be sure to monitor for and report any new complaints by the patient. 

Some of the most common drugs used to treat seizures include:

• Phenytoin (Dilantin)
• Lamotrigine (Lamictal) 
• Levetiracetam (Keppra, Spritam)
• Carbamazepine (Tegretol)
• Topiramate (Topamax)
• Lorazepam (Ativan)

Surgery

Surgery may be recommended to remove structural abnormalities that cause seizures. This treatment is most effective if the seizures always originate in the same part of the brain. Surgery isn't a first-line treatment but may be used when medications fail to control the seizures. 

Surgery may also help to identify and treat tumors or lesions that cause seizures. Physicians may perform the following types of surgeries to treat seizure disorders, including:

• Thermal ablation
• Lobectomy
• Hemispherectomy
• Corpus callosotomy

Electrical Stimulation

Electrical stimulation may be an effective treatment for seizures with one area of origin that a physician can't safely remove through surgical intervention. Several types of electrical stimulation devices can be used, depending on the type of seizures the patient experiences. These types include vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation.

Nurse's Role in Caring For Seizure Patients

As a nurse, seizure prevention and management are integral to your practice. You must thoroughly understand seizure types, risk factors, triggers, and treatments to care for seizure patients properly. In addition, educating the patient and their family about seizure precautions and prevention strategies they can utilize at home is also critical.

If you work in a pediatric institution or a community setting where you see pediatric patients, you'll play a unique role when caring for those with seizures. Not only will you care for the patient, but you'll also need to educate and support the parents and other family members who may be scared and stressed with worries about their child's health. 

Nursing Protocols For Seizures

Knowing and understanding your facility's seizure protocols is essential. Always work fast to secure a safe environment and monitor the patient during the seizure. Call for assistance from the nursing team and others as needed. 

General nursing interventions you can use to ensure safety include:

• Assist the patient to the floor if they are standing or sitting when the seizure happens to ensure safety
• Place a pillow under their head for protection and to reduce the risk of injury
• Remove furniture or other objects to allow the patient to move free of injury 
• Turn the patient onto their side to reduce the risk of choking
• Loosen tight clothing around the neck, chest, and abdomen to allow for easy expansion of the chest during breathing
• Administer supplemental oxygen if you observe signs of respiratory distress
• Administer ordered medications to control and stop seizure activity and monitor for side effects
• Closely monitor the patient once seizure activity stops to ensure safety and assess for needed interventions 

Nursing Care Plans Related to Seizures

Now that you understand the basics of seizure management, you can begin developing nursing care plans for seizure care. Below are some nursing diagnoses and interventions you can use when caring for patients with a seizure disorder. However, it's important to note that care plans must be individualized to the patient and that the below list is not exhaustive. 

Seizure Nursing Care Plan: Risk For Ineffective Airway Clearance

Maintaining a patent airway during a seizure is crucial. Thorough assessment and prompt interventions can minimize lift-threatening situations where the patient can't keep a clear airway unassisted. 

Patients may be at risk of ineffective airway clearance related to cognitive and neuromuscular impairment. A clear airway reduces the risk of aspiration and minimizes the risk of potential long-term effects of the seizure.

Nursing Diagnosis: Risk for Ineffective Airway Clearance

Potentially Related to

• Neuromuscular impairment
• Cognitive impairment
• Muscular rigidity in the neck and chest

Evidenced by

• Difficulty breathing
• Increased respiratory rate
• Abnormal breathing pattern

Desired Outcomes

• The patient will maintain a patent airway to prevent aspiration during the seizure.
• The patient will verbalize strategies they can use at home to maintain an open airway during a seizure.

Risk for Ineffective Airway Clearance Care Plan Assessment

1. Observe the patient for signs of an obstructed airway.
2. Evaluate the patient's ability to expectorate secretions.
3. Monitor the patient's respiratory rate and breathing pattern.
4. Assess for the need for supplemental oxygen to ease breathing difficulty.

