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com/category/nursing-care-plans/page/2/ Fever is among the most common symptom usually seen in infections and can often be a cause for concern for apprehensive parents. In children, a fever can appear quite suddenly and resolve just as quickly although significantly high temperatures may be recorded during the episode. Although a fever may be a sign of the body’s natural defenses against an infection, there are times when a fever can occur without any clear indication of an infection. High fevers may lead to fits (convulsions), often indicating a need for immediate medical intervention. 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 Seizure: “A clinical event in which there is a sudden disturbance of neurological function in association with an abnormal or excessive neuronal discharge.” (Lissauer, 2002). A febrile convulsion is a seizure occurring in a child aged from six months to five years, precipitated by a fever arising from infection outside the nervous system in a child who is otherwise neurologically normal. Febrile convulsions have long been recognised, but only in recent years more fully understood. Hippocrates, writing in the 4th century BC, described such a convulsion, clearly differentiating it from rigors and breath holding attacks. He noted that both generalised and partial seizures can
occurring in about 3% of children between the ages of six months and five years. It is the abrupt rise in temperature rather than the high level that is important. A lumbar puncture may be performed if the child is less than eighteen months old shows signs of meningitis or sepsis. The child should be placed on its side. high fever and a precipitating infection.occur. with loss of consciousness and muscular rigidity forming the tonic stage. explaining the nature of febrile convulsions. Cessation of respiratory movements and incontinence of urine and faeces may occur during this stage. All children with a first febrile convulsion should be admitted to hospital to a) exclude meningitis and b) educate the parents. A urine specimen should be taken to exclude infection. During further febrile illnesses. and typically lasts less than five minutes. they should be reassured. The seizures are tonic or tonic-clonic. Finally. Paracetamol is the preferred anti-pyretic and fluid levels should be maintained. The clonic stage that follows is characterised by repetitive movements of the limbs and face. The seizure usually occurs early on in a viral infection when the temperature is rising rapidly. and realised that there was a strong association with age. Rectal diazepam is the drug of choice. Rectal diazepam should be administered as soon as possible after the start of the convulsion. a doctor should always be consulted in order to determine that the cause is simply a viral infection. and not something more serious such as meningitis. Ibuprofen can be given if the fever does not respond to paracetamol. producing an effective blood concentration of anticonvulsant within ten minutes. Parents should receive written as well as verbal advice on the first aid management of a further convulsion. tepid sponging and giving an antipyretic (paracetamol or ibuprofen) such as Calpol. Management of the fitting febrile child: • • Clothing should be removed and the child covered with a sheet. • • Febrile convulsions are a common paediatric presentation to A&E departments. This may be preceded by a frightened cry from the child. the management of a convulsion and the administration of rectal diazepam. • • • Information should be supplied by the hospital to parents. • . Parents should be instructed on the management of fever. Parents of children with an increased risk of seizure recurrence should be supplied with rectal diazepam to administer for any further seizure lasting more than five minutes. which lasts about 30 seconds. • Treatment of the febrile child: Fever should be treated to promote the comfort of the child and to prevent dehydration. and should not be given after the convulsion has stopped. including information about the prevalence and prognosis. by removing warm clothing. and a blood glucose level should be taken. (Great Ormond Street Hospital for Children NHS Trust). since vomiting with aspiration is a hazard. or prone with its head to one side. parents should be advised to keep the childs temperature low. Following convulsion.
