6 Seizure Disorder Nursing Care Plans

Use this nursing care plan and management guide to help care for patients with seizure disorders. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for seizure disorders in this guide.

Table of Contents

• What are seizures? 
• Nursing Care Plans and Management
  • Nursing Problem Priorities
  • Nursing Assessment
  • Nursing Diagnosis
  • Nursing Goals
  • Nursing Interventions and Actions
    • 1. Preventing Injuries and Suffocation
    • 2. Maintaining Patent Airway Clearance and Preventing Aspiration
    • 3. Enhancing Self-Esteem
    • 4. Promoting Adherence to Therapeutic Management
    • 5. Initiating Patient Education and Health Teachings
    • 6. Administer Medications and Provide Pharmacologic Support
• Recommended Resources
• See also

What are seizures?

Seizures are physical findings or changes in behavior caused by uncontrolled electrical firing or discharges from the nerve cells of the cerebral cortex and are characterized by sudden, brief attacks of altered consciousness, motor activity, and sensory phenomena. The term “seizure” is often used interchangeably with “convulsion.”

In 2017, the International League Against Epilepsy (ILAE) proposed revisions to the terminology, classification, and concepts for seizures and epilepsies, but the ILAE indicates these are guiding principles rather than a presentation of new classification per se (AlEissa & Benbadis, 2022).

• Epileptic seizure. An epileptic seizure is a clinical event presumed to result from an abnormal and excessive neuronal discharge. Epilepsy occurs when two or more epileptic seizures occur unprovoked by any immediately identifiable cause and are more than 24 hours apart.
• Idiopathic epilepsy. This describes epilepsy syndromes with specific age-related onset, specific clinical and electrographic characteristics, and a presumed genetic mechanism.
• Cryptogenic seizure. A cryptogenic seizure is a seizure of unknown etiology and is not associated with a previous CNS insult known to increase the risk of developing epilepsy. This is classified as an unprovoked seizure.
• Symptomatic seizure. This is caused by a previously known or suspected disorder of the CNS. this type of seizure is associated with a previous CNS insult known to increase the risk of developing epilepsy.
• Acute symptomatic seizure. This occurs following a recent acute disorder such as a metabolic insult, toxic insult, CNS infection, stroke, brain trauma, cerebral hemorrhage, medication toxicity, alcohol withdrawal, or drug withdrawal. An example is a seizure that occurs within one week of a stroke or head injury. This is also classified as a provoked seizure.
• Remotic symptomatic seizure. This is a seizure that occurs longer than one week following a disorder that is known to increase the risk of developing epilepsy. The seizure may occur a long time after the disorder. This can also be classified as an unprovoked seizure.

Seizures can be caused by head injuries, brain tumors, lead poisoning, maldevelopment of the brain, genetic and infectious illnesses, and fevers. Sensory symptoms arise from the parietal lobe; motor symptoms arise from the frontal lobe.

Nursing Care Plans and Management

The nursing care plan goals for clients with seizure disorders include ensuring safety during and after seizures, preventing injury, and minimizing the frequency and severity of seizures through appropriate medication management and client education. The plan should also include regular monitoring of seizure activity and side effects of medication, as well as addressing any psychological or social impacts of the disorder.

Nursing Problem Priorities

The following are the nursing priorities for patients with seizure disorders

• Recognize and assess signs and symptoms of seizures.
• Ensure immediate safety of the individual during a seizure episode.
• Administer first aid, if necessary, to prevent injury during seizures.
• Monitor seizure frequency, duration, and triggers.
• Administer prescribed anti-seizure medications as directed.
• Educate patients and caregivers on seizure management, including medication adherence, seizure precautions, and lifestyle modifications.
• Offer emotional support and counseling to patients and families to cope with the impact of seizure disorder.
• Coordinate care and referrals to specialists, such as neurologists or epileptologists.
• Schedule regular follow-up appointments to monitor seizure control, adjust medications if needed, and address any concerns or changes in symptoms.

Nursing Assessment

Assess for the following subjective and objective data:

• See nursing assessment cues under Nursing Interventions and Actions.

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with seizure disorders based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

• The client will verbalize understanding of factors that contribute to the possibility of trauma and or suffocation and take steps to correct the situation.
• The client will identify actions or measures to take when seizure activity occurs.
• The client will identify and correct potential risk factors in the environment.
• The client will demonstrate behaviors, and lifestyle changes to reduce risk factors and protect themself from injury.
• The client will modify the environment as indicated to enhance safety.
• The client will maintain a treatment regimen to control or eliminate seizure activity.
• The client will recognize the need for assistance to prevent accidents or injuries.
• The client will verbalize understanding of the disorder and various stimuli that may increase potentiate seizure activity.
• The client will participate in the learning process.
• The client will exhibit increased interest or assume responsibility for their own learning by beginning to look for information and ask questions.
• The client will adhere to the prescribed drug regimen.
• The client will identify the relationship between signs and symptoms of the disease process and correlate symptoms with causative factors.
• The client will initiate necessary lifestyle or behavior changes as indicated.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with seizure disorders may include:

1. Preventing Injuries and Suffocation

Clients with seizure disorders are at risk for trauma or suffocation due to the loss of muscle control during seizures, which can lead to falls, head injuries, and difficulty breathing. Additionally, seizures can occur during sleep, putting the client at risk of suffocation from airway obstruction or aspiration. The increased risk for injury may be caused not only by seizures, but also by comorbid conditions affecting cognition, vigilance, or balance, which are frequent in people with seizures or might be an effect of interaction between seizures and comorbidities (Mahler et al., 2018).

Determine factors related to the individual situation, as listed in Risk Factors, and the extent of risk.
This influences the scope and intensity of interventions to manage the threat to safety. Information on selected conditions associated with seizures and propensity for injuries and accidents should include stroke, brain tumor, dementia, diabetes mellitus, psychiatric disease, including mental retardation, disorders of psychological development, behavioral and emotional disorders with onset usually occurring in childhood and adolescence, and congenital malformations (Mahler et al., 2018).

