A febrile seizure is a convulsion in a child triggered by a fever.

Such convulsions occur without any

underlying brain or spinal cord infection or other neurologicalcause. According to studies, about 3-5% of
otherwise healthy children between the ages of 9 months and 5 years will have a seizure caused by a
fever. Toddlers are most commonly affected. Most occur well within the first 24 hours of an illness, not
necessarily when the fever is highest.

The first febrile seizure is one of life’s most frightening moments for parents. Most parents are afraid that
their child will die or have brain damage. Thankfully, simple febrile seizures are harmless. There is no
evidence that simple febrile seizures cause death, brain damage, mental retardation, a decrease in IQ,
or learning difficulties. (www.nlm.com) However, a very small percentage of children go on to develop
other seizure disorders such as epilepsy later in life.

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1 Hyperthermia
Benign Febrile Convulsion is a convulsion triggered by a rise in body temperature. Fever is not an
illness and is an important part of the body’s defense against infection. Antigens or microorganisms
cause inflammation and the release of pyrogens which is a substance that induces fever.

Assessmen Nursing Nursing Expected

Planning Rationale
t Diagnosis Interventions Outcome
Subjective Hyperthermia Short term: >Assess >To obtain Short term:
: After 4 hours underlying baseline date. The patient’s
Ө of nursing condition and
>To note for temperature
interventions, body progress and shall have
Objective: the patient’s temperature.evaluate effects decreased
temperature >Monitor andofhyperthermia. from 39°C to
the patient will decrease recorded vital normal range
manifested from 39°C to signs. >To decrease or of 36.5°C to
: normal range totally diminish 37°C.
of 36.5°C to >Remove pain.
> febrile 37°C. unnecessary Long Term:
temp = clothing that >Reduces
39°C Long Term: could only metabolic The patient
aggravate demands or shall have
>flushed After 2 days heat. oxygen. been able to
skin and of nursing be free of
warm to interventions, >Promote >To promote complications
touch the patient adequate rest surface cooling. and maintain
will be able to periods. core
> be free of >To help temperature
convulsion complications >Provide TSB decrease body within normal
and maintain temperature. range.
> RR = 34 core >Advise to
bpm temperature increase fluid >To provide
within normal intake. proper
range. ventilation and
the patient
may >Loosen promote release
manifest: of heat through
evaporation.
> high clothing. >To promote
fever fluid
>Administer management.
> IV fluids at
weakness prescribed > Antipyretics
rate. Monitor lower core
regulation rate temperature.
frequently.

>Administer
antipyretics as
ordered.

2 Imbalanced Nutrition
The nutritional requirements of the human body reflect the nutritional intake necessary to maintain
optimal body function and to meet the body’s daily energy needs. Malnutrition (literally, “bad nutrition”) is
defined as “inadequate nutrition,” and while most people interpret this as undernutrition, falling short of
daily nutritional requirements. The etiology of malnutrition includes factors such as poor food availability
and preparation, recurrent infections, and lack of nutritional education.

Assessme Nursing Nursing Expected

Planning Rationale
nt Diagnosis Interventions Outcome
Subjectiv Imbalance Short term: >Review patient’s >To obtain Short term:
e: Nutrition: After 4 records. baseline data. The patient
Ө Less than hours of >Assess underlying >To determine shall have
the body nursing condition. specific identified
Objectiv requiremen intervention interventions. measures to
e: t related to s, the >discuss eating promote
economical patient’s habits and >To achieve nutrition and
the factors. will identify encourage diet for health needs of follow the
patient measures to age. the patient with treatment
manifeste promote the proper food regimen.
d: nutrition and > Note total daily diet for his
follow the intake includes disease. Long
> body treatment patterns and time of Term:
weakness regimen eating. >To reveal change
that should be The patient
> weight Long Term: >Consult physician made in the shall have
of 7.9kg for client’s dietary demonstrate
After 2 days furtherassessment a intake. d behaviours
> loss of of nursing nd recommendation or lifestyle
appetite intervention regarding food >For greater changes to
s, the will preferences and understanding and regain
> poor demonstrate nutritional support. furtherassessment appropriate
muscle behaviours of specific food. weight.
tone or lifestyle
the changes to
patient regain
may appropriate
manifest: weight.

>
abnormal
laborator
y studies

> pallor

3 Ineffective Tissue Perfusion

The circulation to the tissues is not getting enough oxygen or nourishment. Decrease in oxygen
resulting in the failure to nourish the tissues at the capillary level.