Lastly. autoimmune disease. Conversely. and lasts less than 15 minutes. cancer. Fever is a condition in which body temperature is elevated above normal (generally above 100. most children stop having febrile seizures by the age of five or six. Demographics Fever is the most common cause of seizures in children. The simple febrile seizure accounts for 70 to 75 percent of febrile seizures and is one in which the affected child is age six months to five years and has no history or evidence of neurological abnormalities. and the fever is not caused by brain illness such as meningitis or encephalitis. but without evidence of intracranial infection or defined cause.1°C) and 100°F (37. a healthy person's body temperature fluctuates between 97°F (36. including allergic reactions. information is transmitted in the brain by means of electrical discharges from brain cells. and urinary tract infection. A seizure occurs when the normal electrical patterns of the brain become disrupted. most commonly a high fever that has risen quickly. Causes and Symptoms Under normal circumstances. pharyngitis (throat infection). about 5 percent of febrile seizures are diagnosed as symptomatic. ingestion of toxins. Description Febrile seizures were first distinguished from epileptic seizures in the twentieth century. upper respiratory infection. Male children have been shown to have a higher incidence of febrile seizures. excessive sun exposure.8°C). or tonic-clonic (commencing with a stiffening of the body followed by a clonic phase). The average fever temperature in which febrile seizures take place is 104°F (40°C). First onset usually occurs by two years of age. pneumonia. such as otitis media (ear infection). with the risk decreasing after age three. The National Institutes of Health defined febrile seizures in 1980 as "an event in infancy or childhood usually occurring between three months and five years of age. teething. approximately 33 percent will go on to have more than one. The seizure activity itself is generally characterized as clonic (consisting of rhythmic jerking movements of the arms and/or legs). In some cases no cause of the fever can be determined. Other conditions can induce a fever. or certain drugs.4°F [38°C]). The complex febrile seizure shares similar characteristics with the exception that the seizure lasts longer than 15 minutes or is local (affects a localized part of the brain). Fevers are caused in most cases by viral or bacterial infections. occurring in 2 to 5 percent of children from six months to five years of age. chickenpox. the seizure is generalized (affects multiple parts of the brain). A febrile seizure is caused by fever. . The majority of children who experience a febrile seizure will only have one in their lifetime.Definition Febrile seizures are convulsions of sudden onset due to abnormal electrical activity in the brain that is caused by fever. associated with fever." There are three major subtypes of febrile seizures. trauma. in cases in which the child has a history or evidence of neurological abnormality. or multiple seizures take place and accounts for about 20 to 25 percent of all febrile seizures.
while those who have none of the risk factors have only a 20 percent chance. other symptoms . When to Call the Doctor A healthcare provider should be contacted after a febrile seizure. or if the fever is greater than 105. less than 18 months of age) seizure occurs soon after or with onset of fever seizure-associated fever is relatively low Causes The direct cause of a febrile seizure is not known. or irritability after the seizure Approximately one third of children who have had a febrile seizure will experience recurrent seizures. A visit to the emergency room is warranted if the accompanying fever is greater than 103°F (39. which is fever. Febrile seizures represent the meeting point between a low seizure threshold (genetically and age-determined.5°F (38°C) in an infant of three months or younger or if the seizure is the child's first. however.Febrile seizures generally last between one and ten minutes. A febrile seizure is the effect of a sudden rise in temperature (>39°C/102°F) rather than a fever that has been present for a prolonged length of time. A child experiencing a febrile seizure may exhibit some or all of the following behaviors: • • • • • • • • • stiff body twitching or jerking of the extremities or face rolled-back eyes unconsciousness inability to talk problems breathing involuntary urination or defecation vomiting confusion. if the child's skin starts to turn blue.e. it is normally precipitated by a recent upper respiratory infection or gastroenteritis. a condition called hyperpyrexia. The risk factors include: • • • • family history of febrile seizures young age of the child (i. if the child stops breathing. sleepiness. Several risk factors are associated with recurrent febrile seizures. Diagnosis A key focus of diagnostic tests will be to determine the underlying cause of the fever. A comprehensive medical history including the fever's duration and course.8°F (41°C). Emergency medical personnel (telephone 911) should be called if a febrile seizure lasts more than five minutes.4°C) in a child older than three months or 100. Some mutations that cause a neuronal hyperexcitability (and could be responsible for febrile seizures) have already been discovered. The genetic causes of febrile seizures are still being researched. children who exhibit all four are at a 70 percent chance of developing recurrent seizures. some children have a greater tendency to have seizures under certain circumstances) and a trigger.
