Seizure hall

Nursing Diagnosis & Care Plan for Seizures-A Student’s Guide

Introduction

A seizure is a type of disorder characterized by a sudden, short-term disturbance of the brain activity involving involuntary changes in sensation, behavior, consciousness, or motor function. This article is about the nursing diagnosis and care plan for seizures, and is meant as a guide to nursing students.

When determining a patient’s needs regarding nursing strategy, it is important to know that:

The onset of this disorder can be either sudden or gradual. Sudden onset usually involves intense involuntary motor activity, such as abdominal and chest muscle contractions or jerking of the limbs. The patient may have a loss of bowel and bladder control during a seizure.

Seizures are often characterized by a blank stare, called an “ictal phase.” Afterward, there is usually confusion and lack of memory, called an “interictal period.”

A seizure is described as generalized or partial. A generalized seizure affects both sides of the brain; a partial seizure involves only one side.

There are three classifications of seizures:

  • Generalized seizures- Tonic-clonic, Absence, Myoclonic and Tonic seizures
  • Partial Seizures – Partial Seizures – Simple auras without loss of consciousness, complex partial or secondary generalization with possible loss of consciousness.
  • Complex partial seizures – Transient sensations and movements without awareness. A warning sign does not always precede seizures. A sensation of an aura is possible in 10% to 66% of cases, but it is not definite. When an aura does occur, it may happen before or during the seizure. The most common symptom that people experience prior to a seizure is an emotional

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Nursing Assessment for Seizures

– Numbness or tingling in an arm or leg

– Jerking movements of the arms or legs

– Sudden loss of consciousness, “black out.”

– Oxygen deprivation due to breathing problems resulting from muscle spasms. Some people may have convulsions so strong that they break bones, especially of the spine.

– Brain injury from falls

-Physical stress and sleep deprivation

-Alcohol withdrawal

-Concussions and traumatic brain injuries caused by accidents or explosions.

The disorder’s onset is often sudden and may involve intense involuntary motor activity, such as abdominal or chest muscle contractions or jerking of the limbs.

-The patient may have loss of bowel and bladder control during a seizure.

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Nursing Care Plan for Seizures:

Nursing diagnosis 1: Fluid volume deficit or excess related to seizure activity

Risk factors may include

  • Inadequate oral intake
  • Catheter or tube feeding
  • Diabetic ketoacidosis
  • Increased urinary output
  • Antihypertensive medication (e.g., diuretics)
  • Diarrhea or vomiting associated with a virus or other cause
  • Sepsis
  • Acute respiratory distress syndrome (ARDS)

Nursing care plan goals:

Use the following nursing interventions as indicated:

  • Administer IV fluids as prescribed to maintain hydration status and prevent dehydration, especially in clients who are unable or choose not to eat.

Rationale: IV fluids may be given either on an intermittent or continuous basis, depending on the type of seizure activity and severity of dehydration.

  • Administer prescribed medications as ordered to control seizures and associated effects.

Rationale: Helps to prevent fluid volume deficit or excess resulting from seizure activity (e.g., excessive salivation, perspiration, urinary output).

  • Keep accurate medication administration records for each seizure.

Rationale: Helps to prevent medication errors resulting from misinterpretation of symptoms and side effects (e.g., postictal drowsiness or confusion mistaken for hypoxia) and provides a record for the client to review.

Nursing diagnosis 2: Activity intolerance related to seizure activity

Risk factors may include

  • Unrestrained motor behavior, especially in children and senior clients (e.g., running about)
  • Activities that require alertness and concentration (e.g., driving a car, operating machinery, caring for children)
  • Unfamiliar surroundings or a new environment
  • The reassuring presence of familiar persons

Nursing care plan goals:

  • Maintain or improve activity level.

Use the following nursing interventions as indicated.

  • Encourage clients to limit exposure to seizure triggers (e.g., chemicals, stressors).
  • Identify and eliminate as many seizure triggers as possible.

Rationale: Helps to prevent further injury resulting from a seizure during the activity (e.g., the client could fall, hit self, or hurt others).

  • Opportunities for rest

Rationale: Rest helps to increase alertness and mental clarity.

  • Carefully plan activities that require alertness and concentration.

Rationale: Carefully planning activities help to prevent injury to the self or others (e.g., automobile accidents, machinery mishaps).

  • Follow physician’s orders for activity level as prescribed; avoid strenuous activities that could cause a seizure.

