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Grand Mal (Tonic-Clonic)

A generalized seizure with loss of consciousness and convulsions

Definition

A grand mal (tonic-clonic) seizure is a generalized seizure characterized by sudden loss of consciousness, stiffening (tonic phase), rhythmic jerking (clonic phase), and postictal confusion.

Phases

  1. Aura (optional): Warning sensation.
  2. Tonic: Muscle stiffening, possible cry, loss of consciousness (~10 to 30 seconds).
  3. Clonic: Rhythmic jerking of extremities (~30 to 90 seconds).
  4. Postictal: Confusion, fatigue, headache, amnesia lasting minutes to hours.

Seizure Precautions

  • Lower bed, pad side rails
  • Suction and oxygen at bedside
  • Side-lying position during seizure
  • Do NOT restrain or put anything in mouth
  • Remove nearby hazards

Nursing Actions During Seizure

Protect airway, time the seizure, turn to side, observe and document (onset, duration, activity, incontinence, postictal state). Call for help. Administer lorazepam IV per protocol for seizures >5 minutes (status epilepticus).

NCLEX Relevance

NEVER put anything in the mouth or restrain.