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Febrile seizure are convulsions brought on by a fever in infants or small children.

These convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Less commonly, the child becomes rigid or has twitches in only a portion of the body. Most febrile seizures last a minute or two; some can be as brief as a few seconds, while others last for more than 15 minutes. Physiology A healthy person's body temperature fluctuates between 97F (36.1C) and 100F (37.8C), with the average being 98.6F (37C). The body maintains stability within this range by balancing the heat produced by body metabolism with the heat lost to the environment. The "thermostat" that controls this process is located in the hypothalamus, a small structure located deep within the brain. The nervous system constantly relays information about the body's temperature to the hypothalamus, which in turn activates different physical responses designed to cool or warm the body, depending on the circumstances. These responses include: decreasing or increasing the flow of blood from the body's core, where it is warmed, to the surface, where it is cooled; slowing down or speeding up the rate at which the body turns food into energy (metabolic rate); inducing shivering, which generates heat through muscle contraction; and inducing sweating, which cools the body through evaporation. A fever occurs when the body maintains a higher temperature, primarily in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The chills that often accompany a fever are caused by the movement of blood to the body's core, leaving the surface and extremities cold. Once the higher temperature is achieved, the shivering and chills stop. When the infection has been overcome, or antipyretic (fever-relieving) drugs have been taken, the hypothalamus "resets" the body's baseline temperature, and the body's cooling mechanisms switch on: the blood moves to the surface and sweating occurs. Fever is an important component of the immune response, though its role is not completely understood. Physicians believe that an elevated body temperature has several effects. The immune system chemicals that react with the fever-inducing agent also increase the production of cells that fight off the invading bacteria or viruses. Higher temperatures may inhibit the growth of some bacteria, while at the same time speeding up the chemical reactions that help the body's cells repair themselves. In addition, the increased heart rate that may accompany the changes in blood circulation also speeds the arrival of white blood cells to the sites of infection. Causes About 3 - 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families. Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness Febrile seizures are usually triggered by fevers from:
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Ear infections Roseola infantum (a condition with fever and rash caused by several different viruses) Upper respiratory infections caused by a virus Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down. A child is likely to have more than one febrile seizure if: There is a family history of febrile seizures The first seizure happened before age 12 months The seizure occurred with a fever below 102 degrees Fahrenheit

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Symptoms A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body. Febrile seizures may begin with the sudden contraction of muscles on both sides of a child's body -- usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine. The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue. Finally, the contraction is broken by brief moments of relaxation. The child's body begins to jerk rhythmically. The child does not respond to the parent's voice. A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is usually followed by a brief period of drowsiness or confusion. A complex febrile seizure lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness. Febrile seizures are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure. Other symptoms of febrile seizures include the following:
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Breathing difficulty (e.g., apnea; the child may turn bluish in color) Contraction of the muscles of the face, limbs, and trunk Fever (usually higher than 102F) Illness (e.g., upper respiratory infection) Involuntary moaning, crying, and/or passing of urine Shaking Twitching Vomiting

Febrile Seizure Complications


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Biting oneself Breathing fluid into the lungs, pneumonia Complications if a serious infection, such as meningitis, caused the fever Injury from falling down or bumping into objects Injury from long or complicated seizures Seizures not caused by fever Side effects of medications used to treat and prevent seizures (if prescribed)

Exams and Tests The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis. In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap). To avoid having to undergo a seizure workup:
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The child must be developmentally normal. The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child's body, and not confined to one part of the body. The seizure must not have lasted longer than 15 minutes. The child must not have had more than one febrile seizure in 24 hours.

The child must have a normal neurologic exam performed by a health care provider. Febrile Seizures: Diagnostic Tests The list of diagnostic tests mentioned in various sources as used in the diagnosis of Febrile Seizures includes: Body temperature Tests for fever EEG tests Blood culture Complete Blood Count Urinalysis Urine Culture Cerebrospinal Fluid analysis

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These tests can help determine possible causes of the fever and seizure.

Treatment During the seizure, leave your child on the floor.


