Seizure Symptoms and Pathophysiology | Med Surg Nursing Lecture
In this 20‑minute nursing‑school lecture, Christina Rafano explains the underlying mechanisms of seizures, outlines common risk factors, and presents a four‑step framework that describes how a seizure starts, spreads, and resolves. She differentiates excitatory and inhibitory neuronal activity, describes focal versus generalized onset, and defines status epilepticus. The video then reviews the three clinical phases of a seizure (aura, ictal, post‑ictal) and the hallmark seizure types (tonic‑clonic, absence, myoclonic, atonic), highlighting their characteristic signs. The bulk of the lecture focuses on nursing assessment priorities—patient history, airway protection, safety measures, and precise timing of seizure onset and termination—and on interventions such as airway management, environmental safety, seizure‑precaution equipment, and post‑ictal monitoring (including Glasgow Coma Scale). Throughout, Rafano emphasizes exam relevance, offers study‑aid resources, and encourages viewers to use her Nursing School Study Checklist and Nursing SOS membership for further support.
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Hello. Hello my friend. In this video we are diving into the pathophysiology, the signs and symptoms, and of course the nursing interventions for seizures. Now don't worry, we will break it down like we always do, step by step and we'll make sure that you know the patho or what is actually happening inside the body that could be causing seizures. So you'll know if your nursing school exams so since fully understanding the pathophysiology is the foundation for critically thinking through med surg disorders, you want to be able to apply what you are learning on your exams, right? So not to worry, I've got you covered there, my friend. Of course, after this video you will fully understand what is causing seizures, the path behind it, and why those symptoms are happening. That's why we walk through the critical thinking behind it all, starting step by step. So you'll be a lot more confident for your nursing school exams on seizures. After watching this video, let's dive in. Hello. Hello my friend. My name is Christina Rafano and I am the creator of the nursing school show here on this channel where of course we walk you through how to pass nursing school step by step and have more free time. So hit that subscribe button and click the notification bell and let's dive in. So subscribe. So simply put, a seizure happens when many neurons in the brain are all firing just at the same time. So typically they only fire when they need to relay a message, like if you want to move your legs to walk, or if you want to talk or turn your head, or if you're thinking about something. But during a seizure, there are so many neurons that are activated all at once and it overwhelms the brain and sometimes also the body. A seizure is a one time event. But epilepsy can sometimes be used as a term along with seizures. And epilepsy means that the patient has a history of two or more seizures that reoccur. So you may hear those two phrases kind of mixed together and used when referring to seizures. So, so let's go through what happens during a seizure so that you can start really critically thinking about it and then get ready to of course, totally rock your nursing school exam on seizures. Now, normally neurons fire throughout the brain as they are needed, like we said. So one neuron passes a message to the next neuron and they do this through chemicals called neurotransmitters and then that next neuron then fires and then tells the next neuron the message and so on and so on. So the neurons are always Talking back and forth to each other. Now let's go one step deeper. There's two types of neurons that we'll discuss here. There are excitatory neurons and then inhibitory neurons. Now what are the differences between the two of these excitatory and inhibitory, and what do they do? Well, excitatory neurons, these are the ones that pass the signal from one neuron to the next and then they cause that next neuron to keep the signal, signal going. So in excitatory neurons, the message keeps going from one neuron to the next. But if it hits an inhibitory neuron, then that neuron will stop the message right there and then it won't let it continue. So it's kind of like a game of red light, green light. The message can keep running through the brain through those excitatory neurons as it goes, and it goes and goes until one of those inhibitory neurons says stop. Now, as you can imagine, this balance of excitatory and inhibitory neurons is super duper important. But the thing is that during a seizure, there's something that triggers this normal communication to break down. So two things can happen here. Either the excitatory neurons can get overly active, or the inhibitory neurons aren't active enough. So either the excitatory neurons just keep going on, keep going, going and going. No matter if the inhibitory neurons are telling them to stop, or the inhibitory neurons just aren't active enough and they don't