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9.8 Neurological Conditions (Seizures)

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

9.8 Neurological Conditions (Seizures)

Key Takeaways Explain This Topic AI

During a seizure: protect from injury, turn to side, do NOT restrain or insert objects in mouth, time the seizure

Status epilepticus: seizure lasting > 5 minutes or multiple seizures without regaining consciousness; medical emergency

First-line treatment for status epilepticus: IV benzodiazepines (lorazepam or diazepam)

Post-seizure (postictal) care: maintain airway, orient patient, monitor vitals, document duration and characteristics

  • Seizure precautions include padded side rails, suction at bedside, oxygen available, bed in lowest position
  • Last updated: January 2026

Neurological Conditions: Seizures

Seizures occur when there is abnormal, excessive electrical activity in the brain. They can range from barely noticeable to severe convulsions. Nurses must know how to protect patients during seizures and recognize when seizures become medical emergencies.

Pathophysiology

Seizures result from:

  • Sudden, abnormal electrical discharge in neurons
  • May be localized (focal) or generalized throughout the brain
  • Causes temporary changes in consciousness, movement, sensation, or behavior
  • Types of Seizures

Focal (Partial) Seizures - Start in one area:

  • Type Characteristics
  • Simple Focal No loss of consciousness; motor, sensory, or autonomic symptoms
  • Complex Focal Impaired consciousness; automatisms (lip smacking, picking at clothes)
  • Focal to Bilateral Tonic-Clonic Starts focal, spreads to generalized

Generalized Seizures - Both hemispheres from onset:

  • Type Characteristics
  • Absence (Petit Mal) Brief staring spells (seconds); common in children; no postictal phase
  • Tonic-Clonic (Grand Mal) Loss of consciousness, stiffening (tonic), rhythmic jerking (clonic)
  • Myoclonic Brief muscle jerks; may occur in clusters
  • Atonic (Drop Attacks) Sudden loss of muscle tone; patient falls
  • Tonic Sustained muscle stiffening
  • Clonic Rhythmic jerking movements
  • Causes of Seizures

In Patients WITH Epilepsy:

  • Medication non-compliance (most common)
  • Sleep deprivation
  • Illness, fever, infection
  • Alcohol or drug use
  • Missed meals (hypoglycemia)
  • Stress
  • Flashing lights (photosensitive epilepsy)

In Patients WITHOUT Epilepsy:

  • Head trauma
  • Stroke
  • Brain tumor
  • Metabolic disturbances (hypoglycemia, hyponatremia, hypoxia)
  • Drug toxicity or withdrawal
  • High fever (febrile seizures in children)
  • Eclampsia (pregnancy)
  • Alcohol withdrawal
  • Phases of a Generalized Tonic-Clonic Seizure
  • 1. Aura (Prodromal Phase)
  • Warning sign before seizure
  • Not all patients experience an aura
  • May include visual, auditory, or olfactory sensations
  • Allows patient to get to safety
  • 2. Tonic Phase (10-20 seconds)
  • Loss of consciousness
  • Muscles stiffen
  • May have a cry (air forced through vocal cords)
  • Falls if standing
  • May become cyanotic (not breathing)
  • 3. Clonic Phase (30-60 seconds)
  • Rhythmic muscle jerking
  • May bite tongue
  • Excessive salivation
  • Loss of bladder/bowel control possible
  • 4. Postictal Phase (Minutes to hours)
  • Gradual return of consciousness
  • Confusion, disorientation
  • Fatigue, sleepiness
  • Headache
  • Muscle soreness
  • No memory of seizure
  • Nursing Care During a Seizure
  • The Priority is SAFETY

Do:

  • Stay with the patient - Call for help but do not leave
  • Time the seizure - Duration is critical information

Protect from injury:

  • Lower to floor if standing
  • Move furniture and hard objects away
  • Place padding under head (pillow, folded blanket)
  • Turn to side (recovery position) - Maintains airway, prevents aspiration
  • Loosen restrictive clothing - Ties, collars, tight clothing
  • Maintain airway - Suction secretions after seizure if needed

Do NOT:

  • Do NOT restrain - Can cause injury during forceful movements
  • Do NOT insert anything in mouth - No tongue blades, fingers, or airways
  • Cannot "swallow tongue"
  • Forcing mouth open can break teeth, injure jaw
  • Do NOT give oral medications or fluids during seizure
  • Do NOT leave patient unattended

Exam Tip: The most common incorrect answer choice is "insert a padded tongue blade." NEVER insert objects in the mouth during a seizure!

