Seizure Pts: what to do when it happens?

loricatus · Mar 15, 2009

Pad the bed rails and headboard to prevent injury.

Make sure suction and oxygen is readily available.

Keep environmental stimulus down to a minimum.

Found something that gives you more infromation

http://www.smh.com/sections/services-procedures/medlib/nursing/Procedures/Neuro/neu05_Seizure_111907.pdf

flightnurse2b, LPN · Mar 15, 2009

above all, keep the patient safe and protect them from hurting themselves (lori gave great advice--pad bedrails and headboard! some places even have padded covers you can just slip over the rails) and protect their airway (suction/oxygen @ bedside is a must).

and don't ever try to hold them down (seen nurses do this) or shove things in their mouth (seen nurses do this too) while they are actively seizing.

documenting what has happened before, during and after is important too. ie if the pt c/o of a certain smell or sensation before they seized, how long the sz lasted, orientation pre/post ictal, loss of conciousness, loss of bowel/bladder, etc.

and reorientation and helping keep the pt calm afterwards is very important! the pt recovering from a tonic-clonic sz will more than likely be disoriented and frightened.

mama_d, BSN, RN · Mar 15, 2009

I'd like to add in to be aware of what PRN meds your patient has ordered if they do start seizing. We had one seize at work the other night and the nurse had no idea where his MAR was or what he had ordered. We ended up just checking the Pyxis for what he had ordered and slamming in the IV Ativan that was on his profile...granted, we only gave her about five seconds to look for the MAR before we went to that step, but it still would have been nice for her to have known.

ChristineN, BSN, RN · Mar 15, 2009

At my hospital it's a standing protocal tha any pt that has a history of recent seizures gets suction at the bedside, oxygen set up as well as a ambu bag, and seizure pads on the bed. If your hospital doesn't have seizure pads, you can cover the bedrails in thick blackets, so the patient doesn't hurt themselves on the rails if they start seizing. We all ways put seizure patients on the pulse ox, even if they don't have a history of desating with seizures.

If the patient is having short (2-3) second seizures that are the staring kind, you may not know they seized unless a family member was present. Often with staring seizures the patient's vital signs will remain stable during the seizure. I know that seizures can be scary, because there is all ways that risk that it could become the big Grand Mal. I have personally witnessed a Grand Mal twice in my career, and it is one of the scariest things I've ever seen. If I never seen another Grand Mal seizure in my career it couldn't be soon enough.

2bnurse_it · Mar 18, 2009

thanks guys!

But exactly what do we do if they are actively seizing?

leave them alone? suction? (i've really never got the hang of sunctioning... it goes down their throat??)

thanks again.

lpnflorida · Mar 18, 2009

thanks guys!
But exactly what do we do if they are actively seizing?
leave them alone? suction? (i've really never got the hang of sunctioning... it goes down their throat??)
thanks again.

While a person is actively seizing, stand back make sure the environment is safe. Observe the time the seizure began observe for any tonic/ clonic movement. If you were present when seizure began observe eyes which direction did they drift. Observe that airway remains unobstructed. Be prepared to place patient on their side if vomiting occurs. I have not yet ever had to suction a patient who was having a seizure, just lucky so far I guess. Also observe if they are incontinent.

I have witnessed many grand mal seizures, mostly we observe, just keeping the patient safe. It is if they go into status epilectilis then orders must quickly be gotten for drugs which will help stop the process. If unable to stop the process our patient's were transferred to ICU. It is status epilectilis which is life threatening causing potential brain damage, not necessarily just the grand mal seizure which many patients can have and come out of without harm.

We notify the doctor of the seizure, most often they will order labs to see if anticonvulsant levels are in the norm. We do not administer prn med for the lone seizure while it is occuring, only for status epileticus as I mentioned.

nyrn5125 · Mar 18, 2009

Also get a blood glucose they may be hypoglycemic- don't panic

truern · Mar 19, 2009

Don't try to suction them during a seizure...you'll cause them to chew their tongue at the very least. Never put anything in their mouth.

My daughter has a seizure disorder well-controlled with Dilantin, but she does have the occasional seizure. The best thing you can do is protect from injury...if they're upright gently lower them to a side-lying position to control secretions and protect the airway. Continue to talk to them...reassure them. Time the seizure and note any characteristics such as which side they seize towards. In the postictal stage they'll be groggy and most likely want to sleep it off.

diane227, LPN, RN · Mar 24, 2009

Try to turn them to their side and apply oxygen, by mask, not nasal cannula. Note the type of seizure, length of time, etc. As stated above don't try to put anything in the mouth. Try to protect them from harm. If they are on the floor, leave them there until the event is over.

You also might want to review pseudoseizures. These are often common in psychiatry.

palmettogirl · Mar 26, 2009

I'm glad you posted this. I was about to post the same exact question. I'm still on orientation and my patient had a seizure the other day. I have never seen one, and her family was freakin out so it scared me to death. The nurse I was with was calm and handled the situation very well. I'm scared to death of when this will happen to me own my own...and I hope I know what to do

2bnurse_it · Mar 30, 2009

thanks guys!

very informative!