Care of the Patient with Seizures

A seizure is a violent and sudden contraction or trembling of muscles(Sorrentino & Remmert, 2021). It is caused by electrical activity in the brain that is not normal. Seizures may also be called convulsions. A seizure is a neurological disorder that affects any age, gender, race, or socioeconomic status. The causes for seizures can be from injury, trauma, strokes, tumors, or genetic disorders. Seizures can happen at any time of life and have different symptoms. Patients with a seizure condition can live a productive life.

A seizure happens when neurons in the brain make and send (fire) electrical signals in the wrong way. Neurons are part of the nervous system that fire electric signals to the nervous system to tell the body what to do. A wrong electrical discharge can cause a chain reaction throughout the body, which can cause involuntary movements. Involuntary movements can be in any body part, or seizures can be associated with a smell, taste, or vision problem.

Seizures may be temporary due to a fever or a brain injury that heals. Then, the seizures will stop. When seizures keep happening, the person may be diagnosed with epilepsy. With epilepsy, there is permanent damage to a group of nerves in the brain. People with epilepsy can have strange sensations, emotions, or behaviors. Epilepsy cannot be cured, but the symptoms may be controlled (Sorrentino & Remmert, 2021).

The type of seizure is determined by the area of the brain where it starts: generalized seizure or focal seizure. Depending on the type of seizure, the patient can have several phases.

• The prodromal phase gives the patient a feeling that a seizure is about to happen. This may be described as a sense of something about to happen.
• The aural phase is a sensory warning before a seizure, such as smelling, sweating, or seeing a bright light.
• The ictal phase is the actual seizure happening.
• The postictal phase is the recovery or post-seizure phase.

Each phase does not happen in every seizure.

Generalized seizures happen when both sides of the brain are involved. These patients become unconscious and have body and limb movement during the seizure. There are also types of generalized seizures that involve only a brief episode of altered consciousness, repeated movements, or a lack of muscle tone. Generalized seizure activity tends to be varied due to more brain involvement. These generalized seizures are divided into six categories: tonic-clonic, absence, myoclonic, clonic, tonic, and atonic.

A tonic-clonic seizure, also called grand mal seizure, is the most common type of generalized seizure. The patient experiences a loss of consciousness, contraction of the muscle group (tonic) for a short period, and then jerking of the extremities (clonic). The tonic-clonic activity is commonly known as convulsions. The patient may also show signs of cyanosis due to the muscles of the respiratory system contracting, incontinence, tongue biting, and excessive salivation—seizures of this type usually last 60 to 90 seconds. The patient may be exhausted and sleep for hours afterward. They may not feel normal for several days and have no memory of the seizure.

Absence seizures do not have convulsions. These are also called petite mal seizures. These typically happen in children and rarely continue beyond adolescence. Absence seizures are characterized as a blank stare, motionless, and unresponsiveness. However, there can be motion in areas such as lip-smacking, eyelids, or lack of postural tone. The seizures typically last only a few seconds, after which the child can return to normal activity. Sometimes, the seizures are very subtle and may even go unnoticed. The child may complain of seeing flashes of light or may hyperventilate. Hyperventilate means breathing too fast, which can lead to losing consciousness. They may also appear to be daydreaming. Although the seizures do not last long, if untreated, they may happen up to 100 times a day.

Myoclonic seizures are brief muscle contractions. They are seen as bilateral jerking of muscles, typically of the face, trunk, or one or more extremities. Sudden and excessive jerking of the body and extremities can also be seen. These seizures can also happen in clusters and progress to tonic-clonic seizures. Clusters mean multiple seizures happening close together.

Clonic seizures typically begin with a loss of consciousness and sudden hypotonia. Hypotonia means the muscle becomes weak and limp. The seizure is then seen as limp jerking that may not be symmetrical.

Tonic seizures are seen as sudden onsets of increased tone, typically in extensor muscles. The muscle contracts and becomes rigid. These seizures are often associated with falling.

An atonic seizure is a sudden, split-second loss of muscle tone. This loss can manifest as a slackening jaw, drooping eye, or falling on the ground. Atonic seizures are also known as drop attacks. They tend to start suddenly, and the patient loses consciousness. Consciousness usually returns as the person falls. The patient can resume regular activity immediately.

Focal seizures are the most common type of seizures. They begin on one side of the brain and in a specific area. Patients may know they are having a seizure. Often, these patients will say they know the seizure is coming. This sensation is the prodromal or aural phase. The patient may have a sudden flood of emotions, such as joy or anger. They may also report hearing, smelling, or tasting something that is not there.

A focal seizure can also happen when the patient does not know they are having a seizure. In this type of seizure, the patient becomes unconscious and does not remember having the seizure. The seizure may begin locally but can progress throughout the brain and body. Often, there will be repetitive, unpurposeful movements such as lip-smacking, rubbing of clothing, or grimacing. The patient may exhibit confusion, hallucinations, uncontrollable fear, a flood of ideas, or seem to be daydreaming. Often, the seizures will progress to tonic-clonic seizure activity.