a suction bulb can be used to help clear the airway. If the child vomits. Because of the benign nature of the simple febrile seizure. recent vaccinations or exposure to communicable diseases. however. Parents or caregivers may be instructed to take certain measures at home to reduce the child's fever. magnetic resonance imaging (MRI).4°F (38°C) suggests another cause for the seizure. there are a number of measures that should be taken to ensure the child's safety. tests such as computed tomography (CT) scans. but quick recovery from this state is normal. There is. In the case of children under 18 months of age. Hospitalization is not normally required unless the child is suffering from a serious infection or illness or the seizure itself was abnormally long. If the child is . no evidence that shows fever-reducing therapies reduce the risk of another febrile seizure occurring.the child is experiencing. a lumbar puncture (spinal tap) may be recommended to rule out meningitis because symptoms are often lacking or subtle in children of that age. such as administering fever-reducing drugs (called antipyretics) such as acetaminophen (Tylenol) or ibuprofen (Advil). The caregiver who was present with the child while he or she was having the seizure will be asked questions relating to the child's behaviors in an attempt to determine the type of seizure. The child may move around during the seizure. During the period after the seizure the child may be disoriented and/or sleepy (called the postictal state). During a Seizure If a parent or caregiver observes a child having a seizure. Children who suffer from recurrent febrile seizures are not diagnosed with epilepsy. or encephalitis. After a Seizure A healthcare professional should be called immediately after the seizure in the event that further treatment or tests are required. meningitis. These include: • • • • • • • staying calm laying the child on his or her side or front to prevent vomited matter from being aspirated into the lungs loosening any tight clothing or items that could constrict breathing marking the start and end time of the seizure clearing the surrounding area of unsafe items attending to the child for the duration of the seizure clearing the child's airway if it becomes obstructed with vomited material or other objects Parents or caregivers should not attempt to stop the seizure or slap or shake the child in attempt to wake him/her. and parents should not try to hold the child down. Physicians may administer tests to rule out conditions other than fever that could have caused the seizure. a seizure disorder that is not caused by fever. and medical treatment is not normally needed. such as epilepsy. Treatment During a seizure parents or caregivers need to remain calm and take steps to make sure the child remains safe. and the child's current behaviors may point to the fever's origin. prior or current medical conditions. A temperature below 100. or electroencephalogram (EEG) are not usually recommended.
Prognosis The risk of complications associated with febrile seizures is very low. For children ages three months and older. Treating the Fever The treatment of pediatric fever varies according to the age of the child and the fever's cause. the course of treatment depends on the extent and cause of the fever. providing plenty of fluids to avoid dehydration. Some of the complications that may occur are: • • • • • • • biting the tongue choking on items that were in the mouth at the start of the seizure injury from falling down aspirating fluid or vomit into the lungs developing recurrent febrile seizures developing recurrent seizures unrelated to fever (epilepsy) complications related the underlying cause of the fever Children who have had a febrile seizure are at an increased risk of having another. Alternative Treatment There are some outpatient treatments that parents or caregivers may administer to reduce their febrile child's discomfort. approximately one third of febrile seizure cases become recurrent. The risk of recurrent seizures decreases with age: infants younger than 12 months have a 50 percent chance of having a second seizure. compared to 1 percent for the general population. The risk of a child going on to develop epilepsy is slightly increased at approximately 2–5 percent. such a risk is increased in children who have a history of neurological abnormalities such as cerebral palsy or developmental delays and in children whose seizures recur or are prolonged. applying cold washcloths to the face and neck. These include dressing the child lightly. Low-grade fevers often do not need to be treated in otherwise healthy children. Aspirin should not be given to a child or adolescent with a fever since this drug has been linked to an increased risk of the serious condition called Reye's syndrome. Most fevers and associated conditions can be managed on an outpatient basis. Physicians recommend that newborns less than four weeks of age with fever be admitted to the hospital and administered antibiotics until a complete workup can be done to rule out bacterial infection or other serious illness. Antibiotics may be administered if the child has a known or suspected bacterial infection. The same is recommended for infants ages four to 12 weeks if they appear ill.suffering from a bacterial infection that is the cause of the fever. . if known. Infants of this age who otherwise appear well can often be managed on an outpatient basis with antipyretics and antibiotics in the case of bacterial infection. Research has shown that febrile seizures do not affect a child's intelligence level or achievement in school. and giving the child a lukewarm bath or sponging the child in lukewarm water. Antipyretics may be suggested to lower a fever and make the child more comfortable but will not affect the course of an underlying infectious disease. he or she may be placed on antibiotics. although there is no evidence that indicates such treatments reduce the risk of febrile seizures. while children over the age of 12 months have a 30 percent chance.
