Management of Generalized Seizure and Postictal Seizure State (Nursing)

00:04 Now let's talk about the first topic of managing a generalized seizure.

00:09 Now, one thing I want you to know is that seizures can vary and how serious they can be.

00:14 Sometimes you may see a small convulsion or a seizure from a patient, and sometimes they can be very violent.

00:21 So the first thing to remember to know is protect your patient from injury.

00:26 Not only that, an airway is also a top priority.

00:29 When we're talking about protecting our patient.

00:32 Now, the reason why this is the case is because sometimes with really violent seizures, a patient can choke on their own secretions and they can aspirate.

00:42 So protecting them from injury and also protecting the airway is the utmost importance.

00:48 Now, if your patient is in bed when they have a seizure, try to put up the side rails.

00:53 The reason why we want to do this, we want to protect our patient because we don't want them falling out of bed.

00:59 Now, it's really important to note we do not want to physically hold down a patient or restrain them when they're having a seizure.

01:09 So just know this that they can move around the bed, protect them also from those side rails, from injury.

01:15 Now, if you're patients on the floor when they have a seizure, make sure you put something soft under the nith or head because the consistent seizure can have them keep hitting their head on the hard surface of the floor.

01:26 This can cause trauma.

01:28 Now, if you have a blanket, a towel, a soft pillow, anything underneath their head is really important to protect that.

01:36 Now, notice call for help early and note the time.

01:41 So you want to make sure you get help in there with you to protect the patient.

01:45 Also, we want to note the time this is really important for the provider because we need to know how long did that seizure last.

01:52 Now, if possible, position the patient to their side.

01:56 Now we need to really note.

01:58 Any time someone has a seizure, it's really important that we don't want to physically restrain or hold down the patient.

02:05 This can cause further injury.

02:07 Now, however, if it's safe to do so, turn the patient on their side.

02:12 This will help reduce the risk of aspiration.

02:16 Now, one other important note is do not leave the patient.

02:19 So during a seizure, many things can happen.

02:22 A patient's heart can stop.

02:24 They can stop breathing.

02:25 So it's really important we stay with the patient the whole time.

02:29 Now, if it's safe to do so, remove the patient's eyeglasses so they make sure they don't injure their face in any restrictive clothing.

02:37 Sometimes a patient's gown can get twisted around their neck, and we want to make sure that we remove this if possible.

02:44 Here are some things that we're going to want to consider during or after a seizure, depending on the needs of the patient.

02:51 Oxygen may need to be used because seizures can increase the body's demand for oxygen.

02:58 Now, depending on the type of seizure that the patient is having.

03:01 Oxygen can be applied with a nasal cannula or some sort of mask like a symbol or a reservoir mask.

03:09 Most patients that have been admitted to the hospital will have an IV in place.

03:13 But if they do not have an IV, one should be inserted promptly.

03:18 Now, if seizure medications need to be given to stop a seizure, they cannot be given by mouth.

03:25 I repeat, they cannot be given by mouth.

03:28 So the safest and the fastest way to give them medications will be by IV.

03:34 Now, if getting an IV is not possible, you may need to give medications another route, like using a nasal spray or by injection into a muscle, suctioning a patient's airway is also really important because we want to make sure they don't aspirate.

03:51 Now, we don't want to put anything into their mouth where their teeth are because they can bite down, which can cause it to break and increase their risk for aspiration and choking.

04:01 But at times you may need to suction by their cheek or around their lips to clear out any secretions or vomit.

04:09 Ongoing monitoring during and after is a priority.

04:13 We do not actively vital signs when someone is having a seizure.

04:17 Your role as a nurse is to keep them safe and watch them closely.

04:21 You should be able to take the vital signs after the seizure when the patient is in the postictal state.

04:28 So now I want to talk to you about a period in seizure management called postictal management of a seizure.

04:34 Now, when we're talking about postictal state, this is the time when the seizure subsides and then the patient's returning back to baseline.

04:43 So at this point, the patient's a little bit more cognitive than they were earlier.

04:48 Also, I want to talk to you about postictal delirium.

04:51 Now, this can typically last for hours, but it really can even continue up to 1 to 2 days.

04:57 Now, one thing to note is after a seizure, all your body is under lots of lots of stress and there's a lot of fatigue.

05:04 There's a lot of cognitive drain.

05:06 There's a lot of shock to your system.

05:08 So this may take quite a while for a patient to recover.

05:11 And this is going to vary from case to case.

05:14 Now, in the postictal state, we want to assess for injury.

05:17 Now, many things can happen during a seizure, so we want to take a thorough head to toe assessment of our patient.

05:24 Next, we want to make sure we assess our cognitive state.

05:27 It is really mentally draining after you have a seizure and physically.

05:32 So we want to assess as thoroughly in our patient.

05:35 Now, if you've not already done so, make sure you notify the provider.

05:39 This is really important because, for example, if a patient has maybe epilepsy, a seizure disorder, this is bound to be expected that they have a seizure.

05:49 Right.

05:50 So if that's the case, we need to take a thorough look at their medication.

05:54 However, sometimes patients have seizures because maybe an abnormal electrolyte imbalance, for example, and this seizure could be brand new to the patient.

06:03 So it's really important that you notify the provider and let them know how long the seizure lasts and what kind of seizure and the characteristics of that seizure.

06:13 Now, in that postictal state, because the patient's cognition and physically and mentally, they were drained.

06:19 We need assess for urinary and bowel incontinence.

06:22 We need to make sure the patient's personal hygiene is taken care of and their comfort.

06:27 We also want to continue to monitor those vital signs and make sure we keep an eye on that hemodynamic status.

06:34 Now, if the patient's awake and they're able to converse with you and talk, talk to your patient about the events that started for them before this seizure onset.

06:44 Now, what I'm talking about by this is some people can start feeling what they call maybe an aura that happened or they just had that feeling that they knew the seizure was going to come.

06:54 Now, this is different for every single patient.

06:57 And if they're dealing with a seizure disorder, they typically know what this feels like before a seizure onset.

07:04 So make sure you talk to your patient and gather that data.

07:07 Now, after the seizure, we want to continue to make sure those precautions are in place.

07:13 So if you remember, this is going to be suctioning oxygen, watching their vital signs, protecting that airway.

07:20 And one thing to keep in note is that if you are able to typically there or may be padding or some sort of protective cloth over those side rails, that way, if a patient has a seizure, it will also help them protect from injury.

07:35 Now, during this time, we should be done making sure patient safe, we can remove our gloves, perform our hand hygiene before exiting the room, and document the event thoroughly.