Rationale: Follows physician’s orders, maintains or improves activity level, and prevents injury to the self or others.

  • Prioritize activities for clients with postictal weakness (e.g., ambulating, showering).

Rationale: Activities that require less energy are more easily accomplished by weak clients.

  • Minimize stressors and opportunities for harm to self or others.

Rationale: Carefully planned activities help to prevent further injury from a seizure during the activity (e.g., the client could fall, hit self, or hurt others).

  • Alertness and mental clarity: Maintain awareness of surroundings. Stay with others if possible.

Nursing diagnosis 3: Low self-esteem.

Risk factors may include

  • Inadequate social support system
  • Poor self-image (e.g., obesity, disfigurement)
  • Functional limitations (e.g., impaired mobility, cognitive problems)
  • Fear of having another seizure (mortality rates for epilepsy are high, and many clients have visible physical signs of the condition; many are reluctant to disclose their condition)
  • Limited support for living independently (e.g., physical disability, mental retardation)
  • Life-threatening consequences of a seizure episode (e.g., head trauma from falls, coexisting medical conditions)

Nursing care goals:

  • Improve self-image.

Use the following nursing interventions as indicated:

Identify resources for information and support about epilepsy (e.g., self-help groups, websites).

  • Rationale: Having a better understanding of the condition may improve the client’s self-image.

Support activities that help to restore self-worth.

  • Rationale: Activities that encourage self-worth help to improve the client’s self-image (e.g., recreational, occupational, and independent living activities).

Carefully plan for first seizure activity after discharge from the hospital (e.g., driving) if appropriate; obtain necessary special equipment or instruction for safe use of equipment.

  • Rationale: Carefully planning helps to prevent further injury from a seizure (e.g., the client could injure self, others, or property).

Activity intolerance related to seizure activity: Avoid situations that increase seizures (i.e., precipitating events) and limit activities that are implicated in seizures.

  • Rationale: Carefully planning activities that require alertness and concentration helps to prevent further injury during a seizure.

Carefully plan driving activity as prescribed by a physician; use support person or special equipment (e.g., automatic transmission, antiepileptic medications) to help prevent car accidents.

  • Rationale: Driving is an activity that requires alertness and concentration to prevent further injury during a seizure.

Follow physician’s orders for activity level as prescribed; avoid strenuous activities that could cause a seizure.

  • Rationale: Follows physician’s orders, maintains or improves activity level, and prevents injury to the self or others.

Nursing diagnosis 4: Blocked airway/ compromised breathing pattern.

Risk factors may include:

  • Perceptual impairment (e.g., visual or hearing impairment)
  • Oral and pharyngeal dysfunctions (e.g., trismus, oropharyngeal dysphagia)
  • Airway obstruction (e.g., tongue, tumor, dentures)
  • Mucosal edema and inflammation (as a result of conditions that may accompany seizures such as cerebral tumors, brain injury)

Nursing care goals:

  • Promote airway patency.

Use the following nursing interventions as indicated:

Protect client’s airway (e.g., suction if obstructive mucus) during activity and at risk times for seizures when sedation is not used.

  • Rationale: Prolonged obstruction of the airway increases the risk for aspiration and is dangerous.

Provide adequate lighting, assistance with mobility (e.g., handrails), and appropriate positioning of equipment to ensure safe activities.

  • Rationale: Safe activities promote client independence in self-care skills.

Assess client’s tolerance for activity and current limitations; avoid activity if it causes pain or fatigue, exacerbates symptoms (e.g., seizures), or causes decubitus ulcer formation.

  • Rationale: Preventing further injury to the self and others is a priority.

Minimize discomfort by ensuring that oral care is provided; apply appropriate nonirritating mouth rinses, lubricants, toothpaste, and dental appliances.

  • Rationale: The mouth is the route of entry for food and fluids into the body; oral care promotes comfort and the client’s safety.

Use appropriate positioning to prevent airway obstruction (i.e., head tilt or elevation) during or after seizure activity as prescribed by the physician; help the client assume or maintain a position that improves airway patency (e.g., sitting, prone).

  • Rationale: Helps to prevent obstruction of the airway, aspiration, and decubitus ulcer formation.

Use special positioning and handling techniques as prescribed by the healthcare provider to maintain the client’s safety if seizures and postictal states occur frequently.

  • Rationale: Special positioning and handling techniques help to prevent airway obstruction, aspiration, decubitus ulcer formation, or injury.

