Simulation Questions

Cooper Madison

1) Tonic phase last approximately 10-20 seconds. Manifestations include eyes rolling upward, loss of
consciousness, falls to floor or ground if standing, stiffens in generalized symmetric tonic contraction of
entire body musculature, arms usually flexed, legs head neck extended, possible piercing cry, increased
salivation, loss of swallowing reflex, and apnea leading to cyanosis.

Clonic phase lasts about 30 seconds, but can vary from only a few seconds to a half hour or longer.
Manifestations are violent jerking movements as the trunk and extremities undergo rhythmic
contraction and relaxation, may foam at the mouth, and may be incontinent of urine and feces.

Postictal phase arouses with difficulty, confused for several hours, impairment of fine motor
movements, lack of coordination, possible vomiting, HA, visual or speech difficulties, sleeps for several
hours, and no recollection of the seizure.

2) During a seizure

Protect from injury (move furniture away, hold head in lap if on the floor)

Maintain a position to provide a patent airway

Be prepared to suction oral secretions

Turn child to a side-lying position (decreases risk for aspiration)

Loosen restrictive clothing and Do not attempt to restrain the child or open the jaw or insert an
airway during seizure activity (this can damage teeth, lips, or tongue). Do not put anything in the
child’s mouth

Remove the child’s glasses

Administer O2

Remain with the child

Note onset, time, and characteristics of seizure

Allow the seizure to end spontaneously

Postseizure

Maintain the child in a side-lying position to prevent aspiration and to facilitate drainage of oral
secrections

Check for breathing, vital signs, and check position of head and tongue
 Assess for injuries (mouth, tongue, and teeth)

Perform neurologic checks

Allow for rest

Reorient and calm the client (due to agitation or confusion)

Maintain seizure precautions (placing bed in lowest position and padding the side rails)

Administer AEDs if indicated per order (diazepam, phenytoin, carbamazepine, or valproic acid)

Nursing considerations include monitoring for seizure control, adverse effects, and therapeutic
serum medication levels.

3) IVF

Medication Calculation: 45lb/2.2kg = 20.5kg

0.1mg x 20.5kg = 2.1mg