Question

A nurse is caring for a school age child who has experienced a tonic clonic seizure. Which of the following actions should the nurse. take during the immediate postictal period?

A)Place the child in a lateral position
B)Provide the child with play situations that allow for disclosure.
C)Discourage the child from remembering the incident.
D)Deny the suspected perpetrator visiting rights to the child.

Answer 1

The nurse should place the child in a lateral position during the immediate postictal period following a tonic clonic seizure to ensure safety and facilitate recovery.

Step-by-step explanation:

During the immediate postictal period following a tonic clonic seizure, the nurse should place the child in a lateral position. This is important to maintain an open airway and allow fluids or vomitus to drain from the mouth, preventing aspiration. The postictal phase can include confusion, drowsiness, fatigue, headache, or temporary weakness; thus, proper positioning is critical for the child's safety and recovery.

Providing play situations that facilitate expression may be helpful in other contexts, but it is not an immediate postictal care step. Discouraging the child from remembering the incident or denying visiting rights to any alleged perpetrator is not appropriate in the context of immediate seizure aftercare, and any such actions should be taken with consideration of the specific circumstances and professional guidelines.

It is also important for healthcare providers to monitor the child for further seizure activity, check vital signs, and provide reassurance as the child recovers. If a prescriber has ordered anticonvulsants like diazepam, the nurse may prepare to administer these medications if necessary; however, diazepam is typically given during an active seizure, not in the postictal period.