Similarly. a febrile seizure may be the first indication that a child is ill. Children with  febrile convulsions are more likely to suffer from afebrile epileptic attacks in the future if they have a complex febrile seizure. A complex febrile seizure is characterized by longer duration. and do not make the development of adult epilepsy significantly more likely (about 3–5%). They may become incontinent (wet or soil themselves). they may also vomit or have increased secretions (foam at the mouth). allergic reaction. In some cases oral diazepam (Valium) can be administered at the first sign of fever to reduce the risk of febrile seizures. about two-thirds of children who receive this drug experience side effects such as sleepiness and loss of coordination. Parental Concerns A febrile seizure can be a frightening experience for both the child and his or her parents. recurrence. although their eyes remain open. do not tend to recur frequently (children tend to outgrow them). a family history of afebrile convulsions in firstdegree relatives (a parent or sibling). Types There are two types of febrile seizures. Parents may be directed to administer over-the-counter antipyretics at the first sign of fever. or focus on only part of the body. and organ injury. Prevention is. the body will become stiff and the arms and legs will begin twitching. the prognosis after a simple febrile seizure is excellent. and involves the entire body (classically a generalized tonic-clonic seizure). The simple seizure represents the majority of cases and is considered to be less of a cause for concern than the complex. not always possible. Symptoms During simple febrile seizures. J Child Neurol 17S:S44. It is important that parents be educated about the low risk of simple febrile seizures and the measures that can be taken to ensure their child's safety during and after a seizure. Glauser TA: Febrile Seizures. . The patient loses consciousness. Breathing can be irregular. While the use of anticonvulsants such as Phenobarbital or Valproate has been shown to prevent recurrent febrile seizures. Simple febrile seizures do not cause permanent brain injury. The seizure normally lasts for less than five minutes. or a preconvulsion history of abnormal neurological signs or developmental delay. therefore. 2002. partly related to underlying conditions. does not recur in 24 hours. and have not been shown to benefit simple febrile seizures.Prevention In some cases. these drugs are associated with significant side effects such as adverse behaviors. whereas an increased risk of death has been shown for complex febrile seizures. The majority of children who have had a febrile seizure do not need drug therapy. compared with the general public (1%) Template:Shinnar S. • • A simple febrile seizure is one in which the seizure lasts less than 15 minutes (usually much less than this). Only rarely is anticonvulsant therapy recommended for a child with febrile seizures because of the generally benign nature of the seizures and the risk of side effects from the drugs.
Rationale >To obtain baseline date. >To Long Term: decrease or totally The patient diminish shall have pain. > high fever Assessment > weakness >Loosen clothing. Antigens or microorganisms cause inflammation and the release of pyrogens which is a substance that induces fever. temperature. 37°C. >Promote > convulsion the patient will adequate rest be able to be periods. When anticonvulsant therapy is judged by a doctor to be indicated. > RR = 34 free of bpm complications >Provide TSB and maintain the patient core >Advise to may manifest: temperature increase fluid within normal intake. touch nursing interventions.5°C to 37°C. >To help decrease body temperature. Fever is not an illness and is an important part of the body’s defense against infection. >To provide . temperature within normal >To promote range. Objective: the patient’s temperature >Monitor and the patient will decrease recorded vital manifested: from 39°C to signs. >Remove = 39°C unnecessary Long Term: clothing that >flushed skin could only and warm to After 2 days of aggravate heat. >Administer IV fluids at prescribed rate. been able to be free of >Reduces complications metabolic and maintain demands or core oxygen.5°C to a. Expected Outcome Short term: The patient’s temperature >To note for shall have progress and decreased evaluate from 39°C to effects of normal range hyperthermi of 36.Treatment The vast majority of patients do not require treatment for either their acute presentation with a seizure or for recurrences. with sodium valproate showing superiority over clonazepam 1 Hyperthermia Benign Febrile Convulsion is a convulsion triggered by a rise in body temperature. The best way to manage is to control the temperature with acetaminophen (Paracetamol) or by sponging. normal range of > febrile temp 36. range. surface cooling. Nursing Nursing Planning Diagnosis Interventions Subjective: Hyperthermi Short term: >Assess a underlying After 4 hours of condition and Ө body nursing interventions. anticonvulsants can be prescribed. Sodium valproate or clonazepam are active against febrile seizures.