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You may want to slide a blanket under the child if the floor is hard. Move him only if he is in a dangerous location. Remove objects that may injure him. Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up. If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing. Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements. Focus your attention on bringing the fever down: Insert an acetaminophen suppository (if you have some) into the child's rectum. Do NOT try to give anything by mouth. Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse. After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen. After the seizure, the most important step is to identify the cause of the fever.

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Prognosis The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties. A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures. Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy.

About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime. Most children outgrow febrile seizures by age 5. The prognosis of febrile convulsion in terms of intellectual outcome is good. Most children with febrile convulsions do not develop epilepsy. Recurrence Risk of Febrile Convulsion
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Risk of recurrence is 50% if the febrile convulsion occurs in the first year of life. Major predictor for recurrence of febrile convulsion is early age of onset.

Risk of Intellectual Deficit


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Only among those with pre-existing neurological or developmental abnormality. And in those who developed subsequent a febrile convulsions.

Risk Factors for Developing Epilepsy


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Preexisting neurological abnormality. Family history of a febrile convulsion. Complex first febrile convulsion.

Nursing Management: 1. Monitor the entire seizure event, including prodromal signs, seizure behavior, and postictal state. 2. Monitor complete blood count, urinalysis, and liver function studies for toxicity caused by medications. 3. Provide safe environment by padding side rails and removing clutter. 4. Place the bed in low position. 5. Do not restrain the patient during seizure. 6. Do not put anything in the patients mouth during seizure. 7. Maintain a patent airway until the patient is fully awake after a seizure. 8. Provide oxygen during the seizure if the patients become cyanotic. 9. Place the patient on side during a seizure to prevent aspiration. 10. Protect the patients head during the seizure. 11. Teach stress reduction techniques that will fit into the patients lifestyle. 12. Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to sedation. 13. Encourage the patient to determine existence of triggering factors for seizures, such as skipped meals, lack of sleep, and emotional stress. 14. Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check ups, and visual examinations. 15. Encourage mother to guide the patient to follow a moderate lifestyle routine, including exercise, mental activity, and nutritious diet.

Acute Management of Febrile Convulsion:


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Maintain a clear airway. Protect the child from injury. Place the child in a semi-prone position. Loosen clothing or remove excess clothing. Give oxygen if available. Apply suction for nasal or oral secretions if facility available Treat fever by sponging with tepid water and antipyretics (e.g. acetaminophen). Monitor vital signs. If facilities and medications are available? Administer rectal diazepam 0.2-0.5 mg/kg/dose if convulsion lasts for more than 5 minutes. Administer intravenous anticonvulsant if the child is still convulsing for >15 minutes (diazepam, lorazepam or phenobarbital), (preferably in the listed order), and depending on the availability of anticonvulsant. a. Intravenous diazepam, 0.2-0.5 mg/kg/dose (maximum rate: 1-2 mg/minute) to a maximum dose of2-4 mg in an infant or 5-10 mg in the older child. The same dose can be repeated every 10 to 30 minutes to a total of 3 doses, if necessary. b. Intravenous lorazepam, 0.05-0.10 mg/kg/dose (maximum rate: 1 mg/minute) to a maximum dose of4 mg can be given; with an additional 0.05 mg/kg 10 minutes later if needed. c. Intravenous phenobarbital in a dose of 15-20 mg/kg (rate: 30 to 100 mg/minute); with half of the initial dose repeated in an hour if necessary.

Management of febrile seizures. a. Acute Attack: (i) Position patient semiprone (ii) Place oral airway (iii) O2 through mask (iv) Control seizures : Rectal or IV Diazepam 0.5 mg/kg, repeated after 15 minutes if necessary (v) Control of fever antipyretics paracetamol 10 mg/kg per dose every 4-6 hourly. Management of Fever
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There is no evidence that antipyretic treatment prevents the recurrence of febrile convulsions. Fever should be treated in order to promote the comfort of the child and to prevent dehydration. Use of antipyretic drug is effective and paracetamol or ibuprofen is advised. An adequate fluid intake is advisable.

