This guide is about seizures, diagnosis of seizures, treatment for seizures, and 3 nursing care plan examples for seizures. Use it to develop educational nursing care plans for seizures.
What is a seizure?
Seizure is the general term associated to any sudden and uncontrolled disturbance in the brain’s functioning. The effects of seizures could either be changes on the person’s behavior, body movements, and level of consciousness. Seizure episodes of two or more within 24 hours that have no identifiable cause could be considered epilepsy. There are different types of seizure disorders, each varying on severity, accompanying manifestations, location in the brain, and extent of the affected area. Seizures commonly last 30 seconds to two minutes. However, seizures lasting more than five minutes are a medical emergency and would need prompt intervention.
What are the signs and symptoms of seizures?
The clinical manifestations of seizures are the following:
- Temporary confusion
- Staring spells
- Uncoordinated, uncontrollable jerking of any part of the body, usually the arms and legs
- Loss of consciousness
- Cognitive symptoms such as fear or anxiety
What are the types of seizures?
Seizure disorders are subdivided into two groups, focal and generalized seizures:
- Focal seizures. These are seizures that affect the electrical activity of one area of the brain. It can be subclassified as either of the following:
- Focal seizure with impaired awareness – oftentimes, this seizure type is characterized as having dream-like state of consciousness. The patient may seem awake but is actually in a trance-like state while performing repetitive movements. The patient is not aware or cannot remember the seizure in this subtype.
- Focal seizure without impaired awareness – in this subtype, the patient will have altered senses or change in perception. For example, the patient may feel suddenly angry, but would have accompanying difficulty in speaking and experience flashing lights.
- Generalized seizures. Generalized seizures involve all areas of the patient’s brain. These seizures are further subdivided into other subtypes:
- Absence seizure – seizures that are characterized by staring blankly into space with subtle jerking or movement of the body (e.g. smacking of lips). Episodes lasts for 5 to 10 seconds but can occur multiple times in a day and in clusters. It is oftentimes seen in children. This is previously known as petit mal seizures.
- Tonic seizure – another seizure subtype wherein it causes for the muscles of the back, arms, and legs to stiffen, and consequently will make the patient lose balance.
- Atonic seizure – a seizure subtype wherein the patient suddenly loses muscle control of his body and may cause him/her to collapse to the ground. Another term for this is drop seizure.
- Clonic seizure – these seizures that causes for the rhythmic and repeated jerky movement of the patients’ muscles of the extremities.
- Myoclonic seizure – a seizure subtype wherein there are sudden and brief jerky movements on the patients arms and legs.
- Tonic-clonic seizure – a seizure subtype characterized by sudden loss of consciousness, body stiffness, jerky movements, and sometimes loss of bladder control with biting of the tongue. This is previously known as Grand Mal seizures.
What are the causes and risk factors of seizures?
The neurons in the brain create, transmit, and receive electrical impulses all throughout the brain. Any disruptions from this would cause seizures to the patient. Recent studies are looking at whether genetic mutations may also result to seizures.
The most common cause of seizures is epilepsy. However, other causes or trigger factors may cause seizures. They are:
- High fever
- Sleep deprivation
- Visual stimulants (moving objects, flashing lights)
- Medications (Antidepressants, pain relievers)
- Head trauma
- Structural abnormalities in the blood vessels of the brain
- Autoimmune disorders
- Brain tumor
- Use of illegal substance
- Alcohol abuse
What are the complications of seizures?
- Falls. Seizure episodes can make the balance of the patient unstable and thereby causing them to fall and causing injuries
- Drowning. Patients with seizure disorders are prone to accidental drowning
- Car accidents. If there is any loss of consciousness during a seizure activity, the patient will be prone to accidents while driving vehicles or operating machineries.
- Pregnancy complications. Seizure disorders compromise both the mother and infant. This is especially true for patients on anti-epilepsy medications for these can cause birth defects.
- Emotional health issues – People with seizure disorders oftentimes have depression and anxiety, either caused by difficulties in dealing with the condition or as side effects of medications taken.
Diagnosis of Seizures
How do you diagnose a seizure?
- Neurological exam – to assess for baseline health of the patient pertaining to mood and cognitive functions of the brain.
- Blood tests – to look for signs of infection, genetic conditions that may cause seizures.
- Lumbar puncture – to test the cerebrospinal fluid by doing lumbar punctures; this will help in assessing for signs of infection in the brain.
- Electroencephalogram (EEG) – to assess the electrical activity of the brain in order to look for dysfunction that may cause seizures.
- MRI – to assess the brain’s internal structure to look for abnormalities (e.g. tumors, etc.).
- CT scan – another imaging test used to visualize the brains structures. Single-photon emission computerized tomography (SPECT) uses low dose radioactive material to make 3D map of the brain during seizures.
- PET scan – this is an imaging test involving using small dose radioactive material that will help visualize active and inactive areas in the brain.
Treatment for Seizures
What are the available treatment options for a patient suffering from a seizure?
Medications. The use of medications such as benzodiazepines, anticonvulsants, anti-epileptics, and other anti-seizure drugs are utilized to control, if not stop the occurrence of seizure.
Diet therapy. Some studies suggest that having a ketogenic diet or high fat, low carbohydrate diet can improve seizure control. This should be consulted with the dietitian and physician if appropriate to the patient.
