Recognising a Seizure on an Oncology Ward | Future Nurse Thinking for Student Nurses

🚨 WHAT WOULD YOU DO?

 

“I Thought She Was Just Cold…”

It’s one of those shifts. Call bells are going off, admissions keep arriving and everyone seems to need something at the exact same time. You’re trying to stay organised, but your brain already feels overloaded.

You walk past the bed of a patient who was admitted yesterday to the ward following worsening confusion and reduced mobility linked to metastatic disease affecting the brain. She had been mostly alert and conversational, although intermittently confused throughout the shift.

 

Now, you notice she’s shaking slightly. Not violently. Just enough to catch your eye. You stop.

• “Are you cold?”
• She nods. “Yeah…”

Fair enough, you think. The ward feels freezing tonight. You grab a warm blanket, tuck it around her and ask if that’s better. She nods again. You’re about to leave when something makes you pause.

Her left arm looks strange. Rigid. Locked tightly into a fist. And suddenly your brain starts trying to work it out: Is she shivering badly? Is she becoming hypothermic? Is it pain? Rigidity? You don’t fully know yet, but you know it doesn’t look right.

 

1. Assess: Trust the “something feels off”

Future nurse thinking isn’t about instantly knowing the diagnosis. It’s recognising: "This picture doesn’t fit.” Instead of walking away, you decide to grab another blanket and the obs machine. On the way out of the bay, you quickly say to your nurse:

"Can you check Room 9 please? She says she’s freezing but her arm’s gone really rigid. I’m just grabbing another blanket and the obs machine to get her temperature.”

That matters. You didn’t ignore it. You didn’t leave it until the next routine obs round. You escalated uncertainty early. And honestly? That’s how a lot of deteriorating patients get caught.

 

2. Recognise: The picture changes fast

You come back into the bay with the obs machine. Your nurse is already beside the bed and instantly the atmosphere feels different. The patient’s arm is now completely rigid. Her movements have become repetitive, rhythmic and jerking. Her awareness is dropping rapidly.

Your nurse looks at you: "She’s having a seizure. Pull the emergency buzzer.”

And suddenly the room changes pace completely.

 

3. Respond: Calm actions inside chaos

This is the part students remember forever. The first seizure you witness can be terrifying. You pull the emergency buzzer and the room suddenly becomes packed with people:

• Oxygen gets pulled from the wall
• The emergency trolley arrives
• Staff appear rapidly
• Doctors begin entering the bay
• The obs machine gets attached

And through all the noise, your nurse looks directly at you and says: "Start the timer. We need an exact duration.” Suddenly you realise: timing isn’t just a detail. It’s critical clinical information.

The Clinical Why: Correctly timing a seizure is vital. A generalised seizure lasting longer than around 5 minutes is far less likely to stop on its own and becomes a medical emergency known as Status Epilepticus. The longer seizure activity continues, the greater the risk of airway compromise, severe hypoxia (low oxygen levels), aspiration, metabolic stress on the body and irreversible neurological injury.

That’s why nurses become intensely focused on exact timings during seizures. The difference between a seizure lasting 1 minute versus 8 minutes completely changes escalation, medication decisions and emergency management.

And now your own adrenaline is through the roof. But you still have a role.

 

4. Think: Knowing your patient matters

While the medical team prepares emergency medication, somebody asks: “Is she epileptic?”

Because you admitted her yesterday and actually checked her chart properly, you can answer: “No diagnosis of epilepsy, but she is prescribed anti-epileptic medication.”

Suddenly that conversation with your mentor from yesterday clicks into place. Your mentor explained that anti-epileptic medications are not only used for epilepsy. In oncology and neurological patients, they’re commonly prescribed for:

• Seizure prevention related to brain tumours or metastases
• Cerebral irritation or swelling
• Post-neurosurgical seizure prophylaxis
• Neuropathic pain
• Previous neurological injury

And suddenly that medication matters. That’s future nurse thinking. Not just: "What medication are they on?” But: “Why are they on it?”