Febrile seizures: an update Abstract Febrile seizures are most common seizures in childhood (2-4%). Children with simple febrile seizures only have a slightly increased risk of epilepsy. Recurrences are common. Diagnostic ascertainment is easy, most evaluations simple, diagnostic routine schedules almost not necessary. Prophylactic antipyretic or anticonvulsant therapies are not recommended. Administration of rectal diazepam at home in case of recurrence is useful. Adequate therapeutical approach also includes physicians guidance and information for the dramatically frightened parents who think their child was about to die. Only complex febrile seizures with high risk of subsequent epilepsy may indicate intermittent diazepam prophylaxis or even continuous anticonvulsant treatment in case of a beginning epileptic syndrome.

Republic of the Philippines J.H. CERILLES STATE COLLEGE COLLEGE OF NURSING Pagadian City Campus West Capitol Road, Balangasan District, Pagadian City Tel/ fax No. (062) 353-1644 STUDENT NAME: Shane Marnelli M. Cabellon SECTION:____A_____ YR:__II________ EXPOSURE DATE:___________________________________________ AREA OF EXPOSURE:____PEDIA WARD_______________________ CLINICAL INSTRUCTOR:___Mr. Mart Manalo____________________

PEDIA NURSING ASSESSMENT GENERAL OBJECTIVE: This aims to distinguish and verify the general health problems and needs of the patient with an admitting diagnosis of Benign Febrile Convulsion vs SVI. This will help enhance the knowledge and skills of the researcher and relate to Pediatric Nursing concepts to her actual related learning experience as a student nurse. This will help the patient know importance of health and its medical understanding of the said condition through the application of nursing skills.

SPECIFIC OBJECTIVE: 1. To gather pertinent and comprehensive data through interview and medical chart. 2. To perform physical assessment in a head-to-toe approach. 3. To have a review of the anatomy and physiology of the systems affected. 4. To trace the pathophysiology of complex febrile seizure. 5. To determine and understand the different medical and nursing management employed. 6. To interpret the results of the laboratory and diagnostic procedures. 7. To study the drugs prescribed to the patient and its effects to her current condition. 8. To formulate and apply nursing care plan utilizing the nursing process. 9.To learn new clinical skills required in the management of the patient who had suffered complex febrile seizure. 10. To render nursing care and information through the application of the nursing skills.

II. GENERAL INFORMATION: NAME OF PATIENT:_Galido, Joice_ DATE/TIME ADMITTED:_2-1-12/8:10pm_ CHIEF COMPLAINT: _Febrile Fever, seizure AGE: __27/12____ SEX: _Female DIET: __NPO__ ATTENDING PHYSICIAN: _Dr. Bancoro RELIGION: Roman Catholic_ DIAGNOSIS: Benign Febrile Convulsion vs SVI_ BIRTH HISTORY Name of Patient: Galido, Joice Age: 27/12 Address: Purok Tisa, Baloyboan Pagadian City Birth Date: June 23, 2009 youngest Gender: Female Religion: Roman Catholic Weight: 12kg NSVD Delivered at home Status: CH Nationality: Filipino Complete Primary Immunized FAMILY HISTORY Fathers Name: Manuel Galido Age: 39 Occupation: Care Taker Religion: Roman Catholic Mothers Name: Eufemia Calido Age: 38 Occupation: House keeper Religion: Roman Catholic Daughter: Marian Louriphel Age:17 Student College Son: Neil Christian Age:15 Student Highschool Daughter: Christine Age: 10 Student Grade 5 Son: AJ Age:8 Student Grade 3 Son: LJ Kent Age: 4 Preschool

HISTORY OF PRESENT ILLNESS Afternoon PTA, onset of high grade fever with no signs and symptoms. Given Paracetamol with no relief 3 hours PTA-) have seizure this brought to ER.

HISTORY OF PAST ILLNESS -In previous hospitalization

GENOGRAM: Maternal Ruben 72 Marina 69 Fraternal Danilo 75 Virginia 72

Alma Reynaldo 18 25

Eufemia 38

Dante 26

Marilou 30

Manuel 39

Joel 42

Marian Louriphel 17

Neil Christia n 15

Christine 10

AJ 8

LJ Kent 4

Joice 27/12

Summary of Interaction: The patient is weak and having a fever , cant stand without the help of the Mother, moaning and crying.

