What are the nurse interventions and management for a patient currently experiencing a seizure?

From the Guidelines

When a patient is having a seizure, the nurse should first ensure patient safety by moving dangerous objects away, loosening tight clothing, and placing something soft under the head if possible, and then activate emergency medical services if the seizure lasts more than 5 minutes or if it's a first-time seizure, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The nurse should not restrain the patient or put anything in their mouth.

• Position the patient on their side to prevent aspiration
• Time the seizure from onset
• Administer emergency medications as ordered, typically benzodiazepines such as lorazepam 2-4 mg IV, diazepam 5-10 mg IV, or midazolam 5-10 mg IM if IV access is unavailable, although the most recent guideline does not specify the exact medication dosage, the general principle of using benzodiazepines is supported by various studies, including those on pediatric patients receiving chimeric antigen receptor T cell therapy 1
• Maintain airway patency, provide oxygen if needed, and monitor vital signs including oxygen saturation
• Document seizure characteristics including duration, body parts involved, eye movements, incontinence, and post-ictal state After the seizure, continue to monitor the patient, check blood glucose levels, and prepare for potential diagnostic tests. Seizures lasting more than 5 minutes or recurring seizures without recovery between episodes constitute status epilepticus, requiring immediate physician notification and more aggressive intervention, as these interventions are critical because prolonged seizures can cause neurological damage due to sustained neuronal firing and potential hypoxia. The most recent and highest quality study, the 2024 American Heart Association and American Red Cross guidelines for first aid 1, provides the most up-to-date recommendations for seizure management, and its guidelines should be prioritized in clinical practice.

From the Research

Nurse Interventions for Seizure Management

• The primary goal of nurse interventions during a seizure is to ensure the patient's safety and prevent injury 2, 3, 4
• Nurses should be aware of the different types of seizures and their corresponding management strategies, including airway clearance and ventilatory support if necessary 3, 5
• The use of benzodiazepines, such as diazepam, lorazepam, and midazolam, is commonly recommended for the emergency management of seizures 2, 5
• Phenytoin and its prodrug (ACC-9653) are also used in the management of seizures, with the prodrug offering advantages such as rapid onset of action and freedom from drug interactions 2

Management Strategies

• Nurses should follow a seizure classification-based algorithm to determine the appropriate equipment and care for patients with seizures 3
• The algorithm can also be used to educate parents on how to care for their child with seizures at home, ensuring consistency in care between hospital and home settings 3
• Nurses play a crucial role in educating patients and their families on seizure first-aid instructions, teaching points, and online resources for epilepsy management 6, 4
• In cases of status epilepticus, nurses should be aware of the latest treatment strategies, including the use of nasally delivered benzodiazepines and other medications such as levetiracetam, fosphenytoin, and valproic acid 5

Education and Advocacy

• Nurses should act as educators and advocates for patients with epilepsy, providing them with the necessary knowledge and skills to self-manage their condition 6, 4
• Nurses should also be aware of when to refer patients to specialized care or provide additional support, ensuring comprehensive care for patients with epilepsy 4