Note the client’s age, gender, developmental age, decision-making ability, and level of cognition or competence.
It affects the client’s ability to protect themself and others and influences the choice of interventions and teaching. The risk due to seizures does not differ by seizure type and are similar in men and women, although women in general had a slightly lower risk than men. No increased risk can be seen in clients exposed to seizures prior to age 15, while all other age categories showed a risk increase among epilepsy cases (Mahler et al., 2018).

Ascertain knowledge of various stimuli that may precipitate seizure activity.
Alcohol, various drugs, and other stimuli (loss of sleep, flashing lights, prolonged television viewing) may increase brain activity, thereby increasing the potential for seizure activity. For clients with a known seizure disorder, the most likely cause is subtherapeutic levels of antiepileptic medications, which usually occur due to medical nonadherence, or systemic derangement that may disrupt the absorption, distribution, and metabolism of medications (Zonnoor & Chang, 2022).

Review diagnostic studies or laboratory tests for impairments and imbalances.
Such may result in or exacerbate conditions, such as confusion, tetany, pathological fractures, etc. An American College of Emergency Physicians Clinical Policy recommends the following in adults with new-onset seizures: serum glucose level, serum sodium level, and pregnancy test in women of childbearing age (Zonnoor & Chang, 2022).

Explore and expound seizure warning signs (if appropriate) and the usual seizure patterns. Teach significant others (SO) to determine and familiarize warning signs and how to care for the client during and after a seizure attack.
This enables the client to protect themself from injury and recognize changes that require notification of the provider and further intervention. Knowing what to do when a seizure occurs can prevent injury or complications and decreases SO’s feelings of helplessness. There may be a noise or cry at the onset of the seizure. Some clients will describe a prodrome or aura before the event (Munakomi, 2023).

Note pre-seizure activity, presence of aura or unusual behavior, type of seizure activity (location or duration of motor activity, and frequency or recurrence. Note whether the client fell, expressed vocalizations, drooled, or had automatisms (lip-smacking, chewing, picking at clothes).
This helps localize the cerebral area of involvement. Many clients with complex focal seizures have an aura warning them of their seizure; the aura itself is a simple focal seizure. Hyperventilation or photic stimulation frequently precipitates absence seizures, which typically begin during childhood or adolescence and may persist into adulthood (AlEissa & Benbadis, 2022).

Provide neurological or vital sign check after seizure (level of consciousness, orientation, ability to comply with simple commands, ability to speak; the memory of incident; weakness or motor deficits; blood pressure (BP), pulse, and respiratory rate).
This documents the postictal state and time or completeness of recovery to a normal state. It may identify additional safety concerns to be addressed. Following a generalized tonic-clonic seizure, clients will have some transient alteration consciousness referred to as the postictal state. Accurate vital signs may be difficult to obtain in a generalized tonic-clonic seizure (Zonnoor & Chang, 2022).

Investigate reports of pain.
This may be a result of repetitive muscle contractions or symptoms of injury incurred, requiring further evaluation or intervention. Pain is a recognized but rare manifestation of epileptic seizures. Pain associated with seizures can be severe and disabling. Ictal pain is usually associated with paresthesia, thermal sensations, or stereognostic disturbance. If localized, paroxysmal pain is the sole manifestation, seizure may be often overlooked as a cause for pain (Sheetal & Kumar, 2020).

Detect status epilepticus (one tonic-clonic seizure after another in rapid succession).
This is a life-threatening emergency that if left untreated could cause metabolic acidosis, hyperthermia, hypoglycemia, arrhythmias, hypoxia, increased intracranial pressure, airway obstruction, and respiratory arrest. Immediate intervention is required to control seizure activity and prevent permanent injury or death. Note: Although absence seizures may become static, they are not usually life-threatening.

Monitor and document AED drug levels, corresponding side effects, and frequency of seizure activity.
A standard therapeutic level may not be optimal for an individual client if untoward side effects develop or seizures are not controlled. Although medication nonadherence and subtherapeutic medication levels are among the most common causes of seizure presentations to the ED, clients should also be screened for underlying infectious or metabolic causes of seizure when indicated (Zonnoor & Chang, 2022).

Monitor CBC, electrolytes, and glucose levels.
These identify factors that aggravate or decrease the seizure threshold. Studies have shown a low yield for extensive laboratory tests in the evaluation of a client presenting with a first-time single seizure. In one study, laboratory tests such as blood counts, blood glucose levels, and electrolyte panels were abnormal in as many as 15% of individuals (Zonnoor & Chang, 2022).

Use and pad side rails with the bed in the lowest position, or place the bed up against the wall and pad floor if rails are not available or appropriate.
This prevents or minimizes injury when seizures (frequent or generalized) occur while the client is in bed. Note: Most individuals seize in place and if, in the middle of the bed, the individual is unlikely to fall out of bed. During a seizure, the client may experience convulsive movements that can cause them to hit their limbs or body against the side rails or the floor. Padding acts as a protective barrier, reducing the impact and lessening the chances of bruises, cuts, or fractures.

Educate the client not to smoke except while supervised.
This may cause burns if the cigarette is accidentally dropped during aura or seizure activity. Additionally, cigarette smoking may also be an important factor influencing the risk of seizures or epilepsy. It has been reported that cigarette smoking is common in adults with epilepsy. The global prevalence of cigarette smoking was 32.1% among 429 people with epilepsy, significantly higher than the 19% smoking rate reported in the general population (Zhong et al., 2022).

Evaluate the need for or provide protective headgear.
The use of a helmet may provide added protection for individuals who suffer recurrent or severe seizures. Wearing a protective helmet is sometimes recommended to minimize the risk of head injury in seizures. The design of helmets for people with seizures usually comprises a dense foam hat encased in leather and worn with a chin strap. The foam can be built up dependent on whether the person usually falls forward or backward (Jory et al., 2019).

Avoid using thermometers that can cause breakage. Use a tympanic thermometer when necessary to take the temperature.
This reduces the risk of the client biting and breaking the glass thermometer or suffering injury if sudden seizure activity should occur. Tympanic thermometers are designed to measure body temperature by detecting infrared radiation emitted by the eardrum. They provide a quick and non-invasive method of measuring temperature, which can be crucial in a situation where a client is experiencing seizures.