Risk for Ineffective Airway Clearance Interventions and Rationales

1. Use padded side rails and place the bed in the lowest position. 
   Rationale: Reduces the risk of injury during a seizure.
2. Evaluate the need for protective headgear and educate the patient on its use.
   Rationale: Protects against head injuries.
3. Educate on the risk of burns related to cigarette smoking and the need to only smoke with supervision.
   Rationale: Reduces the risk of burns during the seizure.
4. Stay with the patient during and after the seizure.
   Rationale: Allows for continuous assessment of injury risk.
5. Support and protect the patient's head and extremities during the seizure. Do not restrain them.
   Rationale: Reduces the risk of injury and allows the body to move freely.
6. Reorient the patient after seizure activity.
   Rationale: Allows the patient to recover from disorientation, confusion, or anxiety to limit the risk of injury.
7. Administer medications to stop the seizure according to the treatment regimen.
   Rationale: Stops convulsions and reduces the risk of injury.

Seizure Nursing Care Plan: Risk for Injury

The Epilepsy Foundation reports that statistics about seizure-related injuries aren't readily available because many aren't reported or recorded. However, patients are at a heightened risk of injury before, during, and after seizures related to muscle and neurological changes. Therefore, prevention and observation are vital to reducing the patient's risk of injury.

 Nursing Diagnosis: Risk of Injury

Potentially Related to

• Loss of Consciousness
• Muscle Rigidity
• Convulsions
• Loss of sensations

Evidenced by

• Falls
• Head trauma
• Unexplained bruises, lacerations, skin tears, or other injuries

Desired Outcomes

• The patient will be free of injuries during seizure activity.
• The patient will verbalize at-home strategies they can use to reduce the risk of injury during seizures.
• The patient will perform a home risk assessment and correct environmental risk factors.
• The patient will follow the treatment plan to manage seizure activity to reduce the risk of seizure-related injuries.

Risk of Injury Care Plan Assessment

1. Assess for seizure triggers and patterns. 
2. Assess for caregiver availability.
3. Assess drug-regimen compliance.
4. Note the patient's age, gender, developmental age, and decision-making abilities.
5. Assess the patient's surroundings and remove dangerous objects to minimize seizure-related injuries.

Risk for Injury Care Plan Interventions and Rationales

1. Use padded side rails and place the bed in the lowest position. 
   Rationale: Reduces the risk of injury during a seizure.
2. Evaluate the need for protective headgear and educate the patient on its use.
   Rationale: Protects against head injuries.
3. Educate on the risk of burns related to cigarette smoking and the need to only smoke with supervision.
   Rationale: Reduces the risk of burns during the seizure.
4. Stay with the patient during and after the seizure.
   Rationale: Allows for continuous assessment of injury risk.
5. Support and protect the patient's head and extremities during the seizure. Do not restrain them.
   Rationale: Reduces the risk of injury and allows the body to move freely.
6. Reorient the patient after seizure activity.
   Rationale: Allows the patient to recover from disorientation, confusion, or anxiety to limit the risk of injury.
7. Administer medications to stop the seizure according to the treatment regimen.
   Rationale: Stops convulsions and reduces the risk of injury.

Seizure Nursing Care Plan: Deficient Knowledge

Arming the patient with knowledge about their seizure condition is the best way to reduce the risk of long-term and life-threatening sequelae. Patients with a newly diagnosed seizure disorder will need education about seizure triggers, symptoms, and medications to minimize the frequency and seizure-related risks. In addition, ongoing education is necessary anytime the treatment plan changes or the patient experiences new signs or symptoms. 

Nursing Diagnosis: Deficient Knowledge

Potentially Related to

• Inadequate knowledge about seizure triggers
• Poor knowledge about seizure causes
• Lack of interest in seizure education
• Inability to remember seizure information

Evidenced by

• Inability to identify seizure triggers
• Failure to adhere to seizure medications and treatments
• Increase in seizures
• Injuries resulting from seizures

Desired Outcomes

• The patient will demonstrate seizure management techniques and measures.
• The patient will verbalize triggers and strategies to avoid them. 
• The patient will verbalize seizure information, including seizure types and medications.
• The patient will adhere to their medication and seizure management plan.
• The patient will have no missed seizure medication doses for 30 days.

