What are the nursing responsibilities for seizure precautions?

Nursing Responsibilities for Seizure Precautions

Nurses must immediately help the patient to the ground, place them on their side in the recovery position, clear the surrounding area of hazardous objects, and stay with the patient throughout the entire seizure episode while continuously monitoring for complications. 1

Essential Safety Actions During a Seizure

Immediate Protective Measures

• Position the patient on their side in the recovery position to reduce aspiration risk if vomiting occurs during the seizure or postictal period 1
• Clear the area around the patient of any objects that could cause injury during seizure movements 1
• Remain with the patient continuously throughout the entire seizure episode to monitor for complications and provide ongoing protection 1
• Monitor vital signs, airway patency, and assess for adverse events during and after the seizure 2

Critical Actions to AVOID

• Never restrain the patient during seizure movements, as this causes musculoskeletal injuries and does not stop seizure activity 1
• Never place anything in the patient's mouth (fingers, bite blocks, tongue blades, or oral airways), as this causes dental trauma, airway obstruction, or injury to the rescuer 1
• Never give food, liquids, or oral medications during a seizure or when the patient has decreased responsiveness after a seizure due to high aspiration risk 1

When to Activate Emergency Medical Services

Nurses must recognize situations requiring immediate emergency intervention:

• Seizures lasting >5 minutes require emergency medical services, as they may not stop spontaneously and require emergency anticonvulsant medications 2, 1
• First-time seizures require emergency evaluation for underlying causes 2, 1
• Multiple seizures without return to baseline mental status between episodes 2, 1
• Patient does not return to baseline within 5-10 minutes after seizure activity stops 2

Post-Seizure Monitoring Requirements

Observation Period

• Monitor patients for at least 24 hours for late seizures (tardive seizures) that may occur after the initial seizure event 2
• This 24-hour observation period is the minimum standard of care for seizure monitoring 2

Ongoing Assessment

• Perform regular neurological assessments including level of arousal, cranial nerve function, and motor response 3
• Document all seizure activity including presenting symptoms and observed seizure characteristics 3
• Monitor vital signs at least every 30-60 minutes to ensure hemodynamic stability 3

Special Considerations for Stroke Patients

Aspiration Risk Management

• Keep patients NPO (nil per os) until a validated swallowing screen is completed, as up to 50% of stroke survivors have dysphagia immediately after stroke 3
• Do not give oral medications before completing a swallow screen, as this markedly increases aspiration risk 3
• Recognize that approximately 50% of aspiration events from dysphagia are silent, reinforcing the importance of formal swallow assessment 3

Seizure Risk in Stroke

• Seizures occur more commonly after hemorrhagic stroke than ischemic stroke, but both carry significant risk 4
• Post-stroke seizure patients have higher 30-day mortality, making prompt evaluation essential 4, 3
• Monitor stroke patients continuously for seizure activity and evaluate immediately when it occurs 4

Medication Management Responsibilities

Prophylaxis Guidelines

• Do not initiate routine prophylactic anticonvulsant drugs in stroke survivors who have not had seizures, as this should be avoided 4
• Do not initiate long-term prophylactic anticonvulsants after a single self-limited seizure, as routine prophylaxis is not recommended and may impede neural recovery 3

When Anticonvulsants Are Required

• Educate the patient and family about the seizure condition, pharmacological management, medication regimen, side effects, and precautions 4
• Instruct patients never to adjust or take additional medications without consulting the physician 4
• Provide education that the risk of recurrent seizures is ongoing even if another seizure does not occur 4

Environmental Safety Measures

Fall Prevention

• Implement fall-prevention programs as seizures increase fall risk, particularly in stroke patients 4
• Identify patients at risk and use alarm systems, special equipment (e.g., enclosure beds), and place call buttons and belongings near the patient 4
• Schedule voiding times to prevent falls when patients attempt to reach the bathroom 4
• Consider having a sitter stay with high-risk patients to ensure safety 4

Equipment and Resource Availability

• Ensure resources for managing agitation or seizures are available during the observation period 2
• Have EEG monitoring capability available for patients at high risk of seizures, especially those with unexplained reduced consciousness 3
• Obtain neurology consultation if recurrent prolonged seizures occur 2

Common Pitfalls to Avoid

The most dangerous nursing errors in seizure management include attempting oral medication administration before swallow screening in stroke patients (which dramatically increases aspiration risk), restraining patients during seizures (causing injury without benefit), and placing objects in the mouth (causing airway obstruction and dental trauma). 3, 1 Additionally, nurses must avoid the false reassurance of routine anticonvulsant prophylaxis, which lacks evidence and may harm neural recovery. 4, 3