A generalized tonic-clonic seizure has a tonic (stiffening) phase followed by a clonic (rhythmic jerking) phase.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client has been in a continuous generalized seizure for more than 5 minutes without regaining consciousness. The nurse recognizes this as status epilepticus and anticipates administering which medication FIRST?
Answer: A. Status epilepticus is a medical emergency. The first-line treatment is a fast-acting benzodiazepine such as IV lorazepam (or diazepam) to stop the seizure quickly. A longer-acting antiseizure drug such as phenytoin or fosphenytoin is given after to prevent recurrence. Mannitol treats cerebral edema and acetaminophen treats fever, not active seizures.
Question 2 of 5
A nurse is assessing a client who reports an unusual smell and a feeling of deja vu just before a seizure. The nurse documents this as which phenomenon?
Answer: A. An aura is a sensory warning that some clients experience before a seizure, such as an unusual smell, taste, visual change, or a feeling of deja vu. The postictal phase is the period of confusion and fatigue after a seizure. The tonic phase is muscle rigidity during the seizure, and the clonic phase is the rhythmic jerking.
Question 3 of 5
A nurse is assessing a client during a focal (partial) seizure. Which finding is MOST consistent with this seizure type?
Answer: A. A focal (partial) seizure begins in one area of the brain and may cause localized motor activity such as jerking of one hand or arm, or sensory or psychic symptoms, sometimes without loss of consciousness. Generalized tonic-clonic seizures involve the whole body with loss of consciousness. A complete absence of any activity describes a different presentation.
Question 4 of 5
A client has just finished a tonic-clonic seizure and is now sleepy, confused, and difficult to arouse. How should the nurse interpret this finding?
Answer: A. Confusion, drowsiness, fatigue, and even temporary weakness are expected during the postictal phase that follows a tonic-clonic seizure; the nurse provides a calm, safe environment and allows the client to rest. These findings do not by themselves indicate a stroke, status epilepticus (which is a continued or repeated seizure), or a need for immediate intubation.
Question 5 of 5
During a tonic-clonic seizure, the nurse observes the client on the floor with generalized jerking movements. Which action is the PRIORITY?
Answer: A. During an active tonic-clonic seizure the priority is to protect the client from injury and maintain a patent airway. The nurse should ease the client to a safe position, turn the head or body to the side to prevent aspiration, loosen tight clothing, and remove nearby hazards. Nothing should be placed in the mouth and the client should never be restrained.
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What is seizure disorder?
Causes include head injury, infection, fever, tumors, metabolic imbalances, alcohol withdrawal, and missed antiepileptic medication. Nursing focus is protecting the airway and preventing injury during and after the event. Status epilepticus (continuous or back-to-back seizures) is a life-threatening emergency.
Key points to remember
- A generalized tonic-clonic seizure has a tonic (stiffening) phase followed by a clonic (rhythmic jerking) phase.
- An aura (strange smell, taste, or sensation) may warn of an impending seizure.
- The postictal phase after a seizure features confusion, drowsiness, and sometimes temporary weakness.
- Status epilepticus is continuous seizure activity lasting more than 5 minutes or repeated seizures without recovery between them.
- Sudden withdrawal of antiepileptic drugs, alcohol withdrawal, and fever are common triggers.
Nursing priorities
- Protect the airway and turn the patient to the side to prevent aspiration during and after the seizure.
- Stay with the patient, ease them to the floor, and cushion/pad the head to prevent injury.
- Do NOT restrain the patient and do NOT put anything in the mouth.
- Time the seizure, note the type and progression, and loosen restrictive clothing.
- For status epilepticus, ensure airway/oxygen, IV access, and give IV lorazepam or diazepam as ordered.
Labs & values
Patient teaching
- Take antiepileptic medication consistently and never stop it abruptly, as this can trigger status epilepticus.
- Avoid driving until seizure-free per state law, and avoid swimming alone or working at heights.
- Identify and avoid personal triggers such as alcohol, flashing lights, and sleep deprivation, and wear a medical alert bracelet.
Red flags: report now
- Seizure lasting longer than 5 minutes or repeated seizures without regaining consciousness is status epilepticus, an emergency.
- Cyanosis, absent respirations, or airway obstruction during a seizure requires immediate intervention.
- Never insert a tongue blade or fingers into the mouth or attempt to restrain a seizing patient.
References
Clinical references for this topic