Deficient Knowledge Care Plan Assessment

1. Assess what the patient knows about their seizure disorder.
2. Assess the level of compliance with the treatment plan.
3. Assess the patient's medication compliance. 

Deficient Knowledge Interventions and Rationales

1. Review potential triggers.
   Rationale: Educate the patient on potential triggers so they can limit their exposure to reduce the frequency of seizures.

2. Educate on seizure warning signs.
   Rationale: Provides information the patient can use to recognize an impending seizure so they can get to a safe place.

3. Instruct the patient to keep a seizure diary.
   Rationale: Establishes patterns, triggers, and warning signs so the patient can actively participate in their care and seizure management protocols. 

4. Educate on the treatment plan. 
   Rationale: Provides information and interventions the patient must use daily to live with the condition safely.

Seizure Nursing Care Plan: Caregiver Role Strain

Nearly one million adults 55 or older and 470,000 children live with seizures. People in these age groups commonly receive care from others, even without a chronic condition like epilepsy. Caregivers may experience role strain when caring for someone with seizures and trying to juggle other commitments, such as work, caring for other family members, and social involvement.

Nursing Diagnosis: Caregiver Role Strain

Potentially Related to

• Stress due to seizure caretaking activities
• Lack of knowledge about seizure caretaking
• Ineffective coping strategies
• Chronic seizures
• Unpredictability of seizures
• Inadequate support from family and loved ones
• Lack of resources like transportation
• Pediatric patients with new or worsening seizures

Evidenced by

• Physical and emotional exhaustion of the caregiver
• Inability to meet the seizure management needs of the patient
• Increase in stress levels
• Anxiety and depression
• Isolation from loved ones
• Failure to care for the patient with seizures
• Disturbed sleep
• Inability to maintain employment

Desired Outcomes

• Caregiver voices their own needs and takes actions that support those needs. 
• Caregiver implements effective coping strategies, including relaxation techniques.
• Caregiver identifies needed community and family resources. 
• Patient reports a decrease in seizure activity which lessens caregiver stress. 
• Patient actively participates in their care as much as possible to relieve the caregiver's burden. 

Caregiver Role Strain Care Plan Assessment 

1. Assess the caregiver's roles and responsibilities.
2. Assess the patient's ability to manage their seizures.
3. Assess the caregiver's support system.

Caregiver Role Strain Care Plan Interventions and Rationales

1. Encourage the caregiver to set up respite care and other care coordination support.
   Rationale: Provides support and rest for the caregiver so they can recover and employ 
   self-care activities.

2. Offer community-based resources.
   Rationale: Provides the caregiver with information about support groups for education and funds to help with medical, transportation, or housing expenses. 

3. Recommend a specialist or epilepsy center.
   Rationale: Establishes a relationship with a healthcare provider that offers expanded services and support for patients with seizures and those who care for them. 

4. Refer to a nurse case manager.
   Rationale: Provides additional support and resources to ensure the caregiver receives the help they need to provide comprehensive at-home care to the patient with seizures. 

Seizure Nursing Care Plan: Risk for Falls

Seizure patients may experience a seizure type that causes muscular rigidity and jerky movements, resulting in a fall. Sudden falls are evident in seizure patients with both primary and secondary seizure types. 

It is important to note that falls can cause severe injuries or even death. However, the type of injuries after a fall differs based on the age and gender of the patient.

Nursing Diagnosis: Risk for Falls

Potentially Related to

• Muscular contraction and jerking seizure episodes
• Poor balance
• Decreased muscle strength
• Confusion or changes in neurological status

Evidenced by

• Observation of a fall during s seizure 
• Loss of balance during a seizure 
• New bruises, cuts, scrapes, or other injuries following a seizure

Desired Outcome

• The patient will be free of falls during seizures.
• The patient will be free of injuries during seizures. 
• The patient will verbalize ways to prevent falls during seizures. 
• The patient will demonstrate compliance with medication regimens to prevent seizures, thereby reducing the risk of falls during seizures. 
• The patient recognizes warning signs of a seizure and how to get to a safe place before the seizure happens. 
• The patient reduces exposure to seizure triggers to prevent seizures.

