Seizures

A patient 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 patient 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 patient, 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 patients 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 patient 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.

Seizure Precautions

Seizure precautions are a bundle of environmental and nursing actions implemented for any patient at risk for seizures (epilepsy, eclampsia, alcohol withdrawal, post-craniotomy, electrolyte imbalances). The environment is set up proactively: bed in lowest position, padded side rails up, suction equipment at bedside and tested, oxygen and oral airway within reach, IV access maintained. During an active seizure, your priorities follow a strict hierarchy: protect the airway, protect from injury, observe and document. Turn the patient to the side to maintain airway patency and prevent aspiration. Never force anything into the mouth — no tongue blade, no oral airway, no fingers. The patient cannot swallow their tongue; attempting to insert objects risks broken teeth, soft tissue injury, and aspiration of fragments. Time the seizure from onset. If it lasts longer than 5 minutes or seizures recur without recovery of consciousness between episodes, this is status epilepticus — a medical emergency requiring immediate intervention (typically IV benzodiazepines per protocol). After the seizure, the postictal phase includes confusion, drowsiness, and possible incontinence. Maintain a safe, quiet environment, perform a neurological assessment, and document seizure type, duration, body parts involved, preceding aura, and postictal behavior.

Key Distinctions

Don't confuse seizure precautions (proactive environmental setup) with seizure management (actions during the event) — NCLEX tests both separately. Students think you should restrain the patient during a seizure; you never restrain — you guide, not hold. Padded tongue blades are outdated and dangerous; nothing goes into the mouth during a seizure, despite what older references state.

Clinical Pearl

During a seizure: time it, turn them, stay with them. Nothing in the mouth — ever. If it hits 5 minutes, think status epilepticus.