Nursing Diagnosis 5: Trauma/ risk for suffocation.

Risk factors include:

  • Severe or prolonged seizure activity with loss of consciousness.
  • Weakness, such as that caused by alcohol or sedative-hypnotic medications.
  • Postictal states may include drowsiness, confusion, disorientation, agitation, and inability to communicate adequately (i.e., verbal output limited or difficult to interpret).
  • Sensation loss (i.e., the client may not feel pain).

Nursing care goals:

  • Prevent injury during seizure activity and postictal state; ensure safety when the client is at risk for trauma.

Use the following nursing interventions as indicated:

Position client to prevent head/facial injuries (e.g., padded sides of the bed, soft pillow).

  • Rationale: Protects client from injury during seizure activity or postictal state. Protects client from injury during seizure activity or postictal state.

Relieve excessive salivations by keeping mouth slightly open (e.g., during sleep); consider installing suction devices in the home environment.

  • Rationale: Allows excess saliva to drain, reduces chances for aspiration and decubitus ulcer formation.

Use special positioning and handling techniques as the healthcare provider prescribes to prevent trauma (e.g., airway obstruction, incontinence) if seizures and postictal states occur frequently.

  • Rationale: Special positioning and handling techniques make the client safe during seizure activity or postictal state.

Nursing Diagnosis 6: Knowledge deficit.

Risk factors include:

  • Client’s limited health literacy.
  • Failure to provide adequate information about anticonvulsant medications; physician-provided drug information is frequently inadequate regarding adverse effects, contraindications, dosage schedules, and therapeutic interactions.
  • Patient/family misconceptions (e.g., seizure activity is a sign of impending death, life will never be the same after a seizure).

Nursing care goals:

  • Improve client’s knowledge about medications and seizures.

Use the following nursing interventions as indicated:

Administer medications according to physician orders; provide education about appropriate administration (e.g., with food, if possible).

  • Rationale: Improves compliance and helps prevent harmful side effects of medication(s). Medication may need to be administered at different times for different reasons.

Provide education about the nature and course of epilepsy.

  • Rationale: Clients need to understand how seizures occur, what triggers them, and when they are likely to occur. Knowledge empowers clients in their ability to control the condition and live a normal life.

Encourage the client to monitor themselves for seizure triggers (e.g., stress, missing meals).

  • Rationale: Early identification of triggers may allow the client to take preventive action and reduce the frequency or severity of seizures.

Teach family/significant others about medications and their side effects; provide information about equipment maintenance in the home environment.

  • Rationale: Client compliance and comfort are improved, as is the ability to detect adverse reactions to medications. The family or significant others need information about seizures, anticonvulsant medications, appropriate seizure precautions in the home setting (e.g., removal of sharp objects), maintenance of equipment (if applicable), and how to give emergency treatment.

Provide information about epilepsy for schools, employers, and other settings outside the home to which the client will be exposed (e.g., community groups).

  • Rationale: Clients are empowered with knowledge that may reduce their vulnerability to discrimination by others who lack awareness of epilepsy as a manageable condition.

Nursing diagnosis 7: Anxiety/fear.

Risk factors include:

  • Client’s poor self-concept; family concerns about epilepsy and its impact on the family, siblings of the client, or economic status.
  • Seizure triggers (e.g., stress, fatigue); frequent seizures.

Nursing care goal: Reduce the anxiety/fear related to epilepsy.

Use the following nursing interventions as indicated:

Prepare client and family for what to expect during and after seizures.

  • Rationale: Prepares clients/families/significant others for expected irregularities in their lives (e.g., changes in behavior or personality, fatigue, confusion, memory lapses). Assures client and family that episodes will pass, and the client will return to their previous self.

Reassure the client that seizures are not a sign of impending death.

Teach relaxation techniques (e.g., deep breathing, guided imagery).

  • Rationale: Can reduce the anxiety associated with seizures. Assists client in coping with their fear of having another seizure and allows for better adherence to an anticonvulsant medication regimen. Encourages a positive feeling about life by reducing the stress around epilepsy.

Provide opportunities for client contact with others who are knowledgeable about epilepsy.

  • Rationale: Enhancing the client’s self-esteem and control over the condition by providing a positive role model.

Plan activities that will help keep the client busy and focused on valued life tasks.

  • Rationale: Reduces boredom, which can contribute to restlessness and difficulty concentrating, which may increase anxiety.

