seizures

Seizures Nursing Care Plans Diagnosis and Interventions

Seizures NCLEX Review Care Plans

Nursing Study Guide for Seizures

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.

Nursing Stat Facts

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Nursing Stat Facts

There are different types of seizure disorders, each varying on severity, accompanying manifestations, location in the brain and extent of 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.

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

Types of Seizures

Seizure disorders are subdivided into two groups, focal and generalized seizures:

  1. 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.
  1. 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.

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)
  • Hyponatremia
  • Medications (Antidepressants, pain relievers)
  • Head trauma
  • Structural abnormalities in the blood vessels of the brain
  • Autoimmune disorders
  • Stroke
  • Brain tumor
  • Use of illegal substance
  • Alcohol abuse

Complications of Seizures

  1. Falls. Seizure episodes can make the balance of the patient unstable and thereby causing them to fall and causing injuries
  2. Drowning. Patients with seizure disorders are prone to accidental drowning
  3. 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.
  4. 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.
  5. 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

  • 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

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.

Electrical stimulation

  • 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.

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.

InterventionsRationales
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.

InterventionsRationales
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 an expedited care during an emergency situation.

Other nursing diagnoses:

Nursing References

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.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

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.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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