INTRODUCTION

The immune system is responsible for knowing the difference between normal bodily
substances and foreign ones, as well as protecting the body from infections and foreign substances.
Different immune response can be perceived if an opportunistic microorganism is introduced in the
body. One common response of the body seen in children from infection is fever. It is a physiologic
response of the body that accompany childhood illnesses, especially infections.

Febrile seizures are convulsions brought on by a fever in infants or small children. 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, such as an arm or
a leg, or on the right or the left side only. Most febrile seizures last a minute or two, although some can
be as brief as a few seconds while others last for more than 15 minutes. The latter is called complex
febrile seizure.

Febrile seizures usually occur in children between the ages of five months and five years and are
particularly common in toddlers. Children rarely develop their first febrile seizure before the age of six
months or after three years of age. The older a child is when the first febrile seizure occurs, the less
likely that child is to have more.

Several factors can contribute to febrile convulsion. Before 5 years of age, the child has not yet
fully developed his/her hypothalamic control centre therefore temperature can easily fluctuate. Family
history of this particular seizure can also contribute in developing benign febrile convulsion. Infection
can be another causative factor in the occurrence of febrile seizure.

This case study features Patient N, 1 year old, lives in 348 Cristobal St., Sampaloc, Manila, was
admitted last August 30, 2010, with an admitting diagnosis at Ospital ng Sampaloc of Complex Febrile
Seizure without CNS infection.

The researcher has chosen this condition for it is an illness among children. She will be able to
provide information from her previous studies regarding of the said illness. In this way, she will be able
to demonstrate different management provided and enhance her skills and knowledge as a student
nurse for future use.

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 OBJECTIVES

A. General Objective

 This aims to distinguish and verify the general heath problems and needs of the
patient with an admitting diagnosis of Complex Febrile Seizure without CNS infection. 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.

B. 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

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 NURSING HISTORY

A. Initial Data
Date of Admission: August 30, 2010
Ward: Pediatric Ward
Admitting Diagnosis: Complex Febrile Seizure without CNS infection

B. Demographic Data
Patient Name: Toddler N
Address: 348 Cristobal St., Sampaloc, Manila
Date of Birth: March 18, 2009
Age: 1 year old and 4 months
Gender: Female
Weight: 10 kg
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Source of Data/Information: Patient’s mother

C. Chief Complaint

“Nilagnat siya at nagkaconvulsion” as verbalized by the client’s mother.

D. History of Present Illness

10 days prior to admission, Patient N had episodes of cough and colds. Her mother continues to
breastfeed Baby N.

7 days prior to admission, Patient N does not have a cough anymore but she still has common
colds.

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 1 day prior to admission, Patient N is in a febrile state. The temperature was 37.9 oC. She showed
signs of irritability and crying. Baby N’s mother gave Tempra syrup to alleviate her fever.

6 hours prior to admission, Patient N appears to still have fever, common colds, and difficulty of
breathing. Patient N’s mother applied tepid sponge bath to decrease Toddler N’s temperature of
38.5oC.

5 hours prior to admission, Patient N’s temperature didn’t lessen.

1 hour prior to admission, Patient N experienced convulsion and difficulty of breathing.

Upon admission, Patient N was irritable and experienced 2x seizure at the Emergency Room of
Ospital ng Sampaloc. She was given O 2 therapy via face mask to lessen her difficulty of
breathing. Vital signs were taken with a respiratory rate of 44 breaths per minute, heart rate of
137 beats per minute, and a temperature of 39.7 oC. She was later admitted of complex febrile
seizure without CNS infection.

E. Past Health and Medical History

1. Immunization

The client had complete immunizations of BCG, DPT, Hepatitis B, Oral Polio and Anti-
Measles Vaccine.

2. Allergies

The patient has no allergies to food or non-food protein allergens.

3. Illnesses

The patient had a history of neonatal sepsis and pneumonia when she was 2 weeks old.

