seizure questions...help!

**LaurelRN, MSN · Nov 18, 2008

I had a pt who seized for 25 minutes on the way to our hospital- witnessed by medics. He was postictal for more than 4 hours- of course I was worried, so I call the doc, and he didn't seem concernd and just said- are the vitals stable? Does he respond? Then what are you worried about?

So does that mean it's that way for everybody- no..but I guess it just depends on the patient.Just my :twocents:

BlearnRN · Nov 18, 2008

So I have worked with a lot of epilepsy patients. Unfortunately there is no common time for an episode or how long the person is postictal. I think you should ask the doctor what you should do if the person has a seizure. Usually they tell patient if the seizure lasts longer than 5 minutes they should go to the hospital. If it is a violent one where the patient is combative and hitting people - to people turning blue in the face and going into respitory distress - to bones breaking while seizing ---code it. FYI Most people that I have taken care of who go into seizures we are giving them IVP ativan per doc order to stop the seizure or to keep the person from having another.

skittlebear · Nov 18, 2008

how long after a seziure (say grand mal), should a patient regain consciousness?
several minutes? How long after a seizure do they remain confused? How long will they feel like sleepign for? I want to know what is "normal' so I can determine what is abnormal, should it occur...
Also, if a patient who has a history of seizure disorder i seizing, I would consider calling a code if the seizure lasted longer than 3 minutes. Would this be correct?
Thanks for any insight!

I work in a home care setting with patients who have seizure disorders. How long do they remain confused? How long do they sleep? It all depends on the patient and how severe the seizure was. We have Diastat rectally protocols for each patient since they are in a home care setting. Most of the orders state that if this patient is seizing 3 minutes or longer, may administer Diastat or if this patient has 3 back to back seizures, etc. Tonic-Clonic seizures are very tiring for an individual to go through. I wouldn't be suprised if they slept for hours after...but how each person responds after a seizure is unique to them. I would feel better as long as their vital signs are stable, I could awake them easily, and they are responsive. Of course I would call the doctor and inform them of the seizure and watch closely for further seizure activity or any other abnormalities.

tryingtohaveitall · Nov 18, 2008

Long ago I heard someone give a ballpark guesstimate that for every 10 min of seizure, they'll be postictal for an hour. We will occasionally get kids who have seized for an hour or two and it's not uncommon for them to be obtunded for several hours or til the next day. As people have said, everyone's different but it is usual for them to be postictal for several hours after a prolonged seizure.

marilynmom, LPN, NP · Nov 18, 2008

I don't think there is a normal. That is a good question!

My last patient was a 16 year old who seized for an hour, we gave her ativan (that is what we usually do for any seizure over 2-3 mins) and she was fine. I just continued to watch for more seizure activity to let the docs know about (she did have a lot of mini seizures lasting a few sec's each).

Like the above posters said you would check their VS, is airway maintained, etc? If they were turning blue I would call my resident and the RT while keeping O2 on them and of course in our ICU rooms we have a bag/mask hooked up to 02 for every patient. It is usually not the seizure that is the problem, but why they seized (which may be something like a trauma or just something like a febrile seizure....which some kids can seize over an hour with).

I have seen the postictal stage last for 24 hrs....everyone just seems to react differently to seizures. I work with only children (babies to teens) so I don't know about adults.

RNperdiem, RN · Nov 18, 2008

Everyone is different.

In my experience as a mom of a child with seizures, the longer the seizure the longer the time it takes to fully wake up. If you had to use sedatives to stop the seizure, the patient could spend hours sleeping it off.

If a seizure goes on longer than 5 minutes, it is time to take action. Look at the clock and write the time down when you witness the seizure begin; your sense of time is distorted under stress, so write it down.

If there is a standing PRN order for some valium or ativan, send someone to get some for you right then.

If this is the first seizure in someone without a history of seizures, call the doc right away.

Daytonite, BSN, RN · Nov 18, 2008

when i worked on a neuro unit, this is what we expected to see:

how long after a seizure (say grand mal), should a patient regain consciousness?
- 15-30 minutes
[*]how long after a seizure do they remain confused?
- 15-30 minutes
[*]how long will they feel like sleeping for?
- up to 4 hours

also, if a patient who has a history of seizure disorder is seizing, i would consider calling a code if the seizure lasted longer than 3 minutes. would this be correct?

no. review your facility policy on when to call a code. we only called a code if a patient became

apneic

and we had to start rescue breathing. not all patients who are seizing are apneic for the entire seizure. assess.