Seizures occur when there is an uncontrolled burst of electrical activity in the brain that results in abnormalities in muscle control, sensations, and consciousness. Seizures can occur due to an array of conditions such as high fever, alcohol withdrawal, hyperglycemia/hypoglycemia, or brain tumors. These are one-time occurrences related to a specific cause.
Epilepsy is diagnosed when there are two or more unprovoked seizures. Epilepsy can occur at any age and is usually attributed to genetics, prenatal or perinatal causes resulting in brain damage, brain malformations, severe head injuries, and infections in the brain. There are different types of epilepsy with their own manifestations. There is no cure for epilepsy, though some children may outgrow the disorder and others may become seizure-free after years of treatment.
The Nursing Process
Nurses may care for patients experiencing acute seizures in relation to a larger condition or traumatic injury or a patient who has had epilepsy for many years. In both instances, maintaining safety in the event of a seizure is the first priority. When learning a patient has a history or current diagnosis of seizures, seizure precautions should be implemented (bed in the lowest position, padded side rails). Long-term control of seizures requires education and strict adherence to a treatment plan which the nurse can encourage and support.
Nursing Care Plans Related to Seizures
Risk For Injury Care Plan
Seizures can result in a loss of awareness, consciousness, and voluntary control of the body increasing the risk of falls, injury, and trauma.
Nursing Diagnosis: Risk For Injury
- Loss of muscle control
- Loss of consciousness
- Altered sensations
- Impaired swallowing/airway clearance
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not occurred yet and the goal of nursing interventions is aimed at prevention.
- Patient will remain safe and free from injury when experiencing a seizure
- Patient will modify their environment to prevent injuries from seizures
- Patient and family members will verbalize how to keep the patient safe during a seizure
Risk For Injury Assessment
1. Explore seizure patterns.
Help the patient identify specific times or triggers of seizure activity and how to recognize symptoms so they can keep themselves safe or alert someone else to monitor them.
2. Assess availability of family/caregiver.
Assess if the patient has family support or if they live alone. If caregivers or support is available, ensure they understand what to do in the event of a seizure.
Risk For Injury Interventions
1. Ensure a patent airway.
Turn the patient into their side if lying to maintain an open airway and prevent aspirating. Loosen clothing around the neck. Do not place any objects in the mouth. Apply oxygen if the patient displays respiratory distress.
2. Remove hazardous items.
Remove unnecessary furniture or sharp objects that could cause injury during a fall. Keep their bed in the lowest position.
3. Do not restrain, monitor closely.
A patient who is actively seizing should never be restrained as this can further increase injury. Keep them safe by providing pillows or padding if on a hard surface. Patients in the hospital often have their bed rails padded and a mat on the floor.
4. Instruct on activities that require additional precautions.
A seizure can occur at any moment. Working at heights, swimming unattended, using heavy machinery or power tools, and even driving can be dangerous for a patient, especially if their seizures are not controlled.
5. Encourage a medical alert bracelet or identification.
When a medical emergency occurs, having a medical alert bracelet on or easily accessible identification will assist medical personnel in appropriately treating the patient during a seizure.
Deficient Knowledge Care Plan
A lack of knowledge regarding triggers, treatment, and prevention predisposes the patient to poor seizure control.
Nursing Diagnosis: Deficient Knowledge
- Lack of understanding of seizure causes
- Poor understanding of seizure triggers
- Disinterest in seizure information
- Inability to recall provided education
As evidenced by:
- Poor adherence to medications
- Increase in seizures
- Injury from seizure activity
- Patient will verbalize an understanding of their type of seizure and related symptoms
- Patient will report recognizing their individual seizure triggers
- Patient will report adherence to their medication regimen with no missed doses for 30 days
Deficient Knowledge Assessment
1. Assess the patient’s knowledge of their seizure.
Many types of seizures present with their own set of symptoms. Assess the patient’s knowledge of precipitating factors such as auras, and modifiable risk factors that increase their risk of experiencing a seizure.
2. Assess the patient’s adherence to activity limitations.
Many state laws require a patient to be seizure-free for 6 months to operate a vehicle. Adhering to other safety precautions such as not partaking in high-risk sports or being unattended when swimming or even bathing. Assess the patient’s understanding of why these precautions exist and their adherence to them.
