Seizure Precaution Nursing
Seizure precautions nursing – The secret to success is seizure prevention, close supervision, and early care. More importantly, early treatment not only improves outcomes but also prevents the development of status epilepticus.
Despite sufficient oxygenation, seizures cause neurological dysfunction every time they happen. As a result, regular seizure precautions are important.
Knowledge of Seizure Precautions
Awareness of seizure causes and precipitating factors is one thing to consider when considering seizure precautions. Despite the fact that non-compliance with drugs is one of the most common causes of breakthrough seizures, both caregivers and healthcare professionals should look for any underlying metabolic or infectious triggers in these patients.
Fever or any irregular laboratory parameter should be seen as a cause in patients with therapeutic drug levels. Screening for drug abuse in children and adolescents is important. To determine the risk of seizure recurrence, imaging studies and electroencephalograms (EEG) are needed. Prehospital treatment for seizure patients is almost always positive.
Most seizures, particularly simple febrile seizures in children, last just a few seconds or minutes.
Emergency Considerations for Patients With an Ongoing Seizure
- If the person’s seizures persist in the emergency department, the ABCs(airway, breathing, circulation) resuscitation should be followed.
- If the individual is in status epilepticus, cyanotic, or respiratory insufficiency, give them oxygen. Some people can need rapid sequence intubation, but only a short-acting neuromuscular blocker should be used to prevent masking seizure activity.
- If your blood glucose level is less than 50 mg/dl, you should replace it with IV glucose.
- Consider EEG tracking if the person is intubated and paralyzed to see if seizure activity is still present.
- Two large-bore intravenous(IV) lines should be placed in all patients that are having an active seizure. Give intravenous glucose and thiamine as soon as possible.
- If the patient shows signs of infection, obtain samples and consider antibiotic treatment.
The main goal of treatment is to keep the seizure under control until it causes major neuronal harm, which normally happens between 20 and 60 minutes. Anoxia and infections of the central nervous system (CNS) are linked to a high death rate in status epilepticus.
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Seizure Precautions in Different Stages
Precautions during the seizure
- At first, ensure sufficient ventilation and position patients on their left-hand side on the ground.
- Make sure the airway is clear by loosening the clothes around the neck. If the patient’s teeth are clenched, do not force the mouth wide open with any object, as this may result in serious injury.
- Remove any potentially dangerous things from the region. The patient may be unaware of what is going on and may not even understand what he or she has been doing.
- If the patient is puzzled and walking, gently steer him/her away from outside areas and prevent access to them.
- Be gentle and reassuring to the person.
- Make a 911 call. The seizure usually stops before EMS arrives. Seizures can last anywhere from three to five minutes in some cases. Alternatively, the individual may have established breathing problems or suffered serious injuries. It’s safer to call for an ambulance if a pregnant woman or someone with diabetes has a seizure.
- Finally, call 911 if the individual doesn’t regain consciousness. After a seizure, most people may be puzzled for 45 to 90 minutes, so take caution when calling for an ambulance.
- Instead of using handcuffs, ensure that the patient is on a mattress with secured side rails(guards).
- Place the person in a lateral(better left lateral) position with his or her neck slightly flexed to allow saliva to flow from the mouth and prevent the tongue from rolling inward.
- Remove any surrounding furniture and other potential dangers.
- As the patient regains consciousness, give verbal assurance.
- Call for assistance and begin treatment as directed by the caregiver.
Once seizure occurs, take the following notes;
- Time, Date, and Duration
- Level of movement or activity during the seizure
- Mental status (confused, anxiety, depression, etc.)
- Presence of aura
- Types of body movement and the part
- Progress of the seizure; Symmetrical, unilateral, or bilateral?
- Type of motor activity such as; Myoclonic, clonic, tonic, posturing, dystonic
- Features of eye movement(it’s important), deviation, open/closed, flickering of eyelids, wide pupil, etc.
- Head movement and neck movement
- Respiratory rate and rhythm
- Heart rate and pace
- Record the skin temperature and note it as cold, warm
- Nausea and vomiting
- Light reflex
- Hallucinations and dilusion
- If any other unusual behavior noticed then note it
Precautions after the Seizure-postictal stage
Most patients feel confusion, exhaustion, muscle spasms, and/or a headache after a seizure. As a result, one should allow the person to sleep. Reassurance is important over the next few days. It’s also important to remain calm and assist the individual in reorienting themselves.
