Seizures Cheat Sheet
Seizure types and phases, acute safety interventions, status epilepticus, and antiepileptic drug nursing points — distilled for fast, high-yield NCLEX-RN review.
What's in this cheat sheet
A seizure is a sudden burst of abnormal electrical activity in the brain. This cheat sheet covers the pathophysiology and types, the moment-by-moment interventions that protect the airway during an active seizure, the status epilepticus emergency sequence, long-term management and home safety, and the key nursing considerations for antiepileptic medications.
Pathophysiology & Types
Triggers, generalized vs focal seizures, diagnostics (EEG, CMP, CT/MRI) and the aural, ictal and postictal phases.
Acute Interventions
Seizure precautions, what to do during a seizure (side-lying, never in the mouth) and postictal care.
Status Epilepticus
The >5-minute emergency, the airway-first then IV benzodiazepine sequence, and key monitoring points.
Chronic Care & Medications
Adherence, trigger avoidance, home safety teaching, and AED nursing considerations including the SJS rash rule.
Key Takeaways
High-yield facts most likely to appear on the NCLEX-RN.
During any seizure: side-lying position, cushion the head, time it, clear the area — and NEVER put anything in the mouth.
Status epilepticus is seizure activity >5 minutes — airway first, then IV lorazepam or diazepam to break it.
Long-acting anticonvulsants (phenytoin/fosphenytoin) come second, after benzodiazepines have been given.
Any AED plus a new rash = call the provider immediately; Stevens-Johnson Syndrome can be life-threatening.
Never abruptly stop antiepileptics — taper under provider guidance to prevent rebound status epilepticus.
Phenytoin is diluted only in normal saline (precipitates in dextrose), causes gingival hyperplasia, and has a narrow therapeutic window.
1. Pathophysiology & Types
A single seizure is an event; epilepsy is the condition of recurring unprovoked seizures.
Common triggers & causes
- Metabolic: hyponatremia, hypoglycemia, uremia
- Structural: head trauma, stroke, ↑ ICP, brain tumor
- Toxic/withdrawal: alcohol withdrawal, drug toxicity
- Infectious/fever: meningitis, high fever (febrile seizures)
Generalized
Both brain hemispheres involved — includes tonic-clonic (grand mal) and absence seizures.
Focal (partial)
One brain region — ranges from simple (no LOC) to complex (altered awareness, automatisms).
Diagnostics
- EEG — maps abnormal electrical activity
- Metabolic panel (BMP/CMP) — finds electrolyte and glucose problems
- CT / MRI — rules out structural causes (bleeding, tumor, lesion)
Seizure phases
| Phase | What the nurse observes |
|---|---|
| Aural (before) | Possible aura — unusual smell, visual flash, déjà vu, tingling. Not everyone has one. |
| Ictal (during) | Tonic-clonic: LOC → stiffening → rhythmic jerking → possible cyanosis. Absence: brief stare. Focal: twitching or automatisms. |
| Postictal (after) | Confusion, deep fatigue, headache, muscle soreness — minutes to hours. |
2. Acute Seizure Interventions
Priority during an active seizure = safety and airway.
Before — seizure precautions
- Pad and raise side rails on the bed
- Keep suction equipment and an airway kit at bedside
- Ensure O2 is available; establish IV access if possible
- High-risk: alcohol withdrawal, severe hyponatremia, post-craniotomy
During the seizure
- Cushion the head; turn to side-lying immediately to protect the airway
- Do NOT restrain — guide limbs gently away from hazards
- Loosen restrictive clothing; clear the area of sharp objects
- Never insert anything into the mouth — aspiration and injury risk
- Time the seizure — >5 minutes = status epilepticus, call for help
After — postictal care
- Suction airway and apply O2; keep in side-lying recovery position
- Full neuro assessment (GCS, pupils, LOC); check vitals and for injuries
- Reorient calmly and reassure
- Document onset time, duration, movements and postictal state
3. Status Epilepticus — Medical Emergency
Seizure activity >5 continuous minutes, OR two or more seizures back-to-back without regaining full consciousness. Untreated: hypoxia → hypoglycemia → hyperthermia → irreversible brain injury.
Treatment sequence
- Airway + O2 (position, suction, prepare to intubate)
- IV benzodiazepine FIRST — lorazepam or diazepam (rectal diazepam if no IV)
- Repeat benzo if needed
- Long-acting AED next — phenytoin or fosphenytoin
- Check glucose; give IV dextrose if hypoglycemic
4. Chronic Management & Medications
Adherence & triggers
- AEDs must be taken consistently — missed doses lower the seizure threshold
- Never abruptly stop AEDs — rebound status epilepticus can result
- Regular serum drug-level monitoring is required for most AEDs
- Avoid flashing lights, sleep deprivation, alcohol/drugs and uncontrolled stress
Home safety teaching
- Wear a medical alert bracelet at all times
- Shower instead of taking baths — drowning risk; never leave children unattended in water
- Avoid unsupervised swimming; use the buddy system
- Driving restrictions vary — typically seizure-free 6–12 months before licensure
Antiepileptic medications — key nursing points
| Drug | Critical nursing considerations |
|---|---|
| Benzodiazepines (lorazepam, diazepam) | Acute/rescue, SE first-line. Watch for respiratory depression; have resuscitation equipment ready; rectal route if no IV. |
| Phenytoin (Dilantin) | Dilute only in normal saline (precipitates in dextrose). Narrow window — monitor levels. Causes gingival hyperplasia; report any rash (SJS). |
| Valproic acid (Depakote) | Monitor LFTs and platelets (hepatotoxicity, thrombocytopenia). Teratogenic; report bruising, jaundice or rash. |
| Carbamazepine (Tegretol) | Avoid grapefruit juice (raises levels). Monitor CBC for bone marrow suppression; report rash (SJS). |
Seizures Self-Test
6 quick questions — answers reveal after you submit.
Q1. A client begins having a tonic-clonic seizure in bed. What is the nurse's priority action?
Q2. A client has been actively seizing for 7 minutes. After ensuring the airway and oxygen, which medication does the nurse anticipate administering first?
Q3. A client taking phenytoin reports a new skin rash. What is the nurse's priority action?
Q4. Which statement by a client on long-term antiepileptic therapy requires further teaching?
Q5. The nurse is preparing to administer IV phenytoin. Which IV solution is appropriate for dilution?
Q6. During the postictal phase following a tonic-clonic seizure, which finding does the nurse expect?
Answered 0 / 6 — unanswered count as incorrect.