Nursing diagnosis 8: Impaired family functioning related to epilepsy.

Seizure triggers (e.g., stress).

The following interventions may help manage the crisis related to the impact of epilepsy on family functioning. The interventions are listed in order of priority, from those that should be implemented first to those that may be helpful when the immediate crisis has been resolved:

Reassure client and family that seizures are not a sign of impending death.

  • Rationale: Can reduce feelings of helplessness or hopelessness and contribute to enhanced coping ability.

Reassure client and family that the seizures will not cause permanent brain damage.

  • Rationale: Can reduce feelings of helplessness or hopelessness and contribute to enhanced coping ability.

Help the client identify areas in which emotional support from family members would be helpful (e.g., help with driving when the client is on medication).

  • Rationale: Can promote feelings of closeness and comfort.

Encourage the client to go out in public as much as possible (e.g., to work, school, church, shopping) despite fears about having a seizure in crowds; have family members talk this over with the client.

  • Rationale: Can promote a sense of mastery and confidence in coping with the situation.

Help the client maintain contact with other individuals with epilepsy (e.g., support group).

  • Rationale: Social interaction may provide emotional support to help reduce feelings of isolation.

Encourage family members to do the following:

Occasionally attend support group meetings.

Discuss feelings with other family members so that these feelings can be shared and understood by other important people in their lives.

  • Rationale: Can promote family communication about any problems caused by epilepsy (e.g., deceiving friends or coworkers about the seizures). The increased coping skills of family members will reduce the client’s feelings of helplessness.

Provide a balanced discussion of any triggers that the client has identified (e.g., stress).

  • Rationale: Can reduce feelings of helplessness or hopelessness and contribute to enhanced coping ability.

Nursing diagnosis 9: Noncompliance related to medication side effects

Risk factors may include

  • Lack of knowledge about side effects
  • Difficulty in talking with a physician.

The following interventions may be useful in managing the nonadherence related to medication side effects. The interventions are listed in order of priority, from those that should be implemented first to those that may be helpful when the immediate crisis has been resolved:

Help the client feel empowered by educating them about all possible side effects of anticonvulsant medications.

  • Rationale: Can build a partnership with the client to help manage the problem of nonadherence.

Help client and family understand that side effects are not uncommon and vary from individual to individual.

Facilitate discussion of medication side effects; encourage the client to discuss concerns about side effects with a physician.

  • Rationale: This can increase the client’s feelings of being heard and understood, facilitating the client’s trust in the health care provider.

Help the client initiate discussions with a physician regarding medication side effects (e.g., have family members help talk this over with the client).

  • Rationale: Can promote a sense of control; help client to feel more in charge of the situation.

Help the client and family identify ways other than noncompliance to cope with side effects (e.g., distraction).

  • Rationale: Can promote independence or autonomy.

Nursing diagnosis 10: Disturbed personal identity related to an epileptic seizure disorder

Risk factors may include

  • Loss of control associated with the seizure disorder
  • Physicians lack of client information.

The following interventions may help manage the disturbed personal identity related to an epileptic seizure disorder:

Help the client develop a realistic positive belief about their ability to function and accurately assess future capabilities.

  • Rationale: Can enhance the client’s self-esteem; can promote autonomy, a sense of empowerment, and increased hope for the future.

Encourage the client to develop a personal seizure action plan.

  • Rationale: Enhances self-control, promotes independence, and increased client participation in care; may help the client identify precipitants of seizures.

Realize that each seizure is stressful for the client and family members; encourage them to talk about their feelings about what they have experienced.

  • Rationale: Encourages family members to share their feelings about the seizures and helps them understand the client’s experiences; can help mitigate or prevent family disruption.

Identify support groups for people with epilepsy that may be available in your community.

  • Rationale: May promote positive coping, improved quality of life, and enhance self-esteem.

Treatment for Seizure Dependent Epilepsy

Despite many years of research, there is currently no cure for epilepsy. However, medications are available to control seizures in about 70% of adults and 50% of children.

The long-term goal in managing a seizure disorder is to reduce the frequency and severity of seizures while maximizing the number of days between seizures and minimizing the adverse long-term side effects of treatment.

The first action after a seizure is to ensure that the cause has been identified, as described earlier.

Medical management of seizure

Medical management of seizure disorders consists of controlling the seizures through medication.

The medical approach to seizure management is based on identifying an underlying cause for the seizures and then using medications targeted at that individual cause.

