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Seizures are a common neurologic disorder of childhood, and many pediatric nurses will care for children with epilepsy during their careers. The term "seizure precautions" is used frequently in nursing practice; however, its definition varies among institutions. Childhood epilepsy has many phenotypes, and while some children require airway clearance and ventilatory support in the event of a seizure, many will not. The bedside equipment for a child with seizures should reflect the patient's symptoms. To that end, an algorithm based on seizure classification and current practice in seizure precautions is presented to aid bedside nurses in safely caring for children with seizures. The algorithm may also be used to assist in educating parents about the safest way to care for their child at home, without sending contradictory messages about different needs for equipment in the hospital and in the home.
Over the course of their careers, many inpatient pediatric nurses will care for a patient with seizures or who is at risk for seizures. Although often anxiety-provoking, the fear can be diminished by thinking critically about each child's seizure. The nursing management of pediatric seizures, for which patient safety is the priority, should be driven by the clinical presentation of the child's event. This article will present an algorithm to assist bedside nurses in safely caring for children with a variety of seizure types. The algorithm can be used as a road map to assist staff nurses in safely and appropriately stocking pa - tients' bedsides with emergency equipment as needed for children with seizures. However, to understand the clinical symptoms of a seizure, it is important to first review basic pathophysiology and seizure classification.
What Is a Seizure?
A seizure is a paroxysmal electrical discharge of neurons in the brain that results in a change in function or behavior (Blumstein & Friedman, 2007). The area of cortical involvement and the subsequent temporary changes in cerebral function caused by this abnormal discharge contribute to the clinical manifestation of the event (Fagley, 2007). The clinical presentation of that abnormal neuronal discharge varies from twitching lasting two to three seconds to generalized tonic-clonic movements (a brief period of rigidity followed by rhyth- mic convulsions) that can continue for hours if untreated (Yamamoto, Olaes, & Lopez, 2004)....