Uphold strict bedrest if prodromal signs or aura are experienced. Explain the necessity for these actions.
Clients may feel restless or need to ambulate or even defecate during an aural phase, thereby inadvertently removing themselves from a safe environment and easy observation. Understanding the importance of providing for own safety needs may enhance client cooperation.

Do not leave the client during and after a seizure.
Seizures can be unpredictable, and a client may experience various movements and behaviors during an episode. By staying with the client, the nurse may help ensure their safety and protect them from potential hazards in the environment. In addition, by being present during a seizure the nurse can closely observe the duration, intensity, and characteristics of the seizure. 

Turn the head to the side and suction the airway as indicated. Insert plastic bite block only if jaw relaxed.
This helps maintain airway patency and reduces the risk of oral trauma but should not be “forced” or inserted when teeth are clenched because dental and soft-tissue damage may result. Note: Wooden tongue blades should not be used because they may splinter and break in the client’s mouth. Mouth guards are the most commonly used intraoral device. Stock mouthguards are durable, easy to use, and inexpensive, but loose and limited in their potential for modification. As such, custom-made mouth protectors such as acrylic splints are considered more effective owing to their customizability, stability, and retention (Avashia et al., 2018).

Support the head, place it on a soft area, or assist to the floor if out of bed. Do not attempt to restrain.
Supporting the extremities lessens the risk of physical injury when the client lacks voluntary muscle control. Note: If the attempt is made to restrain the client during a seizure, erratic movements may increase, and the client may injure themself or others. Restraints must be avoided but ensure that the client is in a bed with padded side rails or flat on the floor (Al Sawaf et al., 2023).

Reorient the client following seizure activity.
The client may be confused, disoriented, and possibly amnesic after the seizure and need help to regain control and alleviate anxiety. Provide verbal reassurance as the client is regaining consciousness. Being calm and helping reorient the client is of utmost importance (Al Sawaf et al., 2023).

Allow postictal “automatic” behavior without interfering while providing environmental protection.
The client may display behavior (of a motor or psychic origin) that seems inappropriate or irrelevant to time and place. Attempts to control or prevent activity may result in the client becoming aggressive or combative. Most clients may experience fatigue, confusion, muscle pain, and/or a headache. Thus, the nurse must also permit the client to sleep (Al Sawaf et al., 2023).

Carry out medications as indicated:
Specific drug therapy depends on seizure type, with some clients requiring polytherapy or frequent medication adjustments.

Prepare for surgery or electrode implantation as indicated.
A vagal nerve stimulator, magnetic beam therapy, or other surgical intervention (temporal lobectomy) may be done for intractable seizures or well-localized epileptogenic lesions when the client is disabled and at high risk for serious injury. Success has been reported with gamma-ray radiosurgery for the treatment of multiple seizure activities that have otherwise been difficult to control. Efficacy of the stimulating device at 18 months is 40 to 50%. Many clients report improvement in seizure intensity and general mood when using vagal nerve stimulators (AlEissa & Benbadis, 2022).

Provide information about the benefits of non-invasive, wearable seizure monitoring.
Non-invasive, wearable biosensors have the greatest immediate potential to meet the needs of the majority of people with seizures. Currently, there are two wearable sensors approved by the FDA and EU for detecting convulsive seizures: a wrist-worn smartwatch (Empatica Embrace), which is linked to the wearer’s smartphone, and a device attached by an adhesive patch affixed to the wearer’s bicep and identifies changes in electromyography to detect convulsions (BrainSentinel SPEAC). This device also has a cloud-based data platform and can send caregiver alerts (Schindler & Rahimi, 2021).

Reinforce limitations about driving.
Driving restrictions differ for each client because of the individual features of their seizures, their degree of seizure control, and in the US, state laws. To resume commercial driving across state lines, a client must have a 5-year seizure-free period (AlEissa & Benbadis, 2022).

Advise the client to be vigilant when participating in water activities such as swimming or boating.
Common sense dictates that clients with seizures should not swim alone, and they should be particularly aware of the importance of the presence of an adult lifeguard who can pull them out of the water if needed. Wearing of a life jacket in a boat is important. Additionally, a client who has a seizure while waiting for bath water to warm up may suffer hot-water burns (AlEissa & Benbadis, 2022).

Educate the client to avoid activities that may precipitate an injury, such as using power tools.
Injuries can occur with the use of power tools and other dangerous equipment, as well as burn injuries related to cooking. Clients with seizures may also experience an episode in situations such as being up on a roof or engaging in some activity at considerable height from the floor. Caution or supervision is advised when power tools are used, and the use of safety devices , such as an automatic shutoff switch, is recommended (AlEissa & Benbadis, 2022).

2. Maintaining Patent Airway Clearance and Preventing Aspiration

Clients with seizure disorders is at risk for ineffective airway clearance due to neuromuscular impairment, which can cause the tongue to obstruct the airway or result in the aspiration of saliva or vomit. Additionally, tracheobronchial obstruction can occur due to increased secretions and decreased muscle tone during a seizure, further increasing the risk of airway obstruction. Perceptual or cognitive impairment during or after a seizure can also impair the client’s ability to protect their airway, making airway management critical in these situations.

Determine individual situations related to low self-esteem in the present circumstances.
Verbalization of concerns about future implications can help the patient begin to accept or deal with the situation. Chronic illnesses, such as epilepsy, have often been perceived as stressors for young people and their families due to the changes required to manage the medical condition. It has been proposed that having to cope with additional illness-related demands exceeds their existing capacities and results in higher stress levels (Chew et al., 2017).

Monitor respiratory rate, rhythm, depth, and effort of respirations.
This provides baseline data for evaluating the adequacy of ventilation. Seizures can interfere with normal breathing patterns, leading to inadequate oxygenation of the body. Monitoring respiration is particularly crucial during prolonged or severe seizures.

Assess the client’s ability to cough effectively.
Infections of the respiratory tract can affect the amount and character of mucus. An ineffective cough compromises airway clearance and prevents secretions to expel freely. Seizures can occasionally lead to respiratory complications, such as aspiration of fluids into the lungs or respiratory arrest.