Medical management includes a combination of both drugs and lifestyle adjustments, such as diet control, sleep hygiene, stress reduction techniques, homeopathic/natural remedies, and other alternative treatments.

The nurse’s role in seizure management is to educate the client on how to safely manage a seizure at home and assist with medication adjustments when appropriate.

There are several categories of medications used to manage seizures: anticonvulsants, sedatives/hypnotics (used as an adjunct therapy), other antiepileptic medications, and antimicrobials.

Antiepileptic medications are used to control seizures and are effective in about 70% of adults and 50% of children.

Anticonvulsants (also called antiepileptic drugs or AEDs) are the primary medications used for seizure management. They include carbamazepine, clonazepam, divalproex sodium, ethosuximide, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin sodium, primidone (also called valproic acid), topiramate, and zonisamide.

Antimicrobials are used for seizure management in persons with a bacterial infection, such as meningitis. They include cefotaxime sodium, ceftriaxone sodium, and tobramycin sulfate.

A sedative/hypnotic is an adjunctive therapy that can be used if seizures cannot be controlled by AEDs alone. These medications include clonazepam, lorazepam and zolpidem.

Other medications used to manage seizures that do not fall into any particular category are gabapentin, levetiracetam, pregabalin, and topiramate.

A significant goal of seizure management is to achieve complete control of all signs of seizure activity for as long as possible. The next goal is to minimize side effects.

Treatment plans are formulated based on the underlying cause of the seizure, not by specific types of seizures or epilepsy syndromes.

Nurse responsibilities while administering medical treatment for seizure

  1. The nurse is responsible for managing the client’s medication regimen, including monitoring effectiveness and side effects.
  2. The nurse is responsible for identifying problems with the medication therapy. This includes taking medications correctly, missing doses, or drug interactions.
  3. The nurse is responsible for educating the client and family members about their specific treatment plan.
  4. The nurse is also responsible for educating the client and family members about seizure first aid, signs and symptoms suggesting a change in medication, or adverse effects of medications.
  5. The nurse should be able to identify side effects of anti-seizure medications resulting from either therapeutic or toxic levels. The nurse should consult with the physician if there are significant problems with the client’s medications or with the client’s overall health.
  6. The nurse is responsible for implementing lifestyle and behavioral modifications, such as controlling infections. The nurse should also assist the client in developing self-management skills to help ensure success with the treatment plan.

Nurse responsibilities after a seizure occurs.

  1. In the emergency situation, if an individual experiences a single generalized tonic-clonic seizure of more than 5 minutes duration, the nurse should take an incident history to determine the onset, duration, and aura (if present), if any.
  2. The nurse will also record a brief description of the seizure symptoms and follow seizure precautions as dictated by hospital policy. The patient will be re-evaluated after each episode of status epilepticus or prolonged seizures to confirm the diagnosis, document the seizure type, and estimate future risks.
  3. The nurse obtains baseline vital signs, including a temperature reading in the rectum or axilla (depending on hospital policy) and respiratory rate. The patient will be observed for 1-2 hours for recurrent seizures. If none occur, then they are discharged home with instructions to return for a follow-up visit. If recurrent seizures do occur, the patient will be admitted to the hospital and placed on an anticonvulsant immediately to prevent further seizure activity.
  4. The nurse should obtain a complete medication history, including all past illnesses, allergies, treatments, and current medications.

Patients responsibility for seizure management

  1. The client is responsible for managing the medications correctly, taking them at the scheduled time, and not missing doses.
  2. The client is responsible for informing health care providers about home remedies, alternative therapies, or other medication use that could affect clinical treatments.
  3. The client is also responsible for maintaining overall health, with nutrition and rest; avoiding excessive alcohol and caffeine; maintaining appropriate levels of stress; exercising regularly, avoiding recreational drug use.
  4. The client is responsible for reporting signs or symptoms suggesting a change in treatment plan or adverse effects of medication – such as the onset of new seizure activity, failure to respond to initial treatments with AEDs, side effects that cannot be tolerated.
  5. The client is responsible for maintaining a seizure journal so that patterns of seizure activity can be identified.
  6. The client is responsible for reporting any failure to reach therapeutic levels or the presence of therapeutic levels toxic side effects.

The responsibility of the nurse, when it comes to seizures, is to monitor and educate. The client should monitor their health by maintaining a seizure journal and reporting signs or symptoms suggesting adverse effects of medication or changes in the treatment plan.

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