III. MEDICATION:      Paracetamol 150mg IV q40 RTC Ampicillin 250mg IVTT q 6h (ANSTC) Paracetamol 125/5 5ml q4 RTC Paracetamol 125 supp./ rectum PRN for seizure Metronidazole 125/5 8ml TID

IV. GROWTH AND DEVELOPMENT age:_27/12_

NORMAL Physical Motor Language Sensory Socialization

ACTUAL Weak, cant stand without help of the mother, Cant stand and sit without support, turning to the other side if feels discomfort, Can see. Can smell. Can hear, can taste Smiles when her name is called, response during interaction, Feel comfortable when touch REVIEW OF SYSTEM

NAME OF PATIENT: _Galido, Joice__ DIAGNOSIS: _Benign Febrile Convulsion vs SVI_ VITAL SIGN: RR: _34cpm_ HR: _150bpm_ T: _410C_

DIET: _NPO__ HEIGHT:_______ WEIGHT:_12 kg_

OBSERVATION: The patient is weak and having a fever , cant stand without the help of the Mother, moaning and crying.

GENERAL: Awake on bed, in lying position with # 2 D5LR 500cc @ 60cc/hr HEENT: Anicteric sclera, pink palphebral conjunctiva INTEGUMENTARY: skin color is light brown RESPIRATORY: Clear Breath Sound CARDIOVASCULAR: Normal DIGESTIVE: Abdomen EXCRETORY: Urinates frequently and eliminates stool at least once a day MUSCULOSKELETAL: Stretches his arms and legs and turns his head from one side to another. No weakness and limitation in movement in her extremities. There was no swelling, wounds, or injuries observed by her mother on the patients joints and muscles

PEDIA NURSING ASSESSMENT (GORDONS FUNCTIONAL) Name of the pt.: Galido, Joice Chief complaint: Fever Convulsion, seizure Inclusive date of care: 3 days Diagnosis: Benign Febrile Convulsions vs SVI Date of admission: Feb. 1, 2012/ 8:10pm Diet: NPO Normal Pattern Activity and rest Before hospitalization Playing staff toy, playing other games together with her brother. Rest and sleep in noon for 1 to 2 hours.Wakes up when hungry or needs something. Eats vegetables, fruits, fish, meat. Not allowed to eat junkfoods only biscuits. Drinks milk once a day Hydrated Urinate 4 to 6x a day , defecate 1 to 2x a day, Dont wear diaper Cries when irritates and need something Alert of sound Familiar with faces Day 1 Dont have enough rest and sleep due to interaction of e.g laboratory exams and others, awake when hear voice, moaning and crying. Less responsive. NPO age: 22/12 allergies: to none

Day 2 Sleep every 1 to 2 hours, response during interaction, crying, desires to go home,

Nutrition

DAT

Elimination

Urinate almost of urinate 3 x a day , the time, Defecate 1 defecate 4x a day, t0 2x a day, not wear diaper allowed to drink Cries due to high grade temperature Sleeps always and doesnt respond to sounds around her. Cries because she desires to go home Awake and Sleeps sometimes respond during interaction, smiles when touch and talk. Can turns his head from one side to another, Can stand and sit without the help of the mother. Breaths normally without O2 saturation and V/S are normal Sleep well, when difficulty of breathing occur O2 saturation is given. Still Unable to clean herself without the help of the Mother

Ego integrity Neuro-sensory

Reflexes Can carry his head Use of reflexes

Oxygenation and vital signs

Pain and discomfort

Hygiene/ ADL

Sexuality

Able to breathe properly even without the help of O2 saturation, V/S are normal Cries when in pain O2 saturation is and in discomfort given, Cant sleep comfortably due to her condition Able to clean herself Unable to clean with help of the herself without the Mother, Takes a help of the Mother bath everyday, Brush her teeth, clean her nail through the help of her Mother The pt is only 2 The pt is only 2

Can turns his head from one side to another, Cant stand without the help of the mother Having difficulty in breathing with O2 saturation and V/S are not normal