Surgery. If medications are insufficient, surgery maybe done to control seizures. Surgical procedures for seizure include:
- Lobectomy – the surgical removal of the part of the brain causing seizures.
- Multiple subpial transection – a type of brain surgery wherein portions of the brain are removed when it is difficult to remove entirely the seizure-causing area.
- Corpus callosotomy – a brain surgery involving cutting off the connections of the brain’s left and right hemisphere.
- Hemispherectomy – an extreme surgery wherein half of the brain’s outer layer is removed.
- Thermal ablation – involves the application of targeted heat to the affected area of the brain to stop seizures.
- Vagus nerve stimulation – involves the implantation of a device underneath the skin of the chest that will send signals to the brain to stop it from having seizures.
- Responsive neurostimulation – a device is implanted near the surface of the brain that will deliver an electrical stimulation once it detects beginning seizure activity.
- Deep brain stimulation – involves the implantation of electrodes in the brain to produce electrical impulses to counteract beginning seizures in the brain.
3 Nursing Care Plan Examples for Seizures
What are some of the available nursing care plans for seizures?
Nursing Care Plan 1
Nursing Diagnosis: Risk for Injury related to loss of sensory coordination and muscular control secondary to seizures
Desired Outcome: The patient will be able to prevent trauma or injury by means of maintaining his/her treatment regimen in order to control or eliminate seizure activity.
|Explore the usual seizure pattern of the patient and enable to patient and caregiver to identify the warning signs of an impending seizure.||To empower the patient and his/her caregiver to recognize a seizure activity, and help protect the patient from any injury or trauma. To reduce the feeling of helplessness on both the patient and the caregiver.|
|Place the bed in the lowest position. Put pads on the bed rails and the floor.||To prevent or minimize injury in a patient during a seizure.|
|Advise the carer to stay with the patient during and after the seizure.||To promote safety measures and support to the patient. To ensure that the patient is safe if the seizure recurs.|
|Administer prescribed medications such as benzodiazepines, anticonvulsants, anti-epileptics, and other anti-seizure drugs.||To prevent or control the occurrence of seizures.|
|During seizure, turn the patient’s head to the side, and suction the airway if needed. Use a plastic bite block only when the jaw is relaxed.||To maintain a patent airway. Avoid inserting the plastic bite block when the teeth are clenched to prevent any dental damage. Do not use wooden tongue depressors as they can break or splinter, causing oral damage.|
Nursing Care Plan 2
Nursing Diagnosis: Deficient Knowledge related to seizures as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of seizure and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. decreased cognitive ability).||To address the patient’s cognition and mental status towards the new diagnosis of seizure and to help the patient overcome blocks to learning.|
|Explain what seizure is, its types, and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms.||To provide information on seizure and its pathophysiology in the simplest way possible.|
|Educate the patient about safety measures related to epilepsy and seizure activity. Create a plan for Activities of Daily Living (ADLs) with the patient and the carer, especially including important activities such as driving, operating machinery, swimming, and bathing.||To help the patient avoid alcohol intake that may lead to preventing further damage to the pancreas. To encourage the patient to live his/her daily life optimally, while ensuring that he/she is safe from injury if a seizure occurs.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to manage seizure. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Encourage the patient to wear his/her medical bracelet at all times, which indicates that he/she has a seizure disorder.||To enable the patient to receive expedited care during an emergency situation.|
- Risk for Ineffective Airway Clearance
The following are the common risk factors:
- Neuromuscular impairment
- Tracheobronchial obstruction
- Perceptual or cognitive impairment
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Common goals and expected outcomes:
- Patient will maintain an effective respiratory pattern with airway patent or aspiration prevented.
Nursing Interventions and Rationale
Interventions and actions for the nursing diagnosis Risk for Ineffective Airway Clearance in this seizure nursing care plan are as follows:
|Monitor respiratory rate, rhythm, depth, and effort of respirations.||Provides a baseline data for evaluating adequacy of ventilation.|
|Assess client’s ability to cough effectively.||Infections of the respiratory tract can affect the amount and character of mucus. An ineffective cough compromises airway clearance and prevents secretions to expel freely.|
|Ensure patient to the empty mouth of dentures or foreign objects if aura occurs and to avoid chewing gum and sucking lozenges if seizures occur without warning.||Lessens risk of aspiration or foreign bodies lodging in the pharynx.|
|Maintain in lying position, flat surface; turn head to side during seizure activity.||Helps in the drainage of secretions; prevents the tongue from obstructing the airway.|
|Loosen clothing from neck or chest and abdominal areas.||Aids in breathing or chest expansion.|
|Provide and insert plastic airway or soft roll as indicated and only if the jaw is relaxed.||If inserted before the jaw is tightened, these devices may prevent biting of the tongue and facilitate suctioning or respiratory support if required. Airway adjunct may be indicated after cessation of seizure activity if the patient is unconscious and unable to maintain a safe position of the tongue.|
|Suction as needed.||Reduces risk of aspiration or asphyxiation.|
|Supervise supplemental oxygen or bag ventilation as needed postictally.||May lessen cerebral hypoxia resulting from decreased circulation or oxygenation secondary to vascular spasm during a seizure.|
|Get ready for or assist with intubation, if indicated.||Presence of prolonged apnea postictally may need ventilatory support.|
Other nursing diagnoses:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.