Assess for the presence of obstructive sleep apnea.
Sleep disorders can exacerbate seizures in epileptic clients. OSA occurs as a result of frequent narrowing of the upper airways during sleep. Partial obstruction of the airways may result in snoring, and there is a possibility of complete obstruction in the supine position (Arshad, 2017).

Ensure the client has an empty mouth of dentures or foreign objects if aura occurs and avoid chewing gum and sucking lozenges if seizures occur without warning.
It lessens the risk of aspiration or foreign bodies lodging in the pharynx. A study found that clients had a spoon inserted into their mouth by a caregiver during seizures, wherein the clients sustained injuries, including laceration, bruising, or dental subluxation or avulsion. These injuries far exceeded the number of orofacial injuries in clients who did not have anything inserted into their mouths. (Rossi et al., 2020)

Maintain in lying position, a flat surface; turn head to side during seizure activity.
This helps in the drainage of secretions and prevents the tongue from obstructing the airway. The prone position has been identified as an important risk factor for sudden unexpected death in epilepsy (SUDEP). A recent meta-analysis of publications documenting body position in clients who died from SUDEP found that 73% of clients died in the prone position (Rigg et al., 2017).

Loosen clothing from the neck or chest and abdominal areas.
Loosen clothing around the neck and ensure the airway is patent. If the client is clenching the teeth, do not force the mouth open with any object as this can cause severe damage (Al Sawaf et al., 2023). Loosening tight clothing such as brassieres around the neck and chest, allows for better chest expansion and facilitates easier breathing.

Provide and insert a plastic airway or soft roll as indicated and only if the jaw is relaxed.
If inserted before the jaw is tightened, these devices may prevent biting of the tongue and facilitate suctioning or respiratory support if required. Airway adjunct may be indicated after cessation of seizure activity if the client is unconscious and unable to maintain a safe position of the tongue. Custom-made acrylic splints are more effective in preventing oral injury owing to their customizability, stability, and retention. Splints can be affixed in the mouth for clients with recurrent seizures using bands, wire loops, or cement, creating a barrier to removal (Avashia et al., 2018).

Suction as needed.
This reduces the risk of aspiration or asphyxiation. Seizures can result in excessive saliva or oral secretions, which can accumulate in the mouth and potentially obstruct the airway. The client may also vomit or regurgitate gastric contents during seizures. Suctioning allows for the prompt removal of these secretions, reducing the risk of aspiration and keeping the airway patent.

Supervise supplemental oxygen or bag ventilation as needed postictally.
This may lessen cerebral hypoxia resulting from decreased circulation or oxygenation secondary to vascular spasm during a seizure. Ictal hypoxemia is a feature seen in epileptic seizures, characterized by low oxygen saturation, increasing seizure prolongation risk, and possibly contributing to SUDEP. The National Institute of Health and Care Excellence (NICE) recommends high-flow oxygen use in the hospital management of seizures; however, no reference source is provided (Smith et al., 2021).

Get ready for or assist with intubation, if indicated.
The presence of prolonged apnea postictally may need ventilatory support. Management of seizing clients may require intubation with an endotracheal tube due to respiratory depression. Intubation is not without risks, however, and can lead to laryngotracheal injury, especially if prolonged (Allen et al., 2020).

Advise the client to avoid sleeping in the prone position and to wear devices that monitor sleep posture.
A prone sleeping position has been identified as an important risk factor in SUDEP. Results of a study suggest that clients are least likely to attain a terminal prone position if seizures begin whilst in the supine position. The supine position would also ensure that dystonic head posturing is unlikely to result in a client turning their head into a pillow. The use of sleepwear or wearable devices that monitor sleep posture and awaken the client if they move into specific postures may be indicated (Rigg et al., 2017).

Prepare the client and assist in surgery (obstruction-bypass surgery or tracheostomy), as indicated.
Neurosurgical techniques that involve specific areas of the cerebrum may provide some reduction in seizure activity. Clients with refractory epilepsy pose great clinical difficulties, such as a higher incidence of cognitive and psychological disorders, growth-plate injuries, mortality, and social stigmatization and isolation (Arshad, 2017).

3. Enhancing Self-Esteem

Clients with seizure disorders may experience low self-esteem due to the social stigma and misconceptions surrounding the disorder, as well as the limitations and disruptions it can cause in their daily lives. The unpredictability of seizures and the need to disclose the disorder to others can also contribute to feelings of embarrassment, shame, and isolation, leading to further negative impacts on self-esteem.

Explore feelings about diagnosis and the perception of threat to self. Encourage expression of feelings.
Reactions vary among individuals, and previous knowledge or experience with this condition affects acceptance of the therapeutic regimen. Young people who experienced greater illness demands and seizures were more likely to report correspondingly higher levels of stress and negative illness perceptions. In turn, these young persons reported correspondingly lower self-esteem (Chew et al., 2017).

Assess the client for psychiatric comorbidities.
The increase in depression and anxiety one year after diagnosis of epilepsy is correlated with the degree to which an individual senses loss of self-control, rather than the actual number of seizures. Moreover, quality of life is correlated with depression symptoms in epilepsy (Michaelis et al., 2017).

Analyze possible or anticipated public reaction to the condition. Encourage the client to refrain from concealing the problem.
This provides an opportunity to problem-solve responses and provides a measure of control over the situation. Concealment is destructive to self-esteem (potentiates denial), blocking progress in dealing with a problem, and may actually increase the risk of injury or negative responses when a seizure does occur. Given the nature of epilepsy as a stigmatizing condition, the burden of the diagnosis, including the risk of a public seizure and negative public attitudes toward epilepsy, can result in significant psychosocial difficulties and may ultimately have a significant impact on the quality of life (Lee et al., 2018).

Discuss with the client current and past successes and strengths.
Concentrating on positive aspects can help alleviate feelings of guilt and self-consciousness and help the client begin to accept the manageability of the condition. Personality traits are believed to be biologically determined and temporally stable. They are also conceptualized as the result of the interaction between genetic factors and environmental conditions. Clients with a chronic condition of epilepsy encounter many adverse situations, such as recurrent seizures, social restrictions, or financial difficulties, which may contribute to specific personality characteristics (Lee et al., 2018).

