This is a disorder that involves a sudden episode of abnormal, uncontrolled dis-
charge of the electrical activity of the neurons within the brain. The patient may
experience a variety of symptoms depending on the type of seizure and the cause.
Seizures may be a symptom of another condition—such as a tumor or stroke
which has increased the intracranial pressure, a metabolic disorder, withdrawal
from alcohol or drugs—or may be due to a chronic seizure disorder such as
epilepsy. Prior to the seizure, the patient may experience an aura, a sensory alter-
ation involving sight, sound, or smell. After the seizure, the patient enters a
post-ictal stage where there may be confusion and the patient is often fatigued. The
patient may not recall any of the seizure or the time immediately surrounding
the seizure.
TREATMENT
If there is an underlying condition causing the disorder, removal of this condition
will often result in resolution of the disorder. The patient with a primary seizure
disorder will typically be managed with anticonvulsant medications. Some patients
will need multi-drug regimens to adequately control the seizure disorder. Patients
who do not respond to multiple antiepileptic drugs may be candidates for surgical
intervention.
• Administer antiepileptic medications:
• carbamazepine
• phenytoin
• phenobarbital
• clonazepam
• valproic acid
• lamotrigine
• gabapentin
• levetiracetam
• oxcarbazepine
• primidone
• tiagabine
• topiramate
• Seizure precautions per institution.
• Maintain IV access with saline lock if no intravenous fluids needed for hos-
pitalized patients.
• Surgery to remove seizure focal area or sever the connection between the cere-
bral hemispheres (corpus callostomy) to limit the amount of seizure activity
for patients who do not have adequate control of seizures with medications.
• Vagal nerve stimulation where there is implantation of an electrical device
that provides a predetermined pattern of vagal stimulation. This is used to
decrease the frequency of seizures.
NURSING DIAGNOSES
• Risk for ineffective breathing pattern or airway clearance
• Risk for fall
• Anxiety
NURSING INTERVENTION
• Monitor patient during the seizure for breathing, skin color (cyanosis)—
patient may have diminished oxygenation during seizure.
• May need supplemental oxygen post-seizure.
• Keep oxygen equipment and suction equipment and emergency airway man-
agement equipment at bedside (intubation may be performed by anesthesi-
ologist, nurse anesthetist, or respiratory therapist).
• Monitor duration of seizure and progression of symptoms.
• Monitor for incontinence of bladder or bowel.
• Monitor for status epilepticus—prolonged seizures or repeated seizures,
considered a medical emergency.
• Position patient to decrease risk of injury:
• remove objects that may injure patient.
• turn patient on side to reduce risk of aspiration.
• do not insert anything in patient’s mouth during seizure.
• Assess the patient post-seizure.
• Explain to the patient:
• Medication use, side effects, and interactions.
• Importance of taking medications on time, not skipping doses.
• Importance of checking with prescriber before taking any new medica-
tions or over-the-counter (OTC) medications or supplements.
• Have lab tests for drug level of antiepileptic drugs checked as directed.