Risk for Falls Care Plan Assessment

1. Assess for the occurrence of falls during past seizures.
2. Assess for bruises, scrapes, cuts, and other injuries after a seizure.
3. Assess the patient's location during a seizure if no one witnessed it.

Risk for Falls Interventions and Rationales 

1. Educate the patient on warning signs and to lie down on the floor or another safe place if they feel a seizure starting. 
   Rationale: Recognition of the start of a seizure and relocation to a safe place reduces the risk of injury. 

2. Recommend headgear and educate on its use.
   Rationale: Using headgear for patients who fall often reduces the risk and severity of injuries. 

3. Educate caregivers to assist the patient to the floor before or during the seizure. 
   Rationale: Placing the patient on the floor before the fall or assisting them to the floor during a seizure reduces the risk of injury related to unassisted falls. 

Seizure Nursing Care Plan: Acute Confusion

Seizures may cause disorientation, leading to acute confusion. Seizure patients may show changes in brain activity that cause confusion, delusion, and disorientation just after the seizure stops.

Patients with seizures that start in the brain's temporal lobe may have long-term effects that cause confusion and memory problems. It's common for patients with temporal lobe involvement also to experience difficulty finding words. 

Nursing Diagnosis: Acute Confusion

Potentially Related to

• Changes in brain activity
• Secondary seizure types
• Origination of the seizure in the temporal lobe

Evidenced by

• Delusions and disorientation
• Confused thought process
• Agitation or restlessness
• Memory problems
• Inability to answer questions
• Inability to find the right words 

Desired Outcome

• The patient will be free of confusion after seizures.
• The patient will reorient quickly after seizures.
• The patient will recognize the memory or word identification issues and use strategies to help them communicate effectively. 

Acute Confusion Seizure Care Plan Assessment

1. Reorient the patient after a seizure.
   Rationale: Assists the patient in understanding they had a seizure and lets them know where they are.
2. Perform neuro-checks on the patient after a seizure.
   Rationale: Establishes a baseline and ongoing assessment of the patient's neurological status and any changes that may occur. 
3. Educate caregivers to assess the patient's neurological status following seizures.
   Rationale: Provides consistent at-home care for the patient and helps to establish patterns of seizures that may need further treatment. 

More Seizure Diagnosis

Other nursing seizure diagnoses you may need to consider when caring for someone with seizures include:

• Non-compliance
• Anxiety
• Low self-esteem
• Ineffective seizure control
• Hyperthermia
• Risk for trauma
• Sleep disturbances
• Depression

Seizure NCLEX Test Questions

Here are some seizure-related NCLEX test questions to assess your understanding of seizure nursing diagnosis and care plans:

True or false, a patient with a tonic-clonic seizure should be placed on their side.

A. True
B. Fales

Answer: A - True

You are assessing your patients to determine who has a higher seizure risk. Which of the following patients is most at risk?

A. A patient with COPD
B. patient with a history of stroke
C. patient with a leg fracture
D. patient with congestive heart failure

Answer: B - A history of stroke places the patient at an increased risk of seizure.

You are developing a seizure nursing diagnosis plan for a patient with a seizure disorder. How often should the care plan be updated?

A. Daily
B. Every two weeks
C. Monthly
D. As needed

Answer: D - As needed, seizure care plans should be updated according to the frequency and severity of the seizure disorder.

You are monitoring a patient when they suddenly start seizing. What should you do?

A. Stay with the patient until the seizure activity stops
B. Restrain the patient for their safety
C. Turn them onto their abdomen
D. Stimulate the patient's limbs

Answer: A - Stay with the patient until the seizure stops; keeping seizure patients safe while seizure activity occurs is vital.

Wrapping up Seizure Nursing Diagnoses and Care Plans

Caring for patients with seizure disorders requires a holistic and comprehensive nursing care plan. Self-management, with or without the help of caregivers, is crucial to long-term management for those living with seizures. Nurses must actively participate in the care plan and delivery of all treatment modalities to understand knowledge gaps and educate the patient and family accordingly.