Refrain from overprotecting the client; encourage activities, providing supervision and monitoring when indicated.
Participation in as many experiences as possible can lessen depression about limitations. Observation and supervision may need to be provided for such activities as gymnastics, climbing, and water sports. Successful adaptation during adolescence is reflected in young people’s ability to cope with challenges arising from these changes and achievement of age-appropriate developmental tasks such as increasing autonomy, differentiation from the nuclear family, development of self-identity, and increasing focus on peer relationships (Chew et al., 2019).

Know the attitudes or capabilities of significant others (SO). Help the individual realize that his or her feelings are normal; however, guilt and blame are not helpful.
Contradictory or unfavorable expectations from SO may affect a client’s sense of competency and self-esteem and interfere with the support received from SO, limiting the potential for optimal management and personal growth. One study found that parental support directly influenced child’s mental health and quality of life, and another study found that parental support was an important predictor of self-reported quality of life trajectories (Cahill et al., 2021).

Elaborate on the positive effect of staff and SO remaining calm during seizure activity.
Tension and anxiety among caregivers are contagious and can be conveyed to the client, increasing or multiplying the individual’s own negative perceptions of the situation or self. Caregiver psychopathology has been associated with poorer caregiver-child relationship, quality of parenting, caregiver emotional support, confidence in managing the client’s discipline, and a more protective, controlling, and involved parenting style; these factors have been associated with anxiety and depressive symptoms in children and adolescents with epilepsy (Puka et al., 2017).

Refer the client and SO to a support group (Epilepsy Foundation of America, National Association of Epilepsy Centers, and Delta Society’s National Service Dog Center).
This provides an opportunity to gain information, support, and ideas for dealing with problems from others who share similar experiences. Note: Some service dogs have the ability to sense or predict seizure activity, allowing a client to institute safety measures, increasing independence and personal sense of control. The Epilepsy Foundation of America has a large library of educational materials that are available to the general public. The American Epilepsy Society is a professional organization for people who take care of clients with epilepsy (AlEissa & Benbadis, 2022).

Talk over and explain the referral for psychotherapy with the client and SO.
Seizures have a profound effect on personal self-esteem, and clients or SO may feel guilt over perceived limitations and the public stigma. Counseling can help overcome feelings of inferiority and self-consciousness. While medical providers focus on minimizing seizures and side effects, a primary role that mental and behavioral health providers can have with clients with seizures is to optimize health-related quality of life by providing evidence-based psychological treatments (Michaels et al., 2017).

Encourage self- or family management.
This is defined as activities or steps that an individual or family can perform that are known to control the frequency of seizures. Activities or steps can lie within the individual, family, community, or healthcare system domains. Examples include relaxation, physical exercise, coping skills, etc (Michaelis et al., 2017).

Provide information about adherence interventions.
Adherence interventions are defined as efforts to assist individuals adhere to the advice of healthcare professionals, including taking prescribed self-administered medications, following a ketogenic diet, and avoiding seizure triggers. Taking medication can be broken down into several components, including optimal dose timing, and adequate frequency of dosing (Michaelis et al., 2017).

Encourage the client’s friends or peers to support the client.
Most young people experienced support from their friends and felt that disclosure did not negatively affect their friendships. The client’s friends may demonstrate concern by inquiring about the client’s well-being, particularly after a seizure occurred. Few shared that revealing personal information enriched their relationships with friends (Chew et al., 2019).

Promote participation in social and leisure activities.
Clients with seizure disorders feel that opportunities to engage with their friends are constrained by disruptions caused by seizures, parent-imposed restrictions, and other social barriers to doing and being. In turn, this affected the client’s sense of independence and autonomy. Engaging in regular social activities with friends, participating in church activities and camps with adequate adult supervision, and inclusive attitudes by other people promote a greater sense of acceptance and have a positive impact on the client’s self-esteem (Chew et al., 2019).

Ascertain the presence of stigma in the client’s community or the people surrounding them.
Stigma, ‘an attribute that is deeply discrediting’, has been suggested as a potential risk factor for the development of psychopathology in people with epilepsy or seizures. A recent systematic review of quantitative studies showed that the perceived stigma of epilepsy was positively correlated with depression and anxiety (Lee et al., 2018).

Encourage positive coping behaviors.
Coping behaviors are viewed as clients’ efforts in managing multiple demands. Problem-focused coping styles support positive adaptation. Specific coping behaviors, such as being optimistic, seeking social support, focusing on competence, and adhering to treatment, have been correlated with positive psychosocial outcomes (Chew et al., 2017).

4. Promoting Adherence to Therapeutic Management

Nonadherence in clients with seizure disorders may be due to various factors, including medication side effects, forgetfulness, denial of the condition, financial constraints, and cultural or religious beliefs. However, nonadherence can lead to suboptimal seizure control, increased risk of injury, and poor quality of life, making it essential for nurses to address and mitigate these factors through effective client education, counseling, and support. The prevalence of nonadherence to anti-seizure therapy ranges from 26% to as high as 79% (Teh et al., 2020).

Assess the client’s knowledge about seizures, their medical management, and treatment plan.
This allows nurses to explain or clarify information as indicated and facilitates the development of an individualized care plan that encourages adherence. In this challenging environment with an increased emphasis on quality care, nurses are uniquely positioned to facilitate effective communication with clients, because they typically provide the first interaction during an office visit and perform initial assessments of client conditions and needs (Buelow et al., 2018).

Assess for causes of nonadherence, such as the history of noncompliance, socioeconomic status, forgetfulness, side effects of medications, confusion about medication instructions, or difficulty making significant lifestyle changes.
Determining these causes enables the nurse to focus on the client’s care plan and provide appropriate actions. Nonadherence, whether intentional or unintentional, includes forgetfulness in taking medication, taking more or less than that prescribed or at incorrect timing, premature discontinuation, and failure to refill prescription in the pharmacy (Teh et al., 2020).

