What is a Seizure? : Nursing Precautions, Interventions & Diagnosis

Living with a seizure disorder can be challenging. From the unpredictable seizures to adapting daily routines, it can be an emotional and physical roller coaster – one you never signed up for. Whether you are a nurse who cares for people living with this condition or you have been diagnosed recently, gaining knowledge of what seizure disorders are and what nursing interventions may help is essential in maintaining overall health. This post will discuss everything related to understanding seizure disorder basics and the necessary nursing interventions to provide care.

What is Seizure?

A seizure is an unexpected and sudden electrical disturbance in the brain that can cause movement, sensation, and behavior changes. This neurological phenomenon can be mild or severe, depending on the type of seizure and the individual’s physiology. Attacks can occur at any age and often have no apparent trigger or warning signs.

Typically, the brain produces tiny electrical impulses in a regular pattern. These signals are transmitted along neurons – the brain’s network of nerve cells – and circulated throughout the body with the help of neurotransmitters, which are chemical messengers.

While seizures can be startling, it’s essential to understand that they are relatively common. Around 1 in 10, people will experience a seizure in their lifetime.

Symptoms of Seizure Disorder

The symptoms of a seizure disorder can vary greatly depending on the type and severity. Common signs include:

• Uncontrollable jerking or shaking movements
• Loss of consciousness or awareness
• Hallucinations
• Confusion or disorientation
• Difficulty speaking or understanding language
• Loss of muscle control or coordination

Types of Seizures

There are many types of seizures, and they have a range of symptoms and severity. Seizure types vary by where they begin in the brain and how far they spread. Seizures usually last anywhere between 30 seconds to 2 minutes. If the seizure lasts more than 5 minutes, it is an urgent medical situation requiring immediate attention.

Seizures can be classified into two different types:

1. Focal seizures
2. Generalized seizures

Focal seizures:

Also known as partial seizures, these begin with an area of the brain and can remain localized or spread to other areas. Symptoms depend on the part of the brain affected but may include sensory disturbances such as numbness, tingling sensations, headaches or dizziness.

Focal seizures result from electrical activity in one area of the brain. This type of seizure can occur with or without loss of consciousness:

Focal seizures with impaired awareness: People having Absence seizures may appear awake, but they will be in a trance-like state, unresponsive to their environment. They may repeat certain words or movements, such as hand rubbing, mouth movements, and walking in circles. Usually, individuals who have these types of seizures don’t remember what happened or are even aware that it occurred. It’s almost as if they were dreaming while still conscious.

Focal seizures without impaired awareness. These Seizures can profoundly affect emotions and alter how things appear, smell, feel, taste, and sound. They do not cause loss of consciousness, however.

During these seizures, individuals may experience shifts in their emotions, such as sudden anger, joy, or sadness. Other symptoms can include nausea, difficulty speaking, involuntary jerking of any body part, and sensory changes such as tingling, dizziness, and seeing flashing lights. These seizures do not lead to a loss of consciousness. They may change how people perceive things regarding taste, smell, sound or sight.

Generalized Seizures:

Generalized seizures affect whole areas of the brain from the onset. These seizures include:

Absence seizures: Formerly understood as petit mal seizures, these are common in children and cause a person to stare off or make subtle body movements like eye blinking or lip smacking. Generally lasting 5-10 seconds, they can occur several times daily and may result in a brief loss of awareness.

Clonic seizures: Cause rhythmic and jerking movements of the muscles on both sides of the body. They typically last one to three minutes and can be associated with other symptoms such as loss of consciousness or difficulty breathing.

Myoclonic seizures: This type of seizure results in sudden, brief muscle contractions that can affect limbs, face, neck or torso.

Tonic seizures: These cause sustained muscle contractions that cause rigidity or stiffness in the muscles and can last up to one minute.

Tonic-clonic seizures: Formerly known as grand mal seizures, these involve tonic and clonic components. They are characterized by a loss of consciousness and violent muscle contractions which may be accompanied by foaming at the mouth, biting of the tongue, difficulty breathing, and bladder incontinence.

Atonic seizures. Atonic seizures, also called drop seizures, cause a loss of muscle control. People having this type of seizure may suddenly fall or drop their heads.

