Dwellness™ • Seizure Monitoring

Seizure Monitoring

Dwellness™ customization for:

Your Patient

General Principles

There are several facets to detecting and documenting seizures. This is all based on your powers of observation and communication.

  • Broad categories of observation
    1. Precursors to possible seizures
    2. Seizures
Precursors

Precursors to possible seizures are times when your patient seems to have a generalized tension throughout your patient's body. Your patient may breathe heavily. Your patient's face may contort, showing facial tension. These are not seizures, but they may be an indication of an approaching seizure.

When your patient seems to startle easily, that can be another sign your patient is tending toward having a seizure. Your patient's startle reflex increases when your patient's brainwaves are moving toward seizure activity. In general, surround your patient with a consistent auditory environment; no sudden loud noises. Your patient does like high volume at times — often shouts with joy — but unexpected loud noises can startle your patient easily, sometimes triggering a seizure.

Seizures

The characteristics of your patient's seizures have been fairly stable for a number of years now. They are tonic seizures (not tonic-clonic). At the outset, your patient's right leg stiffens and extends. Your patient's left leg may stiffen, but less than the right leg. Sometimes your patient's arms stiffen, but less than your patient's legs. At the same time, your patient's face changes, your patient's eyes roll up, and your patient's facial expression freezes.

Your patient's seizures generally last about 10-15 seconds. The seizure is considered finished when your patient's right leg starts to relax, and your patient's face starts to regain a normal expression. It usually takes a few minutes for your patient to return to your patient's baseline. If any one seizure lasts more than three (3) minutes, administer the emergency seizure medication: Nayzilam. That can be found hanging from the back of your patient's wheelchair, or in the medication cupboard in the hallway.

See also: "Nayzilam Instructions (PDF)".

Post-ictal effects are most often very mild, but sometimes they can cause your patient to be sleepy and yawning. Watch for this, and take whatever action will make your patient most comfortable.

Daily observations
  • Observe and be aware of your patient's general condition
    • Read and hear about your patient's condition from the previous staff member when you start ("Staff Communication Form")
    • Always communicate your observations in writing and verbally to the next shift as you complete yours ("Staff Communication Form")
    • Several aspects of your patient's general condition that can lead to seizures
      • Gut pressure when your patient is overdue for a BM
      • Gut pressure when your patient has gas
      • Being overly tired
      • Any illness, especially when your patient has a fever
  • Precursors to possible seizures
    • On most days there are very few precursors, or no precursors at all
    • Become familiar with your patient's common precursors
    • Keep your senses open to your patient's signals, which can be subtle
  • Listen for silence
    • Most of the time your patient is pretty vocal and active
    • When your patient suddenly goes silent, take a look
      • Very often this is just your patient being quiet
      • Sometimes this can be a precursor or a seizure

Procedures

Seizure precursors
  • When seizure precursors happen, there is no need to intervene
  • Observe closely the characteristics
  • If the precursors are happening frequently, make sure to keep your patient always within view
    • "Eyes-on"

      • [NOTE: "Eyes-on" is a way of saying that your patient should be watched at all times, with minimal distractions. If you have to be in the kitchen for a while, simply place your patient's chair within view while you’re there.]

  • Auditory environment
    • Since starling can trigger seizures, avoid sudden loud noises when possible
    • For example, before you cough or sneeze say, "I’m gonna sneeze (or cough)."
    • Of if you’re turning on a machine (e.g.: blender or vacuum), announce it first
When a seizure occurs
  1. Be sure your patient is in a safe position

    2. → CAUTION: If your patient has a seizure while standing, gently lower your patient to the floor. Be very careful of your patient's leg positions as your patient goes onto the floor or into bed. Your patient's hips are vulnerable, and a position that is out of alignment can dislocate your patient's hips. ←

  2. Note the time of occurrence
  3. Start timing the seizure duration
  4. Comfort your patient and reassure your patient
  5. Observe closely the characteristics of the seizure

    6. [NOTE: Use the Seizure Log (PDF) to keep careful track of seizures. It is crucial to track the duration and the number of seizure per hour. Each seizure starts its own hour, and the hours may overlap.]

Seizure emergency

→ CAUTION: Your powers of observation — and your personal focus while on duty — are absolutely key to success in dealing with seizures. This applies not only to your awareness of your patient during a seizure, but your skill in observing every subtle characteristic of a seizure when it happens. ←
→ CAUTION: The timing of a seizure — clock time and duration — is crucial to the effectiveness of your intervention. If any seizure lasts more than three (3) minutes, or if there are more than three (3) seizures in any one-hour period, then the emergency seizure medication should be administered and emergency seizure steps should be followed. ←



See Medication Administration Routines and Nayzilam Instructions (PDF)

Timing
  • Clock time
    • Always note the clock time as the seizure starts
    • Each seizure marks the start of a new hour
      • Number the hours on the Seizure Log (PDF)
      • This notation is essential to tracking how many seizures might happen in one hour’s time
    • When it is safe to turn your attention away, note the clock time on the Staff Communication Form and the kitchen calendar
  • Duration
    • As soon as a seizure begins, start timing
      • Preferably use a stop-watch
    • Learn how to spot when the seizure has stopped
    • Even after it seems to have stopped
      • Keep observing closely
      • Be aware of any signs that the seizure has continued
      • Be aware if a new seizure has started
      • Note any unusual or different characteristics
    • When it is safe, record the seizure in the "Seizure Log (PDF)"
What is "one hour"?
  1. Clock time for the very first seizure on any given day should be noted
    • This is the start of "Hour #1"
  2. Clock time for the next seizure should be noted
    • This is the start of "Hour #2"
      • Hour #1 and Hour #2 may overlap
  3. Continue the process of recording clock time and designating hour numbers

    4. [NOTE: Every seizure marks the beginning of its own hour. As each hour with fewer than four seizures expires, cross it off the list of hours included in tracking the number of seizures per hour.]

  4. Log each seizure right after it is over (Seizure Log (PDF))
    • Only when it is safe to divert some attention from your patient
      • Clock time
      • Duration
      • Hour #
        • Cross out each hour as it expires with fewer than four seizures
Emergency seizure medication

[NOTE: If any seizure lasts more than three (3) minutes, or if there are more than three (3) seizures in any one-hour period, then the emergency seizure medication should be administered and emergency seizure steps should be followed. See Medication Administration Routines and Nayzilam Instructions (PDF)]


HPCA Input

Dwellness input from HPCA and family caregivers can serve to improve the ongoing support system. Feel free to speak up!