Med-Surg · Neurological
Seizures & Meningitis
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Prepared for Pass the Shift (owner: Kristina, RN). Always follow your facility’s protocols, provider orders, and current drug references.
1. Overview and Pathophysiology
A seizure is abnormal, excessive neuronal firing. Epilepsy means a lasting predisposition to unprovoked seizures. Classifications include focal vs generalized; motor vs nonmotor. is prolonged seizure activity (often taught as ≥ 5 minutes continuous, or recurrent without recovery)—a life-threatening emergency.
Meningitis is inflammation of the meninges. Bacterial meningitis is a medical emergency with high morbidity; viral is often less severe; fungal/TB occur in specific hosts. Inflammation raises ICP risk and can trigger seizures.
2. Causes and Risk Factors
- Seizures: epilepsy, fever (pediatrics), hypoglycemia, hyponatremia, alcohol withdrawal, trauma, stroke, brain tumor, meningitis/encephalitis, missed AEDs, drug toxicity
- Meningitis: N. meningitidis, S. pneumoniae, H. influenzae, Listeria (age extremes), enteroviruses; dorm living, immunocompromise, neurosurgery, unvaccinated status
3. Signs and Symptoms
Seizure: aura, staring, automatisms, tonic-clonic movements, incontinence, tongue trauma, postictal confusion/sleepiness. Note time, lateralizing signs, and recovery.
Meningitis: fever, severe headache, , photophobia, nausea, altered mentation. and signs may be present. Meningococcal disease: petechial/purpuric rash → septicemia emergency. Infants: bulging fontanelle, poor feeding, irritability.
4. Diagnostics and Labs
Lab reference ranges vary by laboratory. Always use your facility’s ranges.
| Test | Typical / note | Nursing relevance |
|---|---|---|
| Blood glucose | Treat hypo immediately | Common reversible cause |
| Electrolytes, tox screen | — | Provoked seizures |
| EEG | — | Confirms/classifies seizures |
| CT/MRI | — | Structural cause; before LP if herniation risk |
| Lumbar puncture CSF | Bacterial: cloudy, ↑WBC (neutrophils), ↑protein, ↓glucose | Droplet precautions until treated bacterial disease clarified |
| Blood cultures | Before antibiotics when possible | Don’t delay abx in unstable bacterial meningitis |
| AED levels (e.g., phenytoin) | Phenytoin often ~10–20 mcg/mL | Toxicity vs subtherapeutic |
5. Priority Nursing Assessments
- Airway patency, SpO₂, duration timing
- Injury evidence; pregnancy status when relevant
- Mentation between events; seizure precautions environment
- Meningitis: VS, rash, neuro checks, ICP signs, fluid status
- Vaccine history; exposure contacts for meningococcus
- Medication adherence and recent AED changes
6. Priority Nursing Interventions
During seizure: stay with client; ease to floor if needed; protect head; turn side-lying when feasible; loosen tight clothing; nothing in the mouth; do not restrain; suction/O₂ ready; time the event; call for help if ≥ 5 min or first seizure/pregnancy/injury.
After: airway, VS, glucose, reorient, document, side rails padded per policy, fall precautions.
Status epilepticus: ABCs, IV access, benzos first-line per protocol, then ASD load (levetiracetam, valproate, fosphenytoin, etc.), prepare for airway support.
Bacterial meningitis: droplet precautions (until ≥ 24 h appropriate antibiotics for many meningococcal/H. flu cases—follow policy); antibiotics/steroids as ordered; quiet dark room; ICP precautions; fluid management; prophylaxis for close contacts as public health directs.
7. Medications
| Class / examples | Role | Nursing considerations |
|---|---|---|
| Benzodiazepines (lorazepam, diazepam) | Abort status | Respiratory depression; have airway support ready |
| Levetiracetam | Broad ASD | Mood changes possible |
| Phenytoin / fosphenytoin | ASD | IV phenytoin: NS only, filter, cardiac monitoring; gingival hyperplasia; therapeutic levels |
| Valproate | ASD | Hepatotoxicity, teratogenicity, ammonia |
| Carbamazepine | Focal seizures | Hyponatremia, SJS risk, autoinduction |
| Antibiotics + dexamethasone | Bacterial meningitis | Give promptly; steroids per guideline timing |
| Antivirals (acyclovir) | Suspected HSV encephalitis | Don’t delay if highly suspected |
8. Patient Education
- AED adherence; don’t stop abruptly; drug-level monitoring when used
- Trigger diary: sleep, alcohol, flashing lights, missed doses
- Safety: driving laws vary; shower vs bath; medical ID
- Seizure first-aid teaching for family
- Meningitis vaccines (meningococcal, pneumococcal, Hib) as indicated
- Return precautions: fever + stiff neck + confusion = emergency
9. Complications
- Status epilepticus → hypoxia, acidosis, neuronal injury
- Aspiration, head trauma, SUDEP (sudden unexpected death in epilepsy)
- Meningitis: hearing loss, seizures, SIADH, ICP/herniation, septic shock, DIC
- Medication toxicity / Stevens–Johnson syndrome (some ASDs)
10. Memory Aids
- “Turn, time, protect—nothing in the mouth”
- “5 minutes = status until proven otherwise”
- “Droplet until 24 hours of abx” (many bacterial cases—know policy)
- “Cloudy CSF, low glucose → think bacterial”
- “Phenytoin + NS only”
11. NCLEX-Style Practice Questions
1. A client begins tonic-clonic seizure activity in bed. First actions?
A. Insert a tongue blade
B. Protect the head, turn to side when possible, and time the seizure
C. Restrain the arms tightly
D. Leave to get the provider without calling for help
Answer: B. Protect from injury, support airway positioning, and time the event—never force objects into the mouth.
2. Which CSF pattern suggests bacterial meningitis?
A. Clear, normal glucose, mildly ↑lymphocytes
B. Cloudy, ↓glucose, ↑protein, neutrophil-predominant WBC
C. Bloody that clears (traumatic tap only)
D. Normal in all respects
Answer: B. Bacterial infection consumes glucose and raises protein/WBCs; fluid often cloudy.
3. Priority isolation for suspected meningococcal meningitis?
A. Airborne only
B. Droplet precautions per policy
C. No isolation needed
D. Contact only without mask
Answer: B. N. meningitidis spreads by respiratory droplets.
4. IV phenytoin is ordered. Which nursing action is correct?
A. Mix with D5W and push rapidly
B. Administer with normal saline, use a filter as required, and monitor cardiac status
C. Give IM for faster effect
D. Combine with dopamine in the same line routinely
Answer: B. Phenytoin precipitates in D5W; follow IV protocol carefully.
5. A seizure lasts 8 minutes without recovery. Priority medication class?
A. Oral phenytoin only
B. Rapid-acting benzodiazepine per protocol
C. Opioid analgesic
D. Antibiotic
Answer: B. Status epilepticus treatment starts with benzos while supporting ABCs.
References
Centers for Disease Control and Prevention. (n.d.). Meningitis. Retrieved October 15, 2026, from https://www.cdc.gov/meningitis/
MedlinePlus. (n.d.). Seizures. National Library of Medicine. Retrieved October 15, 2026, from https://medlineplus.gov/seizures.html
National Council of State Boards of Nursing. (2026). 2026 NCLEX-RN test plan. https://www.nclex.com/test-plans.page
Huff, J. S., & Murr, N. I. (2023). Seizure. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430765/
Runde, T. J., Anjum, F., & Hafner, J. W. (2023). Bacterial meningitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459360/