yell loud enough for those excitatory neurons to hear them say stop. So either way, the excitatory neurons take over in the brain and they just keep firing and firing and firing all at the same time. Now, you know me and you know how I always love to break things down for you in simple steps, step by step processes. So that's exactly what we're going to do here with the pathophysiology of seizures. Now, you won't see these steps anywhere else in a textbook or anything like that. I am just going to break it down here like this in this way to help make learning about seizures a lot easier for you. So here we go. So step number one in this process is that there is a trigger that causes the neurons to go out of whack. Now, seizures can happen to anyone at any time, but there are a few circumstances that put patients at a greater, higher risk that you should look out for. So things like increased intracranial pressure, ICP or head trauma, pregnant women who are pre eclamptic, if they have had a seizure, it is considered Eclampsia and then hypoglycemia or rapid febrile illness, especially in pediatric patients, patients with meningitis or electrolyte imbalances, specifically sodium electrolyte imbalance, or if the patient has a tumor. Now, it's also important to remember that patients who have had a history of seizures or epilepsy usually have a lower seizure threshold when they are sick. So they are at a higher risk for seizures to occur when they're ill. And sometimes we don't know what triggers the seizure in the first place place. So it's really, it really varies from patient to patient. Now, step number two is when either the excitatory neurons take over or the inhibitory neurons go silent for a while. And then step number three, excitatory neurons keep firing and keep firing uncontrollably. But in either of these cases, it causes the excitatory neurons to fire over and over and over again, which is step number three. Depending on the type of seizure, the seizure can start in a localized area of the brain, like in one lobe or one hemisphere, which is called a focal onset seizure. Or it can start in both hemispheres and affect a large portion of the brain at once. And this is called a generalized onset seizure. Now, step number four, the seizure naturally subsides, usually. Now, as the seizure progresses and the neurons run out of the chemicals and the electrolytes to really keep them active, the seizure may naturally subside. It's kind of like they just run out of steam. However, sometimes the seizure will just keep going, which is called status epilepticus. And it is defined as a seizure that lasts more than five minutes. Now, most seizures don't last more than two minutes, and the longer that the seizure lasts, the more likely that brain damage and death can occur. So those four steps walk you through what is really happening step by step during a seizure. Now, I know that pathophysiology is a lot to learn, but don't worry, my friend. Of course I have a free cheat sheet that walks you through some really, really amazing study tips to help you learn things faster during nursing school. It's called the Nursing School Study Checklist. And I'll put the link down below in the description of this for you to check that out. It's going to help you so much. Now let's talk about the signs and the symptoms that you might see in a patient and the different stages of a seizure and what things you'll need to assess for and then do for a patient who is having a seizure. A seizure like we said, is just that flood of electrical neuron activity in the brain. Now, since we already know what a seizure is in a nutshell, all of this electrical activity is in the brain, happening just all at once. So now let's walk through what seizures might look like and what some of the symptoms, what the signs and the symptoms might be. So there are three main phases, the aura, the ictal and the postictal of a seizure. And each of them have their own signs and symptoms. Now, the first phase is the aura phase. Now this is more of a warning that a seizure is about to happen. Patients may experience this phase phase differently, and some patients just actually don't even have this phase at all. So for them, there may be no warning at all that a seizure will happen. They may have a funny feeling, maybe some patients may smell or taste something different, or experience dizziness or numbness, maybe have changes in their vision, or have visual or auditory hallucinations. They may have a sense of fear or panic, get a headache or feel nauseous. All patients may experience this aura phase in a different way, and it's a warning sign that a seizure might happen. Now the second phase is the ictal or the ictus phase. This usually lasts about 30 seconds to 3 minutes. This is the actual seizure episode itself. It varies based on the type of seizure that's happening and then based on the patient themselves. But seizures usually last anywhere from 30 seconds to 3 to 5 minutes if the seizure has lasted more than 5 minutes, or if the patient had more than one seizure within a 5 minute period, within a 5 minute