While working in the ICU, you are assigned to care for a patient with a seizure disorder. Which of these nursing actions will you implement first if the patient has a seizure?
A. Place the patient on a non-rebreather mask will the oxygen at 15 L/minute.
B. Administer lorazepam (Ativan) 1 mg IV.
C. Turn the patient to the side and protect the airway.
D. Assess level of consciousness during and immediately after the seizure.
Correct Answer: C. Turn the patient to the side and protect the airway.
The priority action during a generalized tonic-clonic seizure is to protect the airway.
Option B: Administration of lorazepam should be the next action since it will act rapidly to control the seizure.
Option A: Although oxygen may be useful during the postictal phase, the hypoxemia during tonic-clonic seizures is caused by apnea.
Option D: Checking the level of consciousness is not appropriate during the seizure, because generalized tonic-clonic seizures are associated with a loss of consciousness.