Assessmen Nursing Nursing Expected

Planning Rationale
t Diagnosis Interventions Outcome
Subjective: Ineffective tissue Short term: > Establish > To gain Short term:
Ө perfusionrealated After 4 hours rapport. patient and The patient
to decreased Hgb of nursing > Monitor VS.S.O.’s trust shall have
Objective: concentration in intervention, and promote demonstrated
blood as the patient > Determine cooperation. behaviour
The patient evidenced by will factors related > To lifestyle
manifested: low Hgb count in demonstrate to individual monitor change.
CBC result behaviour situation. patients
>Body lifestyle status. Long term:
temperature changes to > Evaluate for
changes. improve signs of > To gain The patient’s
circulation. infection information S.O. shall
>Skin especially regarding have
discoloratio Long term: when immune the verbalized
n system is condition. understanding
After 2 days compromised. of the
The patient of nursing >To observe condition.
may intervention, > Discuss for possible
manifest: the patient’s individual risk risk factors.
S.O. will factors.
> Anemia verbalize > This
understanding > Elevate information
of the head of bed at would be
condition. night. necessary
for the
> Discuss the client’s S.O.
importance of
 a healthy > To
diet.. increase
gravitational
blood flow.

>To promote
a healthy
diet to help
increase
RBC
synthesis
and Hgb
count for
faster
recovery.

4 Risk for Infection

The immune system is the body’s defense against bacteria, viruses, and other foreign organisms or
harmful chemicals. It is very complex and it has to work properly to protect us from the harmful bacteria
and other organisms in the environment which may infect our body. If the immune system is
compromised, it can affect the normal production of WBC from the bone marrow. If there is an increase
in number of WBC, therefore it may increase the possibility to increase infection.

Nursing Nursing
Assessme Expected
Diagnosi Planning Intervention Rationale
nt Outcome
s s
S=Ø Risk for Short Term: >Establish >To gain their Short Term:
(spread) good trust and
O = the of After 3 hours of working cooperation
After 3 hours of
patient infection nursing relationship nursing
manifeste interventions, the with the >For interventions, the
d: patient will client and comparative patient shall have
verbalize S.O. baseline data verbalized
>body understanding of understanding of
weakness ways on how to >Monitor >To know when ways on how to
prevent spread of and record to assist client prevent spread of
>fatigue infection. vital signs infection.
>To promote
>poor Long Term: > Determine optimum level of Long Term:
muscle pt’s functioning
tone After 1week of individual After 1week of
nursing strength >To nursing
=The interventions, the preventfatigue a interventions, the
patient patient will be >Provide nd conserve patient shall have
may free peaceful energy been free
manifest: from infectionsa from infectionsa
>elevated nd further environment >.to prevent nd further
body complications occurrence of complications.
temperatu >Provide furtherinfections
re adequate rest
and sleep. >To prevent falls
>Hgb = and injuries
112 >Emphasize
importance >To note for
>WBC = of hand imbalances
22.9 washing
>To ensure
>RBC = >Provide proper hydration
3.97 safety
measures > To replace
>HCT = fluid electrolyte
0.34 >Monitor I loss
&O
>Platelet
count = >Check IV
234 and Regulate
IVF

>Advice pt
to increase
oral fluid
intake when
allowed

5 Risk for Injury

A seizure or convulsion is the visible sign of a problem in the electrical system that controls your brain. A
single seizure can have many causes, such as a high fever and lack of oxygen. Hemoglobin is a protein
in red blood cells that carries oxygen. Therefore, Low levels of hemoglobin in the human body may reult
to seizure. During episodes of convulsion, patients are prone to injuries since they may strike different
objects due to uncontrollable muscle spasms.

Assessme Nursing Nursing Expected

Planning Rationale
nt Diagnosis Interventions Outcome
Subjectiv Risk for Short term: >establish rapport > To gain Short term:
e: injury After 4 hours >monitor and patient’s trust
The SO shall
Ө related to of nursing record Vital Signs >To obtain have
possible interventions baseline data modified
Objective convulsion , the SO will > ascertain knwlge environment
: . modify of safety needs/ > to prevent as indicated
environment injury prevention injuries in to enhance
the patient as indicated home,communit safety.
may to enhance > note clients y, and work
manifest safety. gender, age, setting Long term:
the developmnt stage,
following: Long term: decision makng >affects client’s The SO shall
ability, level of ability to protect have
>Fever After 2 days cognition/competen self/others and verbalized
of nursing ce influence choice understandin
>Convulsi interventions of interventions/ g of
on , the SO will >provide health teachings individual
verbalize care within a factors that
>Low understandin culture of safety >to prevent contribute to
g of errors resulting possibility of
>Low Hgb individual > identify in client injury, injury.
Level = factors that interventions/safety promote client
112 contribute to devices safety and
possibility of model safety
injury. > discuss behaviors for
importance of self client/SO
monitoring of
conditions/ >to promote
emotions safe physical
environment and
individual safety

>it can
contribute to
occurence of
injury

What are febrile convulsions?

A febrile convulsion is a seizure in young children caused by a sharp rise in body temperature (fever).
Febrile convulsions otherwise called febrile seizures (fever seizures) or febrile fits (fever fits) can cause
a lot of concern among parents because of its sudden onset and frightening nature.. A convulsion
triggered by sudden fever is usually harmless and normally does not indicate a long term or ongoing
problem like epilepsy. It is important to note that episodes such as these occur in relation to a rapid rise
in temperature, & is not related to the duration of the fever or the degree of temperature.

What causes of fever seizures?

As previously mentioned, most fever fits occur as a result of a sudden rise in body temperature but it
may also develop as the fever is declining.