time period, but didn't come back to consciousness in between the seizure episodes. It is considered status epilepticus and further emergency care should be followed to help that seizure end. So this ictal phase, or ichthyos phase, is the phase where the actual seizure itself occurs. And the signs and symptoms will be of course, different depending on the type of seizure that is happening. So let's walk through the more common types of seizures that might be on your nursing school exams. The first one is a tonic clonic seizure. It's the most hallmark type of seizure there are. There is a tonic portion which causes seizures, stiffening and rigidity of the body. And the patient will lose consciousness during this. And you may hear a cry or a moan as their respiratory muscles spasm. Now then the patient will have colonic movements or rhythmic jerking movements with hyperventilation. During these two phases, you may notice the patient biting their cheek or their tongue, resulting in bleeding at the mouth and the patient may stop breathing, and you may notice some discoloration or cyanosis around their mouth. Now, the heart rate can increase during these seizures, too, and the pupils may be unequal or unreactive or sluggish. Another type of seizure that might show up on your nursing school exam is called an absence seizure. And that is exactly how it sounds. It's just a period of absence. It's usually discovered in pediatric patients and is identified by very brief period of steering off into space where they are unable to respond to stimuli. They're usually under 30 seconds, and they do not have an aura, and the patient will not remember them happening either. It's more common in children, and they may have multiple seizures throughout the day. Now, myoclonic seizures are another type of seizure that nursing school exams really love to test you on. Now, this is similar to a tonic clonic seizure, but usually less severe. The patient is conscious during this and aware of the seizure happening and has quick jerking motions. Now, they usually last less than 30 seconds, and the patient is usually aware that they're happening, but they're unable to stop that jerking motion. Now, the last type of seizure that you might find on your nursing school exam is an atonic or a kinetic seizure. Now, you may also hear it be called a drop seizure or a drop attack. Now, this is kind of the opposite of a tonic clonic or myoclonic seizure. In those types of seizures, the patient's muscles get rigid and they have jerking movements. But in an atonic seizure, the muscles suddenly just go FL and they have no muscle tone. Now, this can cause the patient to fall, and some patients will need to wear a helmet to protect their head when an atonic, atonic seizure occurs. If you are a nursing SOS member, be sure to log into your dashboard and definitely download the study guide that we have for you on the different kinds of seizures so that you can remember all of these types of seizures as you study. It's going to be a really, really good, gu. Good resource for you to help you remember all of this. And if you're not a nursing SOS member yet, be sure to join the wait list so that you can join the next time that enrollment opens. We'll put the link down below in the description box for you to check out all the details. So those are the different types of seizures that can happen during the ictal phase. Now, again, remember, the ictal phase is where the actual seizure is occurring. Now, we've learned about the aura phase, the ictal phase, and now we'll move into the last phase of a seizure. Now this is called the postictal phase. This is the period immediately following the seizure episode. It can last anywhere from maybe a few minutes to days. Now, this is where the brain is recovering. The patient might be unconscious and unresponsive at first. They might be confused, their pupils might be sluggish and they may have a headache or they may be just really tired. They might have lost control of their bladder or their bowels. And if they had a tonic clonic seizure or a myoclonic seizure, they could definitely be sore from all that rigidity, the muscle rigidity and the jerking movements that happened during that ictal phase. So now that we've talked about the pathophysiology of seizures, the types of seizures that can happen in the signs and symptoms associated with those. Now let's talk about the things you need to assess for. There's five main things that you need to assess for in a patient who has a history of seizures or is who who is actively having a seizure. So make sure you know their history of a seizure. And during a seizure, assess and make sure their airway is open, make sure they are safe, and make sure that you track the start time and the duration of the seizure and the symptoms that they experience in each of the different phases of the seizure. Now let's talk about each of these. If the patient has a history of seizures, you will need to dive a little bit deeper or a lot of bit deeper into what type of seizures that they usually have. How do they feel during the seizure? Like