Seizures: Medication Adherence, Safety Precautions, and First Aid

Who needs this teaching

Clients with epilepsy and the family members, coworkers, or teachers who witness seizures. A seizure is a transient, uncontrolled electrical discharge of cerebral neurons. Medication adherence and trigger control reduce seizure frequency.

The priority teaching points

1. Antiseizure medication adherence. Take each dose every day at the same time, even after a long seizure-free period. Abrupt discontinuation precipitates seizures and status epilepticus. Keep appointments for serum drug levels when ordered; the therapeutic phenytoin level is 10 to 20 mcg/mL.
2. Interactions and pregnancy. Ask the pharmacist before any new medication or supplement. Several antiseizure medications reduce the effectiveness of hormonal contraceptives. Clients of childbearing potential discuss pregnancy plans before conception and take the prescribed folic acid. Valproate causes major birth defects. If pregnancy occurs, continue the medication and notify the provider at once.
3. Trigger control. Common triggers include missed doses, sleep deprivation, alcohol use or withdrawal, emotional stress, fever and illness, and flashing lights in photosensitive epilepsy. Keep a regular sleep schedule and limit or avoid alcohol.
4. Seizure diary. Record the date, time, duration, description, possible triggers, and missed doses. Note any aura, the warning sensation some clients feel before a seizure. Bring the diary to every appointment; it guides medication adjustment.
5. Safety precautions. Follow state driving laws, which require a seizure-free period before driving. Never swim alone. Shower instead of bathing in a tub, and keep the bathroom door unlocked. Avoid heights and dangerous machinery until seizures are controlled. Wear medical alert identification.
6. Seizure first aid. Stay calm and time the seizure. Move hard or sharp objects away and cushion the head. Loosen tight clothing around the neck. Turn the client onto the side to keep the airway open and drain secretions. Never put anything in the mouth. Do not restrain movements. Stay until the client is fully awake and oriented. Give a prescribed rescue medication according to the written seizure action plan.
7. Emergency criteria. Call 911 when a seizure lasts longer than 5 minutes or a second seizure follows before the client regains consciousness; both indicate status epilepticus. Also call 911 for injury, breathing difficulty, failure to wake, a first seizure, a seizure in water, or a seizure during pregnancy or in a client with diabetes.

Red flags the client reports

Teach-back questions

• "Why must you never stop your seizure medicine on your own?"
• "Name two things that trigger your seizures."
• "How will you bathe safely?"
• "Show me how you will position him during a seizure."
• "When will you call 911?"

Teaching tips

• Teach first aid to everyone who lives or works with the client, and rehearse side positioning.
• Provide a written seizure action plan with rescue medication instructions.
• Correct the myth that a person swallows the tongue during a seizure.
• Link medication times to daily routines and review the diary at each visit.

Read more on NCLEXPace

• Seizure Precautions and Status Epilepticus: What Never to Do
• Neuro Map: Stroke, Increased ICP, Seizures, and Spinal Cord Injury
• Therapeutic Drug Levels: The Four You Must Know

Sources

• Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Chronic Neurologic Problems.
• Glauser T, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61.
• Trinka E, et al. A Definition and Classification of Status Epilepticus: Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-1523.