The etiology of malnutrition includes factors such as poor food availability and preparation. “bad nutrition”) is defined as “inadequate nutrition. recurrent infections. measures to interventions. >To promote fluid management . health needs regimen. regarding food Assessment . of eating.9kg Long Term: patterns and timediet for his The patient disease. underlying >To identified Objective: t related to the patient’s condition. weakness treatment of the patient regimen Long Term: > Note total daily with the > weight of intake includes proper food 7. falling short of daily nutritional requirements. Malnutrition (literally. The patient Ө the body nursing >Assess shall have requiremen interventions. > Antipyretics lower core temperature.” and while most people interpret this as undernutrition. 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. shall have > loss of After 2 days of demonstrated appetite nursing >To reveal behaviours or >Consult interventions.Monitor regulation rate frequently. >Administer antipyretics as ordered. proper ventilation and promote release of heat through evaporation. physician for change that lifestyle > poor the will should be changes to further muscle tone demonstrate assessment and made in the regain behaviours or recommendation client’s appropriate the patient lifestyle dietary weight. Nursing Nursing Expected Planning Rationale Diagnosis Interventions Outcome Subjective: Imbalance Short term: >Review >To obtain Short term: Nutrition: patient’s records. and lack of nutritional education. baseline Less than After 4 hours of data. determine measures to economical will identify specific promote the patient factors. nutrition and >discuss eating manifested: promote follow the habits and nutrition and encourage diet >To achieve treatment > body follow the for age.
may manifest: > abnormal laboratory studies > pallor changes to regain appropriate weight. situation. Nursing Nursing Expected Planning Rationale Diagnosis Interventions Outcome Subjective: Ineffective Short term: > Establish > To gain Short term: tissue rapport. nutritional support. demonstrated Objective: Hgb the patient will > Determine behaviour concentratio demonstrate factors related to > To monitor lifestyle The patient n in blood as patients change. shall Long term: immune system the have >Skin is compromised. individual manifested: evidenced behaviour lifestyle status.O. information Assessment . individual risk may manifest: the patient’s risk factors.O. S. for possible condition. Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level. by low Hgb changes to Long term: >Body count in CBCimprove > To gain > Evaluate for temperature result circulation. >For greater understandin g and further assessment of specific food. factors. verbalized discoloration After 2 days of understandin nursing >To observe g of the > Discuss The patient intervention. decreased intervention.’s trust The patient Ө After 4 hours of realated to nursing and promote shall have > Monitor VS. cooperation.O. especially when regarding S. condition. will > Anemia verbalize > Elevate head of> This understanding bed at night. preferences and intake. patient and perfusion S. 3 Ineffective Tissue Perfusion The circulation to the tissues is not getting enough oxygen or nourishment. signs of infection information The patient’s changes.
If there is an increase in number of WBC. >To promote optimum =The patient . If the immune system is compromised. >For the patient comparative shall have baseline verbalized data understandin g of ways on how to >To know prevent when to assist client spread of infection. > Discuss the importance of a healthy diet.. it can affect the normal production of WBC from the bone marrow. >To promote a healthy diet to help increase RBC synthesis and Hgb count for faster recovery. therefore it may increase the possibility to increase infection Nursing Nursing Planning Diagnosis Interventions S=Ø Risk for Short Term: >Establish good (spread) of working infection O = the After 3 hours of relationship with the client and patient nursing manifested: interventions. viruses.of the condition. and other foreign organisms or harmful chemicals.O. > To increase gravitational blood flow. 4 Risk for Infection The immune system is the body’s defense against bacteria.O. strength >poor muscle Assessment tone Long Term: After 1week of >Provide peaceful Rationale Expected Outcome Short Term: >To gain their trust and After 3 hours cooperation of nursing interventions. 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. would be necessary for the client’s S. S. the patient will verbalize >Monitor and >body understanding record vital signs weakness of ways on how to prevent > Determine pt’s >fatigue spread of individual infection.