 

5. Escalate & Treat

The seizure continues. The room becomes intensely time-focused. Emergency medication is prescribed immediately according to local policy. Everything now revolves around timing, airway protection, oxygenation, medication response and ongoing observations.

Rescue medication is checked carefully and administered in escalating doses as the seizure worsens. And even though your adrenaline is through the roof, your role as a student still matters massively.

You are:

• Calling out elapsed time
• Helping with observations
• Documenting medication timings
• Relaying information
• Protecting the patient from injury
• Staying calm inside the chaos

This is something students often don’t realise: You do not need to be the person giving emergency medication to still be hugely important during an emergency. Good emergencies rely on communication, timing, teamwork, documentation, observations and people knowing the patient well - not just the person givingthe medication.

 

6. Afterward: The quiet part nobody talks about

Eventually the seizure activity stops. And suddenly the room becomes quiet again. But your job isn’t done. The patient is now post-ictal - profoundly exhausted, confused, difficult to rouse and requiring close neurological monitoring.

Regular neurological observations begin:

• GCS or AVPU
• Oxygen saturations
• Respiratory rate
• Airway monitoring
• Repeat observations

And as you stand there, your own heart is still racing. Because ten minutes ago? You genuinely thought she was just cold. And honestly? That’s how many deteriorations begin. Not obvious. Just: “Something doesn’t feel right.”

 

7. Document & Handover

You and your Staff nurse document everything chronologically: the initial unilateral rigidity, the shaking, seizure onset, exact duration, observations, medications given, medical staff involved, oxygen therapy and neurological status afterward.

 

Then at handover:

Room 9 developed a seizure at 21:10, initially presenting with unilateral left-sided rigidity and shaking. Emergency buzzer pulled. Seizure duration was 6 minutes 12 seconds requiring IV Lorazepam. Medical team reviewed. Patient now post-ictal and requiring ongoing neurological observations and oxygen therapy.”

Clear. Focused. Relevant.

 

Real-World Shift Reflection

In the real case that inspired this scenario, the seizure lasted over 30 minutes despite two emergency doses of Lorazepam. By the end, the patient was completely unresponsive and required continuous 15-minute neurological and vital sign monitoring for several hours afterward. An emergency CT scan was organised alongside an ICU review due to the severity and duration of the seizure activity.

Cases like this are a critical reminder that prolonged seizures are not just “a patient fitting”; they are true neurological emergencies with potentially life-threatening consequences. The moment you notice that something is slightly off, you have to act on it.

🧠 Bleepbook Takeaway

Seizures Don’t Always Start Dramatically: some begin subtly as isolated rigidity, repetitive movements, staring episodes, “shivering” that doesn’t quite fit or sudden behavioural changes. Trust the feeling that something is wrong.

You Don't Need an Instant Diagnosis: You do not need to instantly know what is happening to escalate concerns early. Escalating uncertainty saves lives.

The Clock Matters: During seizures, exact timing directly affects escalation, medication decisions and emergency management. Never guess the duration.

Know Your Medications: Anti-epileptic drugs are commonly used in oncology and neurological patients even without a formal epilepsy diagnosis. Understanding the WHY changes how you see the patient.

Emergencies are Team Events: Even as a student, your role matters. Timing, observations, communication, documentation and recognising deterioration early all help keep patients safe.

 

"Have you ever had a patient who couldn’t clearly tell you they were deteriorating? What subtle signs helped you recognise the change?”

Bleepbook Disclaimer:

These scenarios are written to help UK student nurses connect theory to real-world clinical thinking. While based on realistic practice situations, they are educational resources only and should never replace local policy, supervision or professional clinical judgement. Patient conditions can deteriorate quickly and every clinical situation is different. Always follow your Trust guidelines, NICE recommendations and the NMC Code and escalate concerns to your mentor or senior clinician if you are worried about a patient.