Seizure Types & Nursing Management

A client stares blankly for 10 seconds then resumes conversation — that was a seizure. If you can't classify it, you can't protect or document it accurately.

Seizures divide into two major categories based on where abnormal electrical activity begins. Generalized seizures involve both hemispheres from onset and always produce loss of consciousness. The most dramatic is the tonic-clonic (grand mal): a tonic phase of rigid muscle contraction (10-20 seconds) followed by a clonic phase of rhythmic jerking (30-60 seconds), often with incontinence and a postictal period of confusion lasting minutes to hours. Absence (petit mal) seizures are brief (5-30 seconds), present as staring spells with possible eyelid fluttering, have no postictal phase, and are most common in children. Focal (partial) seizures originate in one hemisphere. Simple focal seizures preserve consciousness — the client may report an aura (unusual taste, smell, déjà vu). Complex focal seizures impair awareness and produce automatisms (lip smacking, picking at clothes). Nursing priorities during any seizure: stay with the client, do not restrain or insert anything into the mouth, turn to the side when possible, note the time, and document onset body part, progression, duration, and postictal behavior. Pad side rails for known seizure disorder clients and maintain suction at the bedside.

Key Distinctions

Don't confuse absence seizures (brief staring, no postictal phase) with complex focal seizures (automatisms, postictal confusion present). Students often think tonic-clonic is the only generalized type — absence, myoclonic (brief involuntary muscle jerks), and atonic (sudden loss of muscle tone causing 'drop attacks') are also generalized. Never document 'the client had a seizure' — specify the type, body parts involved, duration, and level of consciousness throughout.

Clinical Pearl

Time it, don't fight it. Your job during a seizure is to protect, observe, and document — not to stop the movement or pry open the jaw.