to prevent from occurrence infections and further of further complications. > note clients Assessment Rationale > To gain patient’s trust >To obtain baseline data > to prevent injuries in home. infections >To prevent falls and injuries >To note for imbalances >Advice pt to increase oral fluid >To ensure intake when proper allowed hydration > To replace fluid electrolyte loss 5 Risk for Injury A seizure or convulsion is the visible sign of a problem in the electrical system that controls your brain. Therefore. Low levels of hemoglobin in the human body may reult to seizure. A single seizure can have many causes.97 >HCT = 0.may manifest: >elevated body temperature >Hgb = 112 >WBC = 22. >Emphasize importance of hand washing >Provide safety measures >Monitor I & O >Check IV and Regulate IVF level of functioning >To prevent fatigue and conserve energy Long Term: After 1week of nursing interventions.9 >RBC = 3. patients are prone to injuries since they may strike different objects due to uncontrollable muscle spasms. the patient shall have been free >. interventions. such as a high fever and lack of oxygen. Hemoglobin is a protein in red blood cells that carries oxygen. Nursing Nursing Planning Diagnosis Interventions Subjective: Risk for Short term: >establish rapport injury related to After 4 hours of >monitor and Ө possible nursing record Vital Signs convulsion.34 >Platelet count = 234 nursing interventions. Expected Outcome Short term: The SO shall have modified environment as indicated to enhance safety. During episodes of convulsion. Objective: the SO will > ascertain knwlge modify of safety needs/ the patient environment as injury prevention may manifest indicated to the following: enhance safety. the patient will be free from infections and further complications environment >Provide adequate rest and sleep. .
conditions/ promote emotions client safety and model safety behaviors for client/SO >to promote safe physical environment and individual safety >it can contribute to occurence of injury Diazepam Generic Name: diazepam Brand Names: Apo-Diazepam (CAN). Diazemuls (CAN). community. Valium Pregnancy Category D Controlled Substance C-IV Drug classes: . Long term: developmnt stage. interventions/safet interventions / teachings y devices >to prevent > discuss importance of self errors resulting in monitoring of client injury.>Fever >Convulsion >Low >Low Hgb Level = 112 Long term: gender. cognition/competen>affects verbalized ce the SO will client’s understandin verbalize ability to g of individual understanding >provide health protect factors that of individual care within a self/others contribute to factors that culture of safety and possibility of contribute to influence injury. level of nursing have interventions. possibility of choice of > identify injury. Diastat. Diazepam Intensol. age. and work setting After 2 days of decision makng The SO shall ability.
acute alcoholic intoxication. rectal pediatric gel—2. psychoses. hallucinosis Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due to local pathology (inflammation of muscles or joints) or secondary to trauma. SR capsule—15 mg. inguinal hernia. adjunct in seizure disorders (oral) Preoperative (parenteral): Relief of anxiety and tension and to lessen recall in patients prior to surgical procedures.spasticity caused by upper motoneuron disorders (cerebral palsy and paraplegia). rectal adult gel—10. tremor. may be useful in symptomatic relief of acute agitation. pyloric stenosis when used in first trimester. anxiolytic effectsf GABA. 10 mg. athetosis. coma. potentiates the effects of GABA. neonatal withdrawal syndrome reported in newborns). 10 mg. may act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation. Use cautiously with elderly or debilitated patients. and endoscopic procedures Rectal: Management of selected. 15. . pregnancy (cleft lip or palate. injection—5 mg/mL Dosages Individualize dosage. 20 mg. acts mainly at the limbic system and reticular formation. stiff-man syndrome Parenteral: Treatment of tetanus Antiepileptic: Adjunct in status epilepticus and severe recurrent convulsive seizures (parenteral).• • • • Benzodiazepine Anxiolytic Antiepileptic Skeletal muscle relaxant (centrally acting) Therapeutic actions Exact mechanisms of action not understood. an inhibitory neurotransmitter. 5 mg/5 mL. and in patients with a history of substance abuse. microcephaly. oral solution—1 mg/mL. an inhibitory neurotransmitter. cardiac defects. ataxia.5. refractory patients with epilepsy who require intermittent use to control bouts of increased seizure activity Unlabeled use: Treatment of panic attacks • • • • • Contraindications and cautions • Contraindicated with hypersensitivity to benzodiazepines. delirium tremens. 5. increase dosage cautiously to avoid adverse effects. • Available forms Tablets—2. has little effect on cortical function. impaired liver or renal function. lactation. shock. Indications • • • Management of anxiety disorders or for short-term relief of symptoms of anxiety Acute alcohol withdrawal. cardioversion. acute narrowangle glaucoma. 5. anxiolytic effects occur at doses well below those necessary to cause sedation.