The majority of seizures are painless and resolve on their own. Seizures are not dangerous to others, but they can cause problems such as lungs, brain, and heart tension. People with a history of lung disease can experience labored breathing and breathing difficulties.
As a consequence, oxygen therapy may be needed.
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Once the seizure stops note out the following fact;
- Vital signs
- Presence or absence of gag reflex
- Headache: location, severity, type, duration
- Bladder or bowel incontinence
- Any neurological effect(residual)
- Behavioral change
- Mental status, confusion, or anxiety
- Slurring of speech or not
- Uncoordinated movement
- Consciousness level
Perform a Postictal Examination and note the following;
- What the patient was doing before the occurrence of the seizure
- Previous history of seizure
- Presence of any disease or conditions
- Find out the triggering factors
- If the patient is addicted to coffee, alcohol, or smoking
- History of water consumption
- Fever or body heating
- History of recent head injury or trauma
- Recent infection
- Mood swing
Some blood-related triggering factor to check;
- Hypoglycemia is a condition of low blood sugar.
- Hyponatremia is a condition in which the body’s sodium levels are lower than normal.
- Hypocalcemia is a condition in which the body’s calcium levels are lower than normal.
- Hypomagnesemia is a condition in which the body lacks magnesium.
Medication-related triggering factors;
- Anti-seizure medication dose or frequency changes
- Sudden alcohol withdrawal
- CNS stimulant uses including caffeine
- Antidopaminergic drugs
- Antipsychotics uses
- Tricyclic antidepressant uses
- Quinolone or imipenem/Cilastatin uses
- Exposure to poisons(mostly volatile)
Hormonal and Environmental triggering factors;
- Loud music noise
- Sometimes pregnancy
- Menstruation(regular or irregular)
- Specific scent or odor
Lifestyle Changing Factors;
- Daily work in height
- Climbing tall buildings or painting
- Speed driving
- Cooking in an excess hot environment
- Heavy machinery
- Unsupervised swimming
To avoid any problems, including lawsuits by family members, providers must explain and record these seizure precautions. The issue with seizure precautions is that not every seizure case is the same. Since some people only have nocturnal epilepsy, it’s necessary to use caution when suggesting safety precautions. Sufferers who participate in activities such as biking and skiing, for example, should wear a helmet to avoid head injuries.
Drug management of the patient with active seizure
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Importance of Seizure precautions nursing
Epilepsy can be diagnosed in people who have had two or more unprovoked seizures within 24 hours of each other. However, with a single unprovoked seizure, the current standard of treatment is to avoid the causes. Anticonvulsants are typically only prescribed if a person is at risk of having repeated seizures.
Current research does not support initiating anti-seizure treatment after a first seizure because it does not boost the quality of life while lowering the risk of recurrence. These patients, on the other hand, should consult a neurologist(neuro medicine specialist or neurosurgeon) within 15 days. Patients are counseled on the following risk factors following a new-onset seizure to help them determine whether or not to start anticonvulsants.
- Migraine, TIA, syncope, and psychogenic events are all possible differential diagnoses for a current seizure-like case.
- Ancillary tests: As opposed to magnetic resonance brain imaging, computed head topography is less sensitive, with a sensitivity of just 30%. Low-grade gliomas and hippocampal sclerosis are two common disorders that go unnoticed. Following their first routine, approximately 29% of individuals with new-onset epilepsy would have an irregular electroencephalogram.
- Discuss possible seizure triggers: According to older data, up to 30% of patients with reported alcohol withdrawal seizures had a potentially epileptogenic anatomical abnormality similar to a traumatic injury.
- Prolactin levels can conditionally distinguish a convulsive seizure from a nonepileptic event; this involves assessing prolactin levels 10 to 20 minutes after a reported event and comparing them to a baseline prolactin level taken at least 6 hours before the reported event. The prolactin test can’t say the difference between an epileptic seizure and syncope.
Seizure precautions nursing is very important in emergency circumstances as well as in hospital management. Knowledge about precautions and triggering factors are the lifesavers.
Last Updated on February 23, 2022 by Learn From Doctor Team