Likes to say

Religion

years old , play manica, wear new dresses usually blouses and shorts, likes light colors , Says Gwapa siya The pt. is Christian, Roman Catholic, In one month they go to church 3 times.

years old, cant play, cant wear new dress,

gwapa siya play with her sister, wear proper dress

Unable to be brought to the church due to her Condition but her parents continue to pray and ask GOD for complete healing

Unable to be brought to the church due to hi condition and still he r parents Continue to pray and ask God for Complete healing

Laboratory Results HEMATOLOGY: Complete blood Count WBC count RBC count Hemoglobin Hematocrit Platelet Differential Count Segmented NeitrophilsLymphocytes Monocyte Eusinophils Basophils 81% 14% 05% ________ 100 % 55-61% 20-35% 2-8% 12,900/cu.mm 4,410,000/cu.mm 10.5gms% 34.6vol% Normal Range 5000-10000/cu.mm 4000,000-5000,000/cu.mm 14-17gms% 40- 59 vol% 150,000- 400,000/ cu.mm

Urinalysis Macroscopic Findings: Color: yellow Appearance: clear Reaction: pH 6.0 Specific Gravity: 1.005 Sugar: Negative Albumin: Negative Microscopic Findings: Cellular elements: Pus Cells 2-4/ hpf Epithelial Cells: few Bacteria: Many Crystals: Uric Acid: few

BLOOD CHEMISTRY Electrolytes: Sodium (Na+)143.7 mmol/L -135.0-148.0 mmol/L Potassium (K+) 3.89mm0l/L- 3.5-4.5 mmol/L

REVIEW OF ANATOMY AND PHYSIOLOGY

Temperature control in children is not completed until approximately ve years of age. This maybe due to the immaturity of the nervous system. The maintenance of body temperature is mainlycoordinated by the hypothalamus, a central control center containing large numbers of heat-sensitiveneurons called thermoreceptors. It is an important homeostatic mechanism which allows the bodyenzymes to work ef ciently within a narrow range of 36.5 37.5 C. In response to a change intemperature, the peripheral thermoreceptors transmit signals to the hypothalamus, where they areintegrated with the receptor signals from the preoptic area of the brain.The normal set point in childhood reflects a decreasing basic metabolic rate (BMR) as the childgrows. The body temperature of the three-month-old child is 37.5 C, whereas at thirteen years it is 36.6C. Even as the temperature regulatory mechanisms mature through childhood, babies and smallchildren are highly susceptible to temperature fluctuations, as they produce more heat per kilogram of body weight than older children. Changes in environmental temperature, increased activity, crying,emotional upset and infections all cause a higher and more rapid increase in the younger child. Theyounger the child the less able he or she is to vocalize the feeling of hot or cold or to do somethingabout it. All children may also become too cold. Small individuals who do not have warm clothes andwarm homes will not grow if the temperature of their environment is consistently low. They will usemuch of the energy from their food intake to generate heat (metabolic rate) and leave no spare caloriesfor tissue growth. The smaller the child, the larger the surface area for heat loss in relation to bodymass. The head of a small child is relatively larger in proportion to the rest of the body, and covering the 12head in a cold environment conserves heat for growth. Schoolchildren may experience a sequence of small growth spurts and at times be relatively thin with minimal body fat. At the swimming pool, forexample, where children enjoy jumping in and out of the water as they play, thin children may becomecold more quickly than their fatter friends who have an insulation layer beneath their skin.Heat can generated through the metabolism of the liver, muscles, and other chemical activities.When children are exposed in a cold environment, it can result to hypoglycemia, elevated serumbilirubin, metabolic acidosis, and increased metabolic rate. When heat loss occurred, non-shiveringthermogenesis (NST) heat production takes place in the subcutaneous tissue, hypothalamus, and spinalcord to compensate for the sudden change in temperature.Heat loss transpires through the contact in a cold environment, vasodilation, sweating wherethe preoptic area of the brain stimulates secretion of water to the skin for evaporation. There aredifferent areas in the body where we can measure the temperature such as axillae, tympanicmembrane, and mouth.

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