Evaluate the client’s view of the effectiveness or ineffectiveness of the recommended treatment. Assess the level of adherence.
This enables the nurses to shed light on the client’s view of vulnerability to the disease process and signs of denial of the illness. Objective methods in assessing adherence include pill counts, electronic drug monitoring system, rate of prescription of refills, directly observed therapy, and monitoring of drug concentrations in body fluids. Subjective methods include client self-reporting and client-kept diary (Teh et al., 2020).

Assess the support system of the client.
It helps identify if a problem in the family pattern influences the client’s non-adherence. For example, an indicator of a young client’s growing autonomy is the transition of responsibilities of illness management from parent to child. Young people explain that their parents expected them to assume greater responsibility for self-management. However, parents still retained a dominant role in deciding which activities are appropriate for them (Chew et al., 2019).

Assess the client’s and family members’ health literacy.
The association between a lower education level and non-adherence was pointed out in a review. It found that two-thirds of clients were illiterate or had no formal education, fitting with people with epilepsy having an overall lower educational attainment. Lower schooling was also identified as a risk for non-adherence to other diseases (Mendorf et al., 2022).

Explain ways of dealing with common problems of nonadherence such as financial constraints and workplace discrimination.
Removing and overcoming these barriers is vital in achieving patient adherence to treatment. In some areas, there were various misunderstandings and stigmas about epilepsy that can affect adherence to the treatment. The stigma may affect the level of knowledge about the proper treatment of clients, their families, and society (Ernawati, 2018).

Discuss and clarify myths and stigmas. Give a realistic assessment of risks and correct misconceptions.
This will help identify factors that may affect adherence such as culture, spiritual belief, or personal value. A study in the capital city of Lao People’s Democratic Republic observed that epilepsy was acknowledged as a disease caused by supernatural powers or ancestral factors. The provision of an educational intervention on epilepsy treatment should be conducted together with cultural approaches to the family and carried out continuously with long-term education (Ernawati, 2018).

Provide information regarding the following:

• Steady blood level and half-life of a drug.
• Instruction on missed doses.
• How to refill a prescription if the medication is lost or emptied.
• Schedule of laboratory follow-up.
• Importance of notifying the health care provider if the medication is suddenly terminated.

Intermittent use of medications may be an effort to gain control. Understanding the consequences of nonadherence helps ensure awareness that stopping antiseizure medications can cause severe and life-threatening reactions. A study described that providing educational interventions through counseling could alter the client’s behavior to be more concerned with the administration schedules. This may provide a better effect on the level of medication adherence with a reduction in the percentage of forgetful taking of drugs from more than 70% to 45% (Ernawati, 2018).

Assist in the identification of available support systems such as the local epilepsy centers and epilepsy-specific organizations.
Individuals may be able to understand better and feel the support through the experiences of others with the same condition. Having average or below-average perceived access to pharmacy services was a significant contributing factor to non-adherence among study participants in a research study. In Malaysia, the Malaysian Pharmaceutical Services Division offers several services to improve clients’ access to their monthly medication supply, known as Value Added Services (VAS). these include the Integrated Drug Dispensing System, where clients can choose to collect their monthly supply from the nearest government healthcare facilities (Teh et al., 2020).

Once the factors of nonadherence are identified, discuss the possibility of revising the therapeutic plan with the health care provider. Give instructions about measures in controlling the side effects of anti-seizure medications.
These interventions encourage adherence. Teach the client to avoid alcohol to prevent extra sedative effects and to take the drug with food to lessen gastric upset. Acute seizure action plans can guide the client and their caregivers on medication administration and actions to take. This intervention can reinforce appropriate actions, decrease apprehension, decrease ED visits and costs for the client, and decrease the time of administration of benzodiazepines in areas lacking quick access to emergency services (Zonnoor & Chang, 2022).

Suggest referral to counseling or psychotherapy if indicated.
This helps improve the quality of life and psychological well-being of clients who are struggling with a disease that may be a reason for non-adherence. Several supporting approaches, such as reminder systems, cognitive education, behavioral counseling, social support, and multifaceted interventions were observed as efficient methods to improve adherence (Ernawati, 2018).

Allow the client to vent feelings such as indifference, helplessness, powerlessness, and shame.
The fear of stigmatization and discrimination due to the disclosure of a medical condition is not uncommon among young people with chronic illnesses. Seizures were often sudden and unexpected, particularly when occurring for the first time. Some did not feel ready for their medical information to be known, and most were embarrassed by these experiences. Expressing these feelings may help relieve the client from the stress and anxiety brought on by a chronic, unpredictable condition (Chew et al., 2019).

Establish a therapeutic relationship with the client and their family.
Adherence implies that health professionals have a responsibility to form a therapeutic relationship with the clients, to encourage them to agree to a recommended treatment regimen. This means that clients should be better informed about their medications, and in theory, have greater power to decline treatment (Ernawati, 2018).

Assist the client in understanding each medication prescribed,  its dosages, and its benefits.
The medication factor is another important factor that might affect adherence. Complex dose regimens are associated with poor adherence due to the difficulties of drug administration. Medication regimes can be complex because they contain multiple different medicines, or because they need to be taken with frequent times a day (Ernawati, 2018).

Include family members or caregivers during health education.
Providing comprehensive information as an education intervention must be focused not only on clients but also on others like family. Family support is a major strategy in the treatment of epilepsy, but it is challenging when families feel ashamed of having a family with seizures. Communication and information about the disease and therapy for clients with seizures must be provided as an educational intervention for the family as well (Ernawati, 2018).

Encourage the client to participate in behavioral interventions as indicated.
Behavioral interventions are characterized by cognitive behavioral techniques and therapies focused on dysfunctional emotions, behaviors, and cognitions with the aim to promote healthy lifestyles and positive changes toward symptoms or treatment. These interventions are aimed to change individual behavior in those aspects related to their daily life, which can modify the client’s behavior toward treatment (Ernawati, 2018).

5. Initiating Patient Education and Health Teachings

Clients with seizure disorders may have deficient knowledge about their condition due to misconceptions, inadequate education, or limited access to information. This can lead to difficulties in managing their disorder, making informed decisions about their care, and effectively communicating their needs and concerns with healthcare providers, potentially resulting in suboptimal treatment outcomes. Nursing guidelines for the care and education of clients with epilepsy or seizure are a critical first step to expanding one’s knowledge on epilepsy diagnosis and treatment, client self-management, and psychosocial aspects of care (Buelow et al., 2018).

