Seizure Care Plan


    Gainesville ISD Health Services

    Seizure Emergency Treatment Plan


    Student Name__________________________       Age_______   Weight__________


    Treatment/Medication: ________________________mg: Route: ________ prn for:


    _____ seizure > ____ minutes—OR for _____ seizures in _____ hours

    _____ Use vagal nerve stimulator (VNS) magnet        other _________________

    _____Call 911 immediately and administer rectal gel


    Call 911 if:

    _____ Seizure does not stop by itself or with VNS within _____ minutes

    _____Seizure does not stop by itself within ______ minutes

    _____Seizure does not stop within ____ minutes of giving diazepam rectal gel

    _____Child does not start waking up within _____ minutes after seizure is over

    (no diazepam rectal gel given)

    _____Child does not start waking up within ____ minutes after seizure is over

     (after diazepam rectal gel is given)

    Following a seizure:

    _____Child should rest in the nurse’s office          _____Child may return to class

    _____Parents should be notified immediately

    _____Parents should receive a note/copy of the seizure record sent home with the child

    Current Medications:______________________________________________________



    Type of seizures                   Description*             

    Absence:                                Staring, eye blinking, loss of awareness, other___________

    Simple partial                        Remains conscious, Involuntary rhythmic jerking/twitching on one side,

    Seizures:                                distorted sense of smell, hearing , sight, other_____________       

    Complex partial                     Confused, not fully responsive/unresponsive, may appear

    Seizures:                                fearful, purposeless, repetitive movements, other______________

    Generalized tonic-                Convulsions, stiffening, breathing may be shallow, lips or skin

    clonic seizures:                     may have bluish color, unconsciousness, confusion, weariness, or belligerence when the seizure ends, other________________


    Call parents under the following circumstances:  ____________________________________



    Physician Signature                                                      Printed Name                             Date

    Physician Address________________________________Phone_________________________


    Parent Signature                                           Date               Phone