Causes

Nerve cells in the brain, known as neurons, create, send and receive electrical impulses. This allows the cells to communicate. Anything that disrupts the communication pathways can lead to a seizure. Genetic changes may cause some types of seizure disorders.

The most common cause of seizures is epilepsy; yet, not all individuals who have a seizure suffer from it. Seizures can sometimes be caused or triggered by various factors, such as:

• A high fever. When this happens, the seizure is known as a febrile seizure.
• An infection of the brain. This may include meningitis or encephalitis.
• Head injury or trauma.
• Brain conditions include a tumor, stroke, lack of oxygen to the brain, or low blood sugar levels.
• Drugs and alcohol use or withdrawal.
• Specific medical procedures (such as electroconvulsive therapy).
• Other neurological disorders, such as Alzheimer’s disease.

Different causes of seizures are common in certain age groups.

• Seizures in babies are typically caused by hypoxia-ischemic encephalopathy, central nervous system infections (CNS) infections, trauma, congenital CNS abnormalities, and metabolic disorders. Febrile seizures happen most often in children aged 6 months to 5 years, occurring in 2–5% of them.
• Epilepsy syndromes are commonly seen during childhood.
• Noncompliance with medications and sleep deprivation can be triggered during adolescence and young adulthood.
• Pregnancy, labor, delivery, and the postpartum period (after birth) can increase risk in certain circumstances, such as pre-eclampsia.
• In adults, alcohol abuse, strokes, trauma, CNS infections, and brain tumors can lead to seizures.
• In the elderly, cerebrovascular disease is a prevalent cause. Other causes include CNS tumors, head trauma, and degenerative diseases such as dementia which are more frequent in this age group.

Complications

Seizures can have several short-term and long-term complications. These may include:

• Brain damage. Seizures can cause varying degrees of brain injury, depending on their severity and duration.
• Injury from falls. People who experience seizures may fall and injure themselves if they are not in a safe environment.
• Emotional and psychological issues. Seizures can lead to anxiety, depression, fear, social isolation, and mental health problems.
• Drowning. People with seizures may have a higher risk of drowning if they have them while in the water.
• Car accidents. People who experience seizures can be at risk of car accidents if they have them while driving.

Risk Factors

Several factors can increase the risk of seizures. These include:

• A family history of epilepsy or seizure disorders
• Head trauma
• Stroke
• Brain tumors
• Infections such as meningitis and encephalitis
• Alcohol abuse or withdrawal
• Certain medical conditions include kidney or liver disease, high fever, low blood sugar levels, and electrolyte imbalance.
• Drug use (stimulants, narcotics, and other drugs)

Pregnant women may also be at an increased risk for seizures due to hormonal changes. Additionally, certain medications, such as sedatives, tranquilizers, and antipsychotics, can cause seizures in some individuals.

Medication

Seizure medications function by elevating the threshold for seizures. While there are a variety of drugs available for seizure treatment, the following are frequently used in clinical practice: 

1. Levetiracetam (Keppra): Available IV and PO. Patients typically start on this IV and then transition to PO when they can safely swallow medications. Keppra can cause dizziness, fatigue, and weakness.
2. Phenytoin (Dilantin): Available IV and PO. Dilantin is known for causing nystagmus, gingival hyperplasia, and drug interactions.
3. Valproic acid (Depakote): Available IV and PO. Valproic acid can cause sedation, weight gain, tremors, and hair loss.
4. Lamotrigine (Lamictal): Available IV and PO. Lamictal is known for causing dizziness, headache, and rash.
5. Fosphenytoin (Cerebyx): Available IV. Cerebyx can cause dizziness, nausea, and vomiting.
6. Other treatments may include lifestyle modifications such as avoiding triggers or taking part in relaxation techniques. Surgery, vagus nerve stimulation, dietary changes (such as a ketogenic diet), and brain stimulation therapies are other potential treatment options that may be used to reduce the frequency and severity of seizures.

Seizure Precautions Nursing Management

Nursing care for a child with a seizure disorder includes the following:

Nursing Assessment

Nurses should assess the patient’s medical history, family history of seizures, and current medications. They should also evaluate for precipitating factors or triggers contributing to the seizure.