Ascertain the level of knowledge, including anticipatory needs.
This is to assess the client’s and SOs’ readiness to learn. Clients with epilepsy or seizure disorders have reported feeling inadequately informed regarding aspects of disease treatment or management, despite healthcare quality indicators for epilepsy providers designed to ensure that parameters of client care are addressed. The quality indicators cover topics to ensure clients understand their disease, treatment, side effects, and safety issues, such as getting enough sleep and engaging in stress reduction activities (Buelow et al., 2018).

Determine the client’s ability or readiness and barriers to learning.
The individual may not be physically, emotionally, or mentally capable at this time. In a study, some clients with epilepsy report that they want to be active participants in their own self-management, but the client-provider dynamic is often fraught with difficulties. Time limitations and a lack of client-centered communication techniques often interfere with client-provider goal-setting and hamper client management recommendations (Buelow et al., 2018).

Review pathology and prognosis of the condition and lifelong need for treatments as indicated. Discuss the client’s particular trigger factors (flashing lights, hyperventilation, loud noises, video games, TV viewing).
This provides an opportunity to clarify or dispel misconceptions and present the condition as something that is manageable within a normal lifestyle. The client’s prognosis for disability and for a recurrence of epileptic seizures depends on the type of epileptic seizure and the epileptic syndrome in question. Impairment of consciousness during a seizure may unpredictably result in morbidity or even mortality (Ko & Benbadis, 2022).

Review the possible effects of hormonal changes.
Alterations in hormonal levels that occur during menstruation and pregnancy may increase the risk of seizures. Seizures in pregnancy are a complication of severe, untreated preeclampsia. In fact, eclampsia can occur up to four weeks after delivery. Additionally, clients with postpartum eclampsia, especially those with late postpartum eclampsia, have a higher incidence of cerebral venous thrombosis, intracranial hemorrhage, and acute ischemic stroke than do eclamptic clients diagnosed postpartum (Zonnoor & Chang, 2022).

Stress needs for routine follow-up care and laboratory testing as indicated (CBC should be monitored bi-annually and in the presence of sore throat or fever, signs of other infection).
Therapeutic needs may change and serious drug side effects (agranulocytosis or toxicity) may develop. For clients with known seizure disorders who are currently taking medications, and blood levels of antiepileptic medications should be obtained. For clients with a history of malignancy, serum calcium levels should be obtained.

Discuss the significance of maintaining good general health, (adequate diet, rest, moderate exercise, and avoidance of exhaustion, alcohol, caffeine, and stimulant drugs).
Regularity and moderation in activities may aid in reducing or controlling precipitating factors, enhancing a sense of general well-being, and strengthening coping ability and self-esteem. Note: Too little sleep or too much alcohol can precipitate seizure activity in some people. Barbiturates or benzodiazepine withdrawal may cause seizures. With certain agents, symptoms may not develop for days or even weeks after cessation of use (Zonnoor & Chang, 2022). 

Know and instill the importance of good oral hygiene and regular dental care.
This lessens the risk of oral infections and gingival hyperplasia. Chronic tongue biting during seizures causes soft-tissue, vascular, and lymphatic injuries that lead to edema and predispose the tongue to further injury. As a result, the client may suffer from loss of tissue and superinfection. If the client wears an intraoral device to prevent injury during seizures, this device must be removable to allow for better hygiene (Avashia et al., 2018).

Identify necessity and promote acceptance of actual limitations; discuss safety measures regarding driving, using mechanical equipment, climbing ladders, swimming, and hobbies.
This lessens the risk of injury to self or others, especially if seizures occur without warning. The client can be counseled to be prepared for seizure activity and to avoid things that would put them at risk for complications. By law, clients are not able to drive unless they have been seizure-free on medications for one year. Any recreational activity that puts them at increased risk of injury if a seizure were to occur should be performed with at least one other person who is knowledgeable of the client’s condition and able to intervene if necessary (Zonnoor & Chang, 2022).

Review local laws and restrictions pertaining to persons with epilepsy and seizure disorder. Encourage awareness but not necessarily acceptance of these policies.
Although the legal and civil rights of persons with epilepsy have improved during the past decade, restrictions still exist in some states pertaining to obtaining a driver’s license, sterilization, workers’ compensation, and required reportability to state agencies. If the client’s provider practices in a state that requires mandatory reporting of clients with epilepsy to the Department of Motor Vehicles, they must ensure they are compliant with state laws and have documentation. International variation regarding reporting is also considerable; some countries have more permissive or restrictive laws regarding driving than the US (Ko & Benbadis, 2022).

Review medication regimen, the necessity of taking drugs as ordered, and not discontinuing therapy without healthcare provider supervision. Include directions for a missed dose.
Lack of cooperation with a medication regimen is a leading cause of seizure breakthrough. The client needs to know the risks of status epilepticus resulting from the abrupt withdrawal of anticonvulsants. Depending on the drug dose and frequency, the client may be instructed to take a missed dose if remembered within a predetermined time frame. About 75% of seizure relapses after medication discontinuation occurs in the first year, and at least 50% of clients who have another seizure do so in the first three months (Ko & Benbadis, 2022).

Recommend taking drugs with meals, if appropriate.
This may reduce the incidence of gastric irritation, nausea, and vomiting. Most anticonvulsants have side effects of nausea and vomiting, but these agents are still well-tolerated by most clients. Carbamazepine, however, cannot be taken with grapefruit juice and St. John’s wort because it can decrease the drug levels, and therefore its effectivity (Ochoa & Benbadis, 2022).

Discuss nuisance and adverse side effects of particular drugs (drowsiness, fatigue, lethargy, hyperactivity, sleep disturbances, gingival hypertrophy, visual disturbances, nausea and vomiting, rashes, syncope, ataxia, birth defects, and aplastic anemia).
This may indicate the need for a change in dosage or choice of drug therapy and promotes involvement and participation in the decision-making process and awareness of potential long-term effects of drug therapy, providing an opportunity to minimize or prevent complications. Felbamate is used only as a drug of last resort in medically refractory cases because of the risk of aplastic anemia and hepatic toxicity, which necessitates regular blood tests (Ko & Benbadis, 2022).