are they conscious? Do they have those jerking movements or if their muscles go flaccid, how long do their seizures typically last? If they know, do they have any warning signs that a seizure might happen or occur? Or do they have an aura? Do they get an a headache? Do they get nauseous or have changes in vision? How do they feel after their seizure? In that post dictal phase, how long do they typically stay unconscious? Do they have a headache? Are they usually confused? Things like that? This is all important to help you judge and prepare if a seizure were to occur again. Now, if you are caring for a patient during a seizure, there are those three main things that you will need to assess for their airway safety and time. Now, your number one priority is always airway. Maintaining the patient's airway should always be your number one priority. Now, the patient might stop breathing, they might have an ineffective airway breathing pattern, ineffective breathing pattern like grunting, shallow or rapid breathing and they may have circumoral cyanosis. And then maintain their airway as best as possible. Make sure to remove any restrictive clothing that might be impairing their breathing. Maybe things like a scarf or a tight shirt might need to be removed. And then make sure that you never put anything in their mouth. Now, the NCLEX and your nursing school exams are huge on safety, so make sure that you understand how to keep your patients safe. And an important part of assessing your patient with a history of seizures or a patient who is at risk for seizures is to make sure that the environment, their, their environment is always safe. And then of course, follow your clinical facility seizure precautions. So make sure that there is oxygen available at all times and suction is readily available at the bedside at all times. And make sure that soft surroundings, things like padded side rails or pillows are available. And then keep the bed in the lowest position possible. And if possible, have someone be with the patient or patient on telemetry to monitor them. You may also request to have the patient moved to a room that is closer to the nurse's station. That way they can be more easily monitored. Now, the next key assessment is to track the start and the end time of the seizure. So keeping track of the time is especially important because if the seizure has been happening for longer than, like we said, that three to five minute window, usually emergency medications are needed to break that seizure. If the patient is experiencing respiratory compromise, it is really important to monitor how long this has been occurring and to intervene if possible to support them and then break that seizure. And during the postictal period, the patient could be very tired, it could be confused. It's a good time to do a gcs, a Glasgow Coma Scale, to monitor their progress as they are coming out of that post postictal period. I can guarantee you that your nursing exams will test you on a gcs. So making sure that you understand how to correctly score patients is going to be really important. So the key things to remember, like we said, airway safety and the timing of the seizure, your number one priority should always, always be to ensure that their airway is open and clear and that they are safe. So those are the nursing interventions you'll do for a patient who is having a seiz. Remember, keeping their airway clear is your number one priority. Your next priority should be the general safety needs of your patient. And then, of course, tracking the time of the seizure, the start and the end time. Now, there's three ways that I can help you more through nursing school and particularly Med Surg Number one, Be sure to download the Nursing School Study Checklist that walks you through step by step how to study Med Surg in Nursing School. Number two Be sure to check out our Nursing School boxes that we have available for you that are packed with resources to help you succeed and pass your nursing school exams and have more of a life in nursing school. And of course, if you want me to hold your hand throughout your nursing school journey, you know that that's exactly what I'm here to do. Do not miss out on joining the Nursing SOS US Membership Community. It is filled with step by step nursing lectures to really help you understand everything you need to know for Nursing School Faster for Med Surge so you'll be more prepared for your nursing school exams and more confident too. Now the links to all of those things are down below in the description and if you like this video, be sure to hit that like button. Leave a comment below to let me know that you you loved it and of course share it with a friend who might also need help with Med Surgeon Nursing School and click that subscribe button and hit the notification bell so you never miss another video. And click on one of these videos right over here so you can keep rocking Nursing School. And as always my friend, go become the nurse that God created only you to be. And I'll catch you next time on the Nursing School show. Take care. Bye bye.