Nursing Interventions for Seizures

• Nurses should ensure the child’s safety by placing them in a side-lying position with padding under their head and neck if possible. It is also essential to ensure that the airway remains open and that any secretions are removed from the mouth.
• Nurses should monitor vital signs such as temperature, pulse rate, blood pressure, and respiration. They should also assess for any changes in consciousness or responsiveness.
• Nurses should document the seizure activity, including onset time, duration, and post-seizure symptoms. This information can be used to help determine the best course of treatment.
• Other nursing interventions may include providing emotional support and comfort to the patient and family members, teaching them about the condition and recognizing the signs of a seizure, and helping them make lifestyle modifications to reduce the risk of seizures.

Nursing Diagnosis For Seizure

Based on the assessment data, the primary seizure nursing diagnoses are:

1. Risk for Injury related to falls and lack of awareness of the environment during seizure activity

2. Knowledge Deficit related to the etiology, prognosis, and management of seizure disorder

3. Anxiety related to unpredictable episodes of seizures

4. Fatigue related to chronic illness or medication side effects

5. Impaired Social Interaction related to fear associated with having a seizure in public

6. Activity Intolerance related to fatigue caused by medications or recurrent seizures 

Nursing Care Planning and Goals

Nursing care aims to support and educate the patient and family to reduce the risk of injury, improve knowledge about seizure disorder, decrease anxiety and energy levels, improve social interactions, and promote activity tolerance.

Education Interventions 

1. Provide safety measures such as padding the environment and keeping a safe distance between people and furniture during seizures.

2. Teach the patient and their family about the etiology/prognosis of the condition, medications used for treatment, lifestyle modifications that can reduce seizure frequency or severity, warning signs or triggers for seizures, first aid measures when seizures occur (tum onto the side, etc.) when to seek emergency help, etc.

3. Encourage relaxation techniques such as deep breathing, visualization, and progressive muscle relaxation to reduce anxiety.

4. Assist the patient in making lifestyle modifications such as regular sleep/wake cycles, avoiding triggers or stressors, exercising regularly, etc.

5. Provide emotional support and comfort to the patient and family members during seizures or other difficult times.

6. Monitor for any changes in the level of consciousness, vital signs, or post-seizure symptoms such as headaches or confusion.

7. Refer the patient to additional resources such as support groups or counseling services.

8. Encourage activity tolerance gradually based on individual needs and abilities. 

Evaluation

The goal of nursing care has been met if the patient and family can identify warning signs or triggers for seizures, understand treatment options, make lifestyle modifications to reduce seizure frequency or severity, practice relaxation techniques, and attain an improved level of functioning. The patient should also be able to seek help when needed and access additional resources for support if desired. Nursing interventions should be re-evaluated regularly as necessary based on changes in condition.  

Documentation Guidelines

Documentation in a child with seizure disorder includes:

1. Assessment findings include medical history, family history of seizures, current medications, etc.

2. Seizure activity, including onset time, duration, and post-seizure symptoms

3. Vital signs during seizure activity or post-seizure period

4. Response to nursing interventions or changes in the level of consciousness

5. Patient and family education

6. Referrals to additional resources or support services

7. Re-evaluation of nursing interventions as needed

8. Discharge instructions, including follow-up care, medications, etc.

9. Safety measures implemented for the patient’s environment

Documentation should be completed promptly, and all records should be kept confidential. It is important to remember that seizure disorder can be a life-altering condition, and nursing care is essential in helping the patient adapt to their illness while maintaining the highest quality of life possible.

Final Words

Seizures can be a complex condition to manage, but with the proper treatment and support, patients can achieve a better quality of life. Nursing care is essential in helping patients understand their situation, identify warning signs or triggers for seizures, make lifestyle modifications to reduce risk factors, and access additional resources if needed.

Proper nursing management allows patients to experience fewer seizure episodes and improve functioning. Nurses are essential in helping patients with seizure disorders live fulfilling lives by providing education, emotional support, and appropriate interventions. ​

References

https://en.wikipedia.org/wiki/Seizure

https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711#:~:text=A%20seizure%20is%20a%20sudden,is%20considered%20to%20be%20epilepsy.