How does a nurse prepare a patient with a recent right‑parietal post‑stroke seizure for an electroencephalogram (EEG) and is informed consent required?

EEG Preparation and Consent for Post-Stroke Seizure Patients

Nurses should prepare patients for EEG by explaining the test procedure, ensuring the patient remains NPO until swallow screening is completed, and obtaining informed consent as this is a diagnostic procedure requiring patient authorization.

Patient Preparation Steps

Pre-Procedure Assessment and Education

• Explain the test to the patient and family, describing that EEG is a non-invasive procedure using electrodes placed on the scalp to monitor brain electrical activity 1
• Inform patients that the test typically lasts at least 20 minutes and involves rest periods with stimulation procedures 2
• Reassure patients that EEG is safe, inexpensive, and mobile, making it ideal for bedside use in stroke patients 3

NPO Status and Swallow Screening

• Keep the patient NPO (nil per os) until swallowing screening is completed using a validated tool 1
• This is critical for patient safety, as up to half of stroke survivors are dysphagic immediately after stroke 1
• Do not administer oral medications until swallow screening confirms normal swallowing ability 1
• Consider alternate medication routes (intravenous or rectal) while patient remains NPO 1

Neurological Monitoring

• Perform baseline neurological assessment including level of arousal, cranial nerves, and motor responses 1
• Document the patient's presenting symptoms and any seizure activity 1
• Monitor vital signs at least every 30-60 minutes before the procedure 1
• EEG should be performed as soon as possible after a seizure for optimal diagnostic yield 2

Informed Consent Requirements

Yes, informed consent is required for EEG. While the provided guidelines do not explicitly detail EEG consent procedures, this is a diagnostic test that requires patient authorization as part of standard medical practice. The consent process should include:

• Explanation of the procedure's purpose: to evaluate for seizure activity and rule out precipitating factors 1
• Discussion of the non-invasive nature and safety profile of the test 3
• Clarification that EEG helps confirm or rule out suspected diagnoses but does not definitively prove or exclude seizures on its own 4

Clinical Context for Post-Stroke Seizure Patients

Seizure Risk Assessment

• Seizures occur more commonly after hemorrhagic stroke than ischemic stroke, but both carry risk 1
• Patients with post-stroke seizures have higher 30-day mortality, making immediate evaluation essential 1
• EEG monitoring may be appropriate in patients at high risk of seizures, particularly those with unexplained reduced level of consciousness 1

Timing Considerations

• For new-onset seizures occurring within 24 hours of stroke onset, treat with short-acting medications (e.g., lorazepam IV) if not self-limited 1
• An EEG and other tests to rule out precipitating factors may be warranted in patients with early or late post-stroke seizures 1
• The test should not delay acute stroke treatments if the patient is within treatment windows 1

Common Pitfalls to Avoid

• Do not give oral medications before swallow screening - this significantly increases aspiration risk in stroke patients 1
• Do not delay EEG if seizures are suspected - early EEG is essential for diagnosis and management of epilepsy 2
• Do not assume a single self-limited seizure requires long-term anticonvulsant treatment - prophylactic anticonvulsants are not recommended and may harm neural recovery 1, 5
• Recognize that approximately half of aspirations from dysphagia are silent and go unrecognized, emphasizing the importance of formal swallow assessment 1

Post-Procedure Care

• Continue neurological assessments and vital sign monitoring per institutional protocol 1
• Document EEG results and communicate findings to the interdisciplinary team 1
• If anticonvulsants are initiated based on EEG findings, educate the patient and family about seizure management, medication regimen, side effects, and precautions 1
• Ensure patients understand they should never adjust medications without consulting their physician 1