3. Review adherence to medications.
Missed doses of anti-seizure drugs can lead to breakthrough seizures. Review the patient’s understanding of strict adherence to their medication regimen.
Deficient Knowledge Interventions
1. Instruct on keeping a seizure diary.
The patient should be instructed to keep a log of their seizures including the date, time, duration, aura symptoms, and potential triggers. They may notice a pattern and be able to recognize triggers giving them more empowerment over their seizures.
2. Review potential triggers.
There are many potential triggers of a seizure and the patient should be educated on recognizing theirs. Common triggers include stress, flashing lights, menstruation or hormonal changes, medications, lack of sleep, illness, heavy alcohol use or withdrawal.
3. Help the patient to recognize warning signs.
Seizures can be unpredictable but there are often signs that a seizure is going to occur. An “aura” will be different for each patient but can include unusual feelings, smells, or sensations. The patient may describe an “out-of-body” experience or deja vu. The patient should learn to recognize these symptoms and prepare for an impending seizure.
4. Provide an action plan.
A diagnosis of epilepsy is life-long. An action plan includes information such as the patient’s medication list, healthcare contacts (neurologist, preferred hospital, pharmacy), medical history, and specific seizure details. The patient should have this available at all times and provide copies to their family members for continuity of care.
Caregiver Role Strain Care Plan
Caregiver role strain can result from caring for a child or family member struggling with epilepsy or as a caregiver who personally has epilepsy and is experiencing difficulty in juggling responsibilities with their disorder.
Nursing Diagnosis: Caregiver Role Strain
- Chronic seizures
- Unpredictability of seizures
- Lack of family support
- Insufficient finances
- Lack of resources
As evidenced by:
- Increased stress
- Anxiety, depression
- Disturbed sleep
- Inability to drive resulting in unreliable transportation
- Inability to maintain employment
- Inability to safely care for young children
- Isolation from family and friends
- Caregiver will identify resources to improve family processes
- Patient will report an improvement in caregiver role as evidenced by control of seizures
- Patient will voice realistic expectations of themselves as a caregiver
Caregiver Role Strain Assessment
1. Assess the patient’s role as a caregiver.
Assess the full responsibilities of the caregiver whether they have seizures or they are a caregiver to someone with seizures.
2. Assess for a dependable support system.
Assess for other adults that provide support. A patient that is unable to work or drive due to their seizures will require the support of others.
3. Assess patients’ perception of their epilepsy and its impact.
A patient may feel that their disorder cannot be controlled and may give in to a loss of independence and isolation from living a full life. Encourage the expression of these thoughts to further apply interventions.
Caregiver Role Strain Interventions
1. Recommend an epilepsy center.
All patients with epilepsy should have a neurologist they see regularly. More complex seizure disorders may require assessment at an epilepsy center that provides comprehensive testing and treatment.
2. Encourage delegation and coordination.
The caregiver with epilepsy or parent of a child with epilepsy must learn their strengths and weaknesses in their role. Coordinating and delegating tasks will allow the epileptic patient to feel useful and the caregiver will feel less burdened.
3. Offer resources.
Local epilepsy support groups assist with navigating the role of caregiving and being a caregiver with epilepsy. Grants and funds can assist with financial costs, housing, and transportation.
4. Refer to case management.
Nurse case managers can assist with supporting the patient with epilepsy or the parents of a child with epilepsy. They can provide education on surgical options, dietary recommendations, stress management, and coordinate care with epilepsy providers or other specialists.
References and Sources
- Al Sawaf A, Arya K, Murr N. Seizure Precautions. [Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536958/
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Evaluation of a First-Time Seizure. (n.d.). Johns Hopkins Medicine. Retrieved February 28, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/evaluation-of-a-firsttime-seizure
- First Aid for Seizures. (2015, August 10). Cleveland Clinic. Retrieved February 28, 2022, from https://my.clevelandclinic.org/health/articles/6998-seizures-first-aid
- Schachter, S. C. (2021, July 22). Learn / Triggers of Seizures. Epilepsy Foundation. Retrieved February 28, 2022, from https://www.epilepsy.com/learn/triggers-seizures
- Service Coordination/Case Management Programs. (n.d.). Epilepsy Foundation. Retrieved February 28, 2022, from https://www.epilepsy.com/local/northeastern-new-york/programs/service-coordinationcase-management-programs