Status epilepticus (> 5 yr): 1 mg IV q 2–5 min up to a maximum of 10 mg. skin color. Status epilepticus (> 1 mo–< 5 yr): 0. renal function tests. may give a second dose in 4–12 hr. coma. Nursing considerations Assessment • • History: Hypersensitivity to benzodiazepines. impaired liver or renal function.3 mg/kg. R. liver evaluation. LFTs. CBC Interventions • • • WARNING: Do not administer intra-arterially. affect. ophthalmologic examination. BP. reflexes. • • • • Tetanus (> 1 mo): 1–2 mg IM or IV slowly q 3–4 hr as necessary. adjunctive therapy is recommended. acute alcoholic intoxication. Do not use small veins (dorsum of hand or wrist) for IV injection. adventitious sounds. Change from IV therapy to oral therapy as soon as possible. acute narrow-angle glaucoma. >12 yr: Use adult dose. normal output. . may repeat after 15–30 min. pregnancy. Rectal < 2 yr: Not recommended. If no relief of symptoms after three doses. lactation Physical: Weight. Tetanus (> 5 yr): 5–10 mg q 3–4 hr. gangrene. shock.5 mg PO tid–qid initially. bowel sounds.25 mg/kg IV administered over 3 min. elderly or debilitated patients. lesions.2–0.5 mg/kg. 2–5 yr: 0. Parenteral Maximum dose of 0.5 mg slowly IV q 2–5 min up to a maximum of 5 mg.PEDIATRIC PATIENTS Oral > 6 mo: 1–2. 6–11 yr: 0. orientation. sensory nerve function. Gradually increase as needed and tolerated. Can be given rectally if needed. psychoses. may produce arteriospasm. normal output. P. repeat in 2–4 hr if necessary.
Caregiver should learn to assess seizures. palpitations. Monitor liver and renal function. if you become or wish to become pregnant. rash or skin lesions. . Taper dosage gradually after long-term therapy. presumably because of short duration of drug effect. drowsiness that persists. especially in epileptic patients. Carefully monitor P. difficulty concentrating. dizziness (may lessen. Arrange for epileptic patients to wear medical alert ID indicating that they are epileptics taking this medication.• • • • • • • • Reduce dose of opioid analgesics with IV diazepam. BP. swelling of the ankles. do not permit ambulatory patients to operate a vehicle following an injection. antiepileptic therapy) without consulting your health care provider. dose should be reduced by at least one-third or eliminated. weakness. Discuss risk of fetal abnormalities with patients desiring to become pregnant. CBC during long-term therapy. GI upset (take drug with food). Do not stop taking this drug (long-term therapy. WARNING: Maintain patients receiving parenteral benzodiazepines in bed for 3 hr. crying (reversible). consult with your health care provider. Teaching points • • • • • • Take this drug exactly as prescribed. and monitor patient. respiration during IV administration. Report severe dizziness. Use of barrier contraceptives is advised while using this drug. dreams. fatigue. visual or hearing disturbances. difficulty voiding. avoid driving or engaging in other dangerous activities). It is advisable to wear a medical alert ID indicating your diagnosis and treatment (as antiepileptic). You may experience these side effects: Drowsiness. Monitor EEG in patients treated for status epilepticus. seizures may recur after initial control. nervousness. administer rectal form.
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