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Was this normal?? (kinda long)

Jan 21, 200719 yr

Ok, I have only been a nurse since August and I work on a busy Med/Surg unit. I had a young 24 y/o pt the other day have a seizure and it really freaked me out and I did not know what to do!! I know there is really nothing you can do when a patient has a seizure other than keep them safe, but I still felt horrible because I had to get another nurse to tell me what I needed to do. I told her that I did not know what was happening to the guy, for all I knew he could have been dying right there in front of me. I guess it's because I have never seen a seizure before and this pt had no history of this, he was in the hospital for N/V/D x 2 weeks, it really caught me off guard. I went home feeling very incompetent to handle emergency situations. I had always though I wanted to work ER and this had me second guessing my self. So, the question is...was this a normal reaction for a new nurse?? My co-workers told me it was and that I handled the situation fine, but I still feel bad for panicing. I would love to hear if anyone out there has had something similar happen and what happened the next time, did you react better??

Jan 21, 200719 yr

If by panicking you meant you went and got help and was unsure what to do, then you did fine. You got assistance.

What I have always done when I encounter something new is hit the books and study up so next time I know what to do in that situation. Even 10+ years later I am still seeing and learning new stuff all the time.

Sezuires are scary to someone who has never seen them. The important thing is to make sure there is nothing for them to injure themselves on until it is over.

Chances are with the n/v/d his electrolytes were whacked and this precipitated the sz. Remain with the pt, have someone else page the doc. DO not try to insert ANYTHING into the pts mouth while they are seizing. (this is a good way to lose a finger or two). If it last for more than a minute or two I would probably activate your rapid response team if you have one as they can order valium for the patient if you can't get physician orders immediately, if it continues. While this is going on DO NOT forget to breath yourself.

It sounds like you did fine.

Hang in there.

Jan 21, 200719 yr

If by panicking you meant you went and got help and was unsure what to do, then you did fine. You got assistance.
What I have always done when I encounter something new is hit the books and study up so next time I know what to do in that situation. Even 10+ years later I am still seeing and learning new stuff all the time.
Sezuires are scary to someone who has never seen them. The important thing is to make sure there is nothing for them to injure themselves on until it is over.
Chances are with the n/v/d his electrolytes were whacked and this precipitated the sz. Remain with the pt, have someone else page the doc. DO not try to insert ANYTHING into the pts mouth while they are seizing. (this is a good way to lose a finger or two). If it last for more than a minute or two I would probably activate your rapid response team if you have one as they can order valium for the patient if you can't get physician orders immediately, if it continues. While this is going on DO NOT forget to breath yourself.
It sounds like you did fine.
Hang in there.

I agree. You are going to see new things daily and will become more comfortable and feel more confident with each passing day. I also come home and study up on something new Ive encountered. And it does sound like you handled the situation fine.

Jan 22, 200719 yr

I agree the seizure was most likely because the electrolytes were way off and possibly dehydration played a role. Dont forget though to roll the patient to their side to maintain airway. Even though they look like they arent breathing they do have respirations, their lips may turn purple but will quickly recover when the seizure is over. Always protect the patient of course.

A seizure can also seem much longer than they actually are. Make sure you are watching the time so you can report to the doctor exactly how long they seized and what their post ictal period is like. Either you stay with the patient or have another nurse call the doctor if that makes you feel more comfortable. Some patients recover quickly while some take a while to come out of it and become coherant again. This (post ictal) is also a dangerous time because the patient can become combative and have behavior atypical of their norm.

After the patient is coherent again, ask them if they had any unusual feelings or "auras" prior to the seizure. This information is very important for the patient if they continue to have them. They need to be able to identify when they are moving toward a seizure.

Jan 23, 200719 yr

Some folks have lower seizure thresholds, that is they're more prone to having a seizure when sick. Fevers also can bring one on, most typical with younger babes/kids.

Maintain that airway, remove dangerous objects and protect the person, if they're on the floor, I like to try and get a pillow under their head.

You did fine, gosh, everything is terrifying the first time! and second..!

Jan 23, 200719 yr

Also, wanted to say... don't let it scare you off ER nursing. Usually ER's like people with a year or two of med/surg experience because we see everything and learn so much. I'm a new nurse too and sometimes it seems that we're stretched so thin with having to know a 'little' bit about so much, that when a crisis happens, it's like aaarrghghg, what do I do? We've been worrying about meds, wounds, giving blood, doing iv's, personal cares, family support. And then a crisis happens, yikes! I fantasize about specializing in something someday so I can get really good at it, but until then I'm really enjoying all this learning.

Jan 23, 200719 yr

I remember one of my instructors in school giving me the best advice. She said always as a nurse remember safety is #1. So really my motto is Keep the patients safe. It sounds so silly but if you just always remember this youll be okay. If this situation were me, I would of just made sure the pt was SAFE ( no hitting head, falling down, basic protection) I dont want to sound queer, but I always hear this instructors words in my head at work and it helps me, I hope it helps someone else. :nurse: :flowersfo

Jan 28, 200719 yr

Expert

luvtxnursing. . .in one of my early med/surg jobs i worked on a neuro unit. the first couple of times i had patients with seizures i panicked. afterward, i would silently beat myself up for forgetting what to do. it took sitting down and going over the care of a patient seizing when i was at home and then periodically telling myself at work, "now, if someone has a seizure, you are going to do this. . ." eventually, i got it. i would remember to look at my watch to catch the time (you want to know how long the seizure lasted for your charting). stay with the patient during the entire seizure. always protect the head above all else. have others protect the limbs. if you have to, cup the patient's head in your hands to protect them from banging it against the bedrails if they are having a grand mal seizure. if the patient stops breathing while seizing there is nothing you can do because it is part of the tonic-clonic activity. however, after the seizure has stopped (check your watch to note the time!) make sure they have started breathing again. if not, you may need to start rescue breathing and call a code blue. with grand mal seizures patients are often post ictal and unable to respond consciously for 15 minutes or more. you'll want to note the time on that as well. check for incontinence because that happens frequently as well. sometimes the patients produce a lot of sputum so you need to make sure it isn't interfering with their breathing after the seizure, so they may need suctioning while they are post ictal or turned to the side to prevent aspiration. you'll want to do neuro assessments. patients do sometimes suffer brain damage during seizures so your assessments will be important.

now, you need to know that there are many types of seizures. the most well-known are the grand mals. however, i saw just about every kind of seizure there was working on a neuro unit and some of them are pretty strange. patients can have seizures of one part of their body and remain alert and oriented. just document what you observe (and note the time!)

i imagine you haven't gone through your first code blue either, have you? guess what you're going to feel like after that's all over and done with? remember to check your watch for the time you called it because at least 50 people will ask you that question!

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