Usually, the fevers that trigger febrile convulsions are caused by an infection in the infant’s body, such
as middle ear infections, or other bacterial or viral infections of the nose & throat. A less common, but
more serious cause of such fevers is an infection of the child’s brain & spinal cord, such as meningitis.
The risk of fever seizures can also increase after some common childhood immunizations.

What are the symptoms of febrile fits?

A child experiencing a febrile convulsion may display the following signs and symptoms:

• A fever, usually higher than 38.9 C

 • Loss of consciousness
• Jerking of the arms & legs
• Eyes rolled back in the head
• Difficulty breathing
• Vomiting & urinating
• Crying or moaning

Based on the symptoms, there are two types of febrile convulsions:

A simple, benign febrile fits is an episode of convulsions that lasts for less than 10 minutes. The nature
of convulsions is generalized in that the entire body goes into spasm or becomes stiff. After the episode
of fits subside, the child is normal and suffers no after effects although they may act confused and be
quite sleepy.

In atypical febrile fits, the episode of convulsions lasts for more than 15 minutes. The nature of
convulsions affects only one part of the body and the seizure occurs more than once in 24 hours. The
child may show signs of after effects or damage of the brain.

How are fever seizures diagnosed?

Febrile fits is diagnosed by the doctor by careful history taking with due consideration given to the age of
the baby and the family history

In addition, blood investigations and a lumbar puncture is indicated in special situations to rule out any
infection. A lumbar puncture involves taking a sample of fluid that surrounds the spinal cord to look for
any signs infection.

How are fever seizures treated?

When a child starts having fits, parents must remember not to panic. The infant should not be restrained
& no attempt should be made to stop the seizure movements. The child should be placed on his or her
side to ensure that the airways remain clear and remove any objects or food from the mouth. Measures
must be taken to control the fever & reduce the temperature by removing clothing, applying cool
washcloths to the face & back and sponge the rest of the body with cool water. The child must be taken
to the doctor when the spell passes.

Most febrile seizures stop on their own within a couple of minutes. If the fit last for longer than five
minutes, or if the infant has repeated seizures, immediate medical attention is required.

How to prevent fever seizures?

Simple benign febrile fits can be prevented from recurring by taking the following precautions :

• As soon as the fever begins, the temperature has to be brought down immediately by
paracetamol syrup administration and tepid sponging.
• Until the child recovers completely from the fever episode, he has to be watched carefully for
any sudden rise in temperature.

Benign Febrile Seizures

Definition: A benign condition characterized by a tonic-clonic or tonic seizure occurring in a
6-month-old to 5-year-old that lasts less than 20 minutes and is not accompanied by a
postictal state. (PREP article Jan 97: may have a postictal state) Children are neurologically
normal with no evidence of focal seizure.

Prognosis: Febrile seizures can recur, but usually disappear by 3-4 years of age. No
significant increase in epilepsy unless child has risk factors present.
Risk of Recurrent Febrile Seizures (Arch Ped Ad Med:97;151:371). 31.8% recur with 17%
one recurrence, 9% two recurrences; 6% 3 or more. Risk factors recurrence: Increased if:

a. young age at onset;

b. first degree relative with febrile seizures;
c. low degree of fever when in ER; brief duration between onset of fever and initial
seizure. Early Rx with Ibuprofen doesn’t help prevent febrile seizures.

Risk Factors for Later Development of Epilepsy:

1. Positive Family History for Epilepsy

2. Seizure is focal - not generalized
3. Child is less than 6 months old at time of first seizure
4. Seizure lasts more than 20 minutes
5. Child’s neurological examination is abnormal
6. Repeat seizure occurs with same illness

Differential Diagnosis: Seizure with fever: associated with underlying neurological

abnormalities

How to Approach the Treatment of the Child With Recurrent Febrile Seizures With No
Risk Factors:

1. Reassure parents that there are no problems from recurrent seizures: no brain damage, no
increased epilepsy risk, etc.

2. Take careful history of family, past medical history, and history of actual event – i.e.
generalized, how long lasted, and postictal state. If history and physical are normal fits the
category of benign febrile seizure.

3. Urge parents to give Ibuprofen in future - more effective than acetaminophen in preventing
febrile seizure (Arch Pediatr Adol Med 149:632-637;1995)

4. Urge parents:

• DO NOT put things down child s mouth to open the mouth.

• DO NOT give mouth to mouth resuscitation; the color of the child is due to the
seizure, not to cardiac or respiratory arrest.

5. Do not need to order EEG: Don't know what to do with the information once you get it.

6. No need for referral to neurologist.

How to Approach the Treatment of the Child With Recurrent Seizures, Fever, and Risk
Factors:

1. Must inform parents that this is not the same thing as seizures with no risk factors:

• If one risk factor present: 6-8% later epilepsy

• If two risk factors present: 17-22% later epilepsy
• If 3 risk factors present: 49% later epilepsy

2. Workup will need to be complete: EEG, CT or MRI, possible neurology consult.

3. Depending on nature of seizure and workup, anticonvulsant medications may be indicated.