The overall goal is to keep the patient safe, free from injury, and maintain daily activities.

There may be stigmatism concerns or anxiety about the next seizure. The patient and caregivers must be educated to identify signs that may indicate an impending seizure and what to do if a seizure happens. Patients with seizures usually cannot drive and have difficulty finding or keeping a job. The independence of the patient is an issue that can lead to depression and anxiety. Community resources and services can help the patient maintain a productive life. The staff or caregivers can help the patient express their feelings and find alternative methods to maintain daily activities. The patient should have a daily routine. The patient needs to stay hydrated, eat well, and take all medications as prescribed. They should avoid alcohol and drugs. The level of disability will vary by patient. Provide basic care needed for their level of activity.

Some patients know that a seizure is coming. They may report a flashing light or tell you they are going to have a seizure. Sweating, flushing, dilated pupils, altered level of consciousness, or a dream-like state may be observed. A blank stare or eyes rolling to the back of the head may also signal an absence of seizure. Brief involuntary muscle jerks may signal a myoclonic seizure. A tonic-clonic seizure may be signaled by sudden body stiffening, then the relaxation of muscles, labored breathing, cyanosis, tongue biting, or incontinence. After a seizure, particularly a tonic-clonic seizure, the patient may be drowsy, weak, confused, have difficulty talking, and complain of headaches or muscle aches.

There is a risk of fall, injury, and trauma during a seizure. If the patient seems about to have a seizure, help them to the floor if they are standing. Loosen constrictive clothing, and do not restrain them. Note the time the seizure started and when it stopped. Call for help. Move furniture or objects away from the patient. Please do not put any objects in their mouth. Place something soft beneath their head if available. Turn them on their side once the seizure is over to prevent choking. Report the seizure immediately to the nurse. Make the patient comfortable. The patient may be embarrassed and tired. Comfort them and assure them they are safe and that help is coming.

Immediately report any seizure activity. The report should include how long the seizure lasted, the description or type of seizure, and if any injury happened. If the patient reported any aura or if you observed any changes in the patient before the seizure happened, be sure to tell the nurse. Report vital signs and if the patient is resting comfortably after the seizure. If the patient was transported to the hospital, be sure to report the name of the hospital (Sorrentino & Remmert, 2021).

Observe the resident for any signs that a seizure occurred that were not witnessed or reported. These can include an abnormal respiratory rate, bitten tongue or cheek, cyanosis, high blood pressure, incontinence, or weakness. Report any findings to the nurse.

Most patients with seizures are taking one or more medications. Signs of medication toxicity or adverse reactions can include lethargy, confusion, sleep problems, slurred speech, nausea, vomiting, diarrhea, or vision problems. Poor hand and gait coordination, lowered mental functioning, and decreased general alertness may also be signs of a problem. If any of these signs happen, report them to the nurse.

Report any concerns the patient has regarding the medication. Also, report any observations you may make that are different from the patient’s baseline. This may include the level of consciousness, gait changes, increased seizure activity, changes in vital signs, or changes in physical appearance.

Scenario/situation/patient description

• Mrs. Johnson is a 72-year-old female with a history of absence seizures and has recently been diagnosed with epilepsy. Recently, Mrs. Johnson has had several new tonic-clonic seizures. When you enter the room, you find Mrs. Johnson on the floor in clonic seizures.

Intervention/strategies

• What should you do first? What are the other steps you need to take? First, call for help. Move objects away from her to help keep her safe. Place a towel or something similar under her head. Loosen clothing, especially around her throat. Be sure to observe the time you found her and the time when the seizure stopped. Obtain vital signs and sit with Mrs. Johnson, keeping her comfortable until help arrives. Report to the nurse

Discussion of outcomes

• Mrs. Johnson receives EMS care and is taken to the hospital. 

Strengths and weaknesses of the approach

• This intervention was correct. It is unknown if more preventive care could have been taken. Planning prevention is the responsibility of the healthcare provider and the RN. The CNA is not responsible for planning but is responsible for following the care plan.

Seizures can have a devastating effect on a person’s life and activities. Stigma, anxiety, and fear can be an issue and cause the patient to develop unhealthy activities. The CNA can provide care by understanding the impact this disorder can have on the patient. Remaining open to discussion and encouraging expression of their concern can help the patient cope with this disorder. Also, understanding how to keep a patient safe during a seizure and caring for the patient afterward are important skills to know when working with patients. Supporting the patient can decrease their concerns and fears as well as promote productive functioning of daily activities.

• Sorrentino, S., & Remmert, L. (2021). Mosby’s Textbook for Nursing Assistants (10th ed.). Elsevier.