Seizures
Also Consider: Behavioral Disturbance, Blood Glucose, Delirium, Fever, Mood Change, Weakness (General)
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Symptoms of Seizures
Any or combination of: jerking movements, rigidity, loss of muscle tone (flaccid), loss of consciousness
May be partial/localized, or generalized. Partial seizures can be mistaken for tremors or myoclonus
Injuries, incontinence may occur
May be followed by a deep sleep (postictal phase) that can be mistaken for delirium
Usually last 2-3 minutes. If the seizure lasts longer than 5 minutes, it is an emergency called Status Epilepticus
Causes
Common: low blood sugar, electrolyte imbalance, medications, hypoxia, Previous stroke, dementia
Less common: brain tumors, brain infections, head injuries, multiple sclerosis, alcohol, illegal drugs
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Fingerstick glucose (patients with diabetes)
Seizure symptoms (type, location) and duration
Injuries (bruising, laceration, tongue-biting, fractures)
Neurologic changes: consciousness/alertness, orientation, new weakness
Recent alcohol intoxication or drug use
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
Any new-onset seizure activity (patient has not had a seizure before), OR
Persistent seizure in someone with known intermittent seizure activity
Notify medical staff on the next business day
Self-limited seizure in someone with known seizure activity who is already on an anticonvulsant
SBAR Report
Situation: (New Onset) (Recurrent) "Seizure activity lasting” (duration) (associated with injury)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Description of seizure
Any treatments used.
Abnormal Vital Signs
MOLST / Advance Directives
Prior history of seizures, medications used, recent anticonvulsant drug levels
Recent illness, medication changes, falls, abnormal labs
General observation of patient condition
Blood glucose
Signs or symptoms of head trauma or other injury
Recent alcohol intoxication or drug use
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC, CMP/Chem14, Magnesium, Drug levels, toxicology screen
Stop/reduce a medication that causes seizures: antipsychotic. antidepressant, ciprofloxacin, insulin, lidocaine
Additional dose of current anticonvulsant medication
Start an anticonvulsant medication
Start an as-needed (prn) parenteral medication for future seizures
Other:
CT scan of head
EEG
Neurology consult
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 24 hours
Offer fluids frequently
Oral, IV, or subcutaneous fluids if needed for hydration
Place on Intake & Output monitoring
Monitor meal acceptance
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of:
Significantly abnormal values in lab tests (refer to appropriate Situation)
WBC > 12,000 or neutrophils > 90%
Update care plan regarding seizure precautions, fall risk, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative
Update advance directives if appropriate
2025-04-27
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