Provide information about potential drug interactions and the necessity of notifying other healthcare providers of the drug regimen.
Knowledge of anticonvulsant use reduces the risk of prescribing drugs that may interact, thus altering the seizure threshold or therapeutic effect. For example, phenytoin potentiates the anticoagulant effect of warfarin, whereas isoniazid and chloramphenicol increase the effect of phenytoin, and some antibiotics can cause an elevation of serum level of carbamazepine, possibly to toxic levels (Ochoa & Benbadis, 2022).

Familiarize the proper use of diazepam rectal gel (Diastat) with the client, SO, and caregiver as appropriate.
This agent is useful in controlling serial or cluster seizures. It can be administered in any setting and is effective usually within 15 minutes. It may reduce dependence on emergency department visits. Clients may carry rectal diazepam for the treatment of breakthrough seizures. Many seizures are preceded by an aura, and clients can be educated to recognize their aura to prepare for a seizure (Zonnoor & Chang, 2022).

Encourage the client to wear an identification tag or bracelet stating the presence of a seizure disorder.
This expedites treatment and diagnosis in emergency situations. In 2018, the FDA cleared for marketing the first smartwatch for seizure tracking and epilepsy management. The Embrace smart watch identifies convulsive seizures and sends an alert via text and phone messages to caregivers. The device also records sleep, rest, and physical activity data (Ko & Benbadis, 2022).

Establish a seizure action plan together with the client and their caregivers.
Acute seizure action plans can guide clients and their caregivers on medication administration and actions to take before the arrival of EMS or a visit to the emergency department. Seizure action plans should be developed with a client’s primary healthcare provider or neurologist, but a generalized care plan can be provided to the clients upon discharge from the ED as they wait for follow-up appointments. These plans can clarify when rescue medication should be administered when it is appropriate to wait to see a provider as an outpatient, or when to call 911 or visit an emergency department (Zonnoor & Chang, 2022).

Use communication tools when providing care and information to the client.
Given that nurses without epilepsy specialization will increasingly encounter and provide care for clients with epilepsy, a tool, such as the Epilepsy Nursing Communication Tool, can be used to help improve nurse-client communications and positively affect a nurse’s approach to care for clients with epilepsy using the model of client-centered care. Client care can be customized according to the client’s needs and values, with the client as the source of control. Knowledge and information are freely shared between clients and their healthcare providers, client needs are anticipated, and treatment decisions are made based on the best available evidence (Buelow et al., 2018).

Refer the client to a neurologist as indicated.
While most clients in the emergency department are manageable without a neurological consultation, a neurology consult may be considered if a client meets the definition of status epilepticus, the client with known epilepsy has a breakthrough seizure, and the client is in a prolonged post-ictal state. Non-adherence to anticonvulsants is a leading cause of the emergence of breakthrough seizures, therefore the client may need medication changes to prevent future seizures (Al Sawaf et al., 2023).

Reinforce seizure precautions as appropriate.
One of the major problems with recommending seizure precautions is the unpredictability of the seizure recurrence. The onus is on healthcare professionals to discuss seizure precautions in clients diagnosed with seizures. These precautions must be discussed and documented to prevent any issues including future litigation by the family members. Some clients may only have nocturnal epilepsy, thus one needs to use judgment in recommending safety maneuvers (Al Sawaf et al., 2023).

6. Administer Medications and Provide Pharmacologic Support

Antiepileptic drugs (AEDs): phenytoin, primidone, carbamazepine, clonazepam, valproic acid, divalproex, acetazolamide, ethotoin, methsuximide, fosphenytoin
AEDs raise the seizure threshold by stabilizing nerve cell membranes, reducing the excitability of the neurons, or through direct action on the limbic system, thalamus, and hypothalamus. The goal is optimal suppression of seizure activity with the lowest possible dose of a drug and with the fewest side effects. Fosphenytoin reaches therapeutic levels within 24 hours and can be used for non emergency loading while waiting for other agents to become effective. Note: Some clients require polytherapy or frequent medication adjustments to control seizure activity. This increases the risk of adverse reactions and problems with adherence.

Topiramate, ethosuximide, lamotrigine, gabapentin
Adjunctive therapy for partial seizures or an alternative for clients when seizures are not adequately controlled by other drugs. Lamotrigine is quickly absorbed if given orally, and 55% is bound to plasma proteins. Topiramate is approved for generalized, primary generalized, tonic-clonic, and partial-onset seizures (AlEissa & Benbadis, 2022).

Phenobarbital
This potentiates and enhances the effects of AEDs and allows for the lower dosage to reduce side effects. If the client has received a benzodiazepine, the potential for respiratory supression significantly increases. This agent is the best-studied barbiturate for the treatment of status epilepticus (AlEissa & Benbadis, 2022).

Lorazepam
This is used to abort status seizure activity because it is shorter acting than Valium and less likely to prolong post-seizure sedation. Lorazepam, when available, is thought to be the most effective of the benzodiazepines and has a longer seizure half-life than diazepam. It is the favored agent when intravenous access is preferred (Zonnoor & Chang, 2022).

Diazepam
This may be used alone (or in combination with phenobarbital) to suppress status seizure activity. Diastat, a gel, may be administered rectally, even in the home setting, to reduce the frequency of seizures and need for additional medical care. The client can also carry rectal diazepam for treatment of breakthrough seizures. Many seizures are preceded by an aura, and clients can be educated to recognize their aura to prepare for a seizure (Zonnoor & Chang, 2022).

Glucose, thiamine
This may be given to restore metabolic balance if a seizure is induced by hypoglycemia or alcohol. A 50 mL bolus of 50% dextrose IV and 100 mg thiamine can be administered, especially in status epilepticus cases, in some settings where drug intoxication might be likely, consider also adding naloxone to the dextrose bag (Roth & Berman, 2021).

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See also

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