Post-Seizure (Postictal) Care

After the seizure ends:

  • Maintain airway - Keep on side, suction if needed
  • Assess breathing - Apply oxygen if needed
  • Check for injuries - Tongue lacerations, head trauma, fractures
  • Provide orientation - Reorient patient gently; speak calmly
  • Allow rest - Patient will be exhausted

Document thoroughly:

  • Time seizure started and ended
  • Behavior before seizure (aura)
  • Body parts involved, progression
  • Loss of consciousness
  • Postictal state and duration
  • Status Epilepticus

Definition: A seizure lasting longer than 5 minutes OR two or more seizures without regaining consciousness between them.

  • This is a MEDICAL EMERGENCY
  • Why It's Dangerous
  • Prolonged seizure activity causes brain damage
  • Hypoxia from impaired breathing
  • Hyperthermia from muscle activity
  • Metabolic acidosis
  • Can be fatal
  • Treatment of Status Epilepticus

Priority Order:

  • Maintain airway - May need intubation
  • Oxygen - High flow
  • IV access - Establish immediately
  • Check blood glucose - Treat hypoglycemia with D50W

First-line medications:

  • Medication Dose Notes
  • Lorazepam (Ativan) 4 mg IV Preferred first-line; may repeat x1
  • Diazepam (Valium) 10 mg IV Alternative; shorter duration
  • Midazolam (Versed) 10 mg IM If no IV access

Second-line if benzodiazepines fail:

  • Fosphenytoin or phenytoin IV
  • Levetiracetam (Keppra) IV
  • Valproate IV

Refractory status epilepticus:

  • Propofol, pentobarbital, or ketamine infusion
  • ICU admission required
  • Seizure Precautions

For patients at risk for seizures:

  • Precaution Rationale
  • Padded side rails Prevents injury during seizure
  • Bed in lowest position Reduces fall injury
  • Suction at bedside Clears secretions post-seizure
  • Oxygen at bedside Available for post-seizure hypoxia
  • IV access Ready for emergency medications
  • Call light within reach Patient can summon help
  • Remove sharp/hard objects Prevents injury
  • Antiepileptic Drugs (AEDs)

Common medications for seizure prevention:

  • Medication Key Points
  • Phenytoin (Dilantin) Therapeutic level 10-20 mcg/mL; causes gingival hyperplasia
  • Carbamazepine (Tegretol) Monitor blood counts; many drug interactions
  • Valproic Acid (Depakote) Weight gain, hair loss; contraindicated in pregnancy
  • Levetiracetam (Keppra) Few drug interactions; well tolerated
  • Lamotrigine (Lamictal) Risk of Stevens-Johnson syndrome

Patient Education:

  • Take medications as prescribed; do not skip doses
  • Do not stop medications abruptly (can cause seizures)
  • Avoid alcohol
  • Get adequate sleep
  • Know triggers and avoid them
  • Wear medical identification
  • Febrile Seizures in Children
  • Occur with fever in children 6 months to 5 years
  • Usually benign; most do not develop epilepsy
  • Manage fever with acetaminophen or ibuprofen
  • Tepid sponge bath (not ice water)
  • Education for parents on seizure first aid
  • Key Points for the NCLEX
  • DO NOT restrain during seizure
  • DO NOT insert anything in mouth
  • Turn to side to protect airway
  • Time the seizure - critical documentation
  • Status epilepticus = seizure > 5 minutes = emergency
  • Lorazepam IV is first-line for status epilepticus
  • Seizure precautions: padded rails, suction, oxygen, bed low
  • Postictal: patient is confused and exhausted; orient gently
  • Phenytoin: watch for gingival hyperplasia, therapeutic level 10-20 mcg/mL