Management of Generalized Seizure and Postictal Seizure State (Nursing)

by Samantha Rhea

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    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 on 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 For 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 when we are talking about protecting our patients.

    00:32 Now, the reason why this is the case, is because sometimes with really violent seizures, a patient could 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, for your patient who is in bed when they have a seizure, try to put up side rails.

    00:53 The reason why we want to do this is, 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 are having a seizure.

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

    01:15 Now, if your patient is on the floor when they have a seizure, make sure you put something soft underneath their head, because the consistent seizure can have them keep hitting their head on the hard surface of the floor, 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 know the time.

    01:41 So, you want to make sure you get help in their way with you to protect the patient, also we want to know the time.

    01:47 This is realty important for the provider because we need to know how long that seizure lasts.

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

    01:56 Now, we need to really note, anytime someone has a seizure it’s really important we don’t want to physically retain or hold down the patient, this could cause further injury.

    02:07 Now, however, if it’s safe to do so, turn the patient on their side, this will help reduce the risk of aspiration.

    02:16 Now, one other important note is do not leave the patient, so, during a seizure many things can happen, a patient’s heart can stop, they can stop breathing, so, it’s really important to say with the patient the whole time.

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

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

    02:44 So, shortly after a seizure, we need to manage care for that patient.

    02:48 So, first of all, administer oxygen as needed after the seizure.

    02:52 We need to support their oxygen status.

    02:56 Now, next, this where the IV catheter comes in, we want to set this up and make sure the patient has IV access.

    03:03 So, this is really important because if a patient has a seizure, what we don’t want to happen is the patient to have multiple seizures after that.

    03:13 Therefore, we’ll have IV catheter in for emergency drugs and something like Ativan for example to prevent further seizures.

    03:23 Now.

    03:23 This is important about suctioning the patient’s airway and keeping that airway open.

    03:28 Now, a really important point is notice we are talking about suctioning after the seizure.

    03:35 One thing I want you to note, during an active seizure, please never pit something in a patient’s mouth during an active seizure.

    03:43 That’s really dangerous for the patient and could be potentially dangerous for you.

    03:48 So, notice after the seizure, we are going to suction the patient out, try to clear those secretions and prevent aspiration.

    03:56 Now, all your monitoring after seizure is really important, to watch their hemodynamic status.

    04:02 Now, this can change before, during and even after a seizure.

    04:07 So, please make sure you keep an eye on your patient and provide frequent monitoring.

    04:11 So, now, I want to talk to you about a period in seizure management called postictal management of a seizure.

    04:18 Now, when we are talking about postictal state, this is the time when the seizure subsides and then the patients are returning back to baseline.

    04:27 So, at this point the patient is a little more cognitive than they were earlier.

    04:32 Also, I want to talk to you about postictal delirium, now, this can typically last for hours but it really can even continue up to 1 -2 days.

    04:41 Now, one thing to notice is after a seizure, your body is under lots and lots of stress and there’s a lot of fatigue, there’s a lot of cognitive drain, there’s a lot of shock to your system.

    04:52 So, this may take quite a while for a patient to recover and this is going to vary from case to case.

    04:58 Now, in the postictal stress we want to assess for injury.

    05:01 Now, many things can happen during a seizure, so, we want to take a thorough head to toe assessment of our patient.

    05:08 Next, we want to make sure we access their cognitive state.

    05:11 It is really mentally draining after you have a seizure and physically.

    05:15 So, we want to assess this thoroughly in our patients.

    05:19 Now, if you haven’t done so, make sure you notify the provider.

    05:23 This is really important because for example, if a patient has maybe epilepsy, a seizure disorder.

    05:30 This is bound to be expected that they have a seizure, right? So, if that’s the case we need to take a thorough look at their medication.

    05:37 However, sometimes patients have seizures because maybe an abnormal electrolyte imbalance for example, and this seizure could be brand new to the patient.

    05:47 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.

    05:56 Now, in that postictal state, because the patient’s cognition and physically they were drained, we need to assess for urinary and bowel incontinence.

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

    06:10 We also want to continue to monitor those vital signs and make sure we keep an eye on that hemodynamic status.

    06:18 Now, if the patient is awake and they are able to converse and talk, talk to your patient about the events that started for them before their seizure onset.

    06:28 Now, what I’m talking about by this is some people can start feeling what they call maybe an oh, that happened or they just had that feeling they knew that the seizure was going to come.

    06:38 Now, this is different from every single patient, and if they are dealing with a seizure disorder, they typically know what this feels like before seizure onset.

    06:47 So, make sure you talk to your patient to gather that data.

    06:51 Now, after the seizure we want to continue to make sure those precautions are in place.

    06:57 So, if you remember this is going to be suctioning, oxygen, watching their vital signs, protecting that airway.

    07:04 And one thing to keep a note, is if you were able to, typically there are maybe parting 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.

    07:19 Now, during this time, we should be done making sure the patient’s safe, we can remove our gloves, perform our hand hygiene before exiting the room and document the event thoroughly.

    About the Lecture

    The lecture Management of Generalized Seizure and Postictal Seizure State (Nursing) by Samantha Rhea is from the course Seizure Precautions and Management (Nursing).

    Included Quiz Questions

    1. Put up the side rails on the bed.
    2. Put a blanket under the client’s head if they are on the floor.
    3. Place the client in a side-lying position.
    4. Physically restrain the client.
    5. Suction the client's airway.
    1. Administer oxygen as needed
    2. Monitor the client’s vital signs
    3. Suction the client’s airway as needed
    4. Put the client's bed in Trendelenburg
    1. The period immediately following a seizure until the client returns to baseline
    2. The period immediately before a seizure
    3. The period immediately before a seizure until the seizure subsides
    4. The period when a client is actively having a seizure
    1. The student nurse initiates bilateral wrist restraints on the client to prevent injury in the event of a second seizure.
    2. The student nurse assesses the client to see if they are oriented to person, place, and time.
    3. The student nurse calls the client’s doctor to inform them of the client’s seizure.
    4. The student nurse places protective padding over the side rails of the client's bed.

    Author of lecture Management of Generalized Seizure and Postictal Seizure State (Nursing)

     Samantha Rhea

    Samantha Rhea

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