4. Injuries/Accidents

On July 2010, the patient’s mother stated that Patient N has fallen from a 2 ½ feet
height table.

5. Hospitalizations

As stated by the patient’s mother, Toddler N had a history of hospitalization at Jose R.

Reyes Memorial Medical Center last March 2009 with an admitting diagnosis of Neonatal Sepsis

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 and Pneumonia when she was 2 weeks old. The patient stayed 1 week long for treatment at the
hospital.

F. Family Medical History

Patient’s mother has a family history of hypertension, and asthma while patient’s father
has a family history of hypertension.

Family Genogram

LEGEND:

Hypertension
Neonatal Pneumonia
Female Male

Neonatal Sepsis Asthma Identified Patient

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G. Psychosocial History

Patient N’s father is both a smoker and an alcohol drinker. According to the patient’s
mother, they live cohabitually with her mother-in-law in Sampaloc, Manila. The type of housing
they lived in is made of mixed materials: cement and wood. The environment they live in is
clean, and peaceful. They have a harmonious relationship with their neighbours. They have a
good and clean housing condition with an adequate electricity and water supply.

H. Health Maintenance Activities

1. Sleep – According to the patient’s mother, Toddler N sleeps at least 14-16 hours a day.

2. Diet – The patient’s mother continues to breastfeed Toddler N at least 4-6 times a day.

The patient’s food intake is approximately 5-6 tablespoon per meal. Usually, Toddler N

eats rice porridge. They normally eat three times a day.

3. Elimination – Toddler N usually consumes 3 fully used diapers per day. The diaper

weighs approximately 20-30 grams. She defecates at least twice a day. The stool is

watery and yellowish brown in color.

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 REVIEW OF SYSTEMS

General: According to the mother, Toddler N is irritable, restless, and cries often upon staying at the
hospital for 1 day.

Integumentary: Toddler N’s skin color is light brown. According to the patient’s mother, Toddler N has
rashes along her extremities and body, both posterior and anterior, upon staying in the hospital for 1
day.

Eyes/Ears/Nose/Mouth/Throat: According to the mother, the patient has no pus or redness seen in the
eyes. There is no problem in getting the child’s attention upon calling her name. Toddler N has clear,
watery secretions seen in her nose.

Cardiovascular: Toddler N, according to the mother, has no previous heart problem.

Respiratory: Toddler N, according to the mother, appears to have difficulty in breathing during
convulsion but without the active seizure, the client has no problem breathing.

Gastrointestinal: The patient’s mother feeds Toddler N through breastfeeding 4-6 times per day and
intake of solid foods, usually rice porridge. The patient doesn’t experience vomiting. Toddler N has an
increased bowel movement at least four times upon staying in the hospital for 1 day. According to the
mother, Toddler N normally defecates twice a day. The patient’s mother has observed that the stool of
Toddler N is watery and yellowish brown in color.

Genitourinary: According to Toddler N’s mother, the patient consumes at least 3 fully used diapers per
day. The diaper normally weighs 20-30 grams per day. The urine is clear and light yellow in color.

Musculoskeletal: Toddler N has no weakness and limitation in movement in her extremities. There was
no swelling, wounds, or injuries observed by her mother on the patient’s joints and muscles.

Neurologic: The patient is awake and appears alert upon getting her attention according to the mother.

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 PHYSICAL ASSESSMENT

General Appearance

Toddler N has a weight of 10 kg. The patient is clean and does not have any offensive odor.
Toddler N is irritable, restless, and cries frequently during her stay in the hospital for 1 day.

Vital Signs

Vital signs were taken with a respiratory rate of 39 breaths per minute, heart rate of 137 beats
per minute, and a temperature of 37.1 oC upon assessment.

Skin, Hair, and Nails

Toddler N has a uniform light brown skin. She does not have edema, lesions, or nodules present
on her skin. There are rashes present in her upper extremities and body, both posterior and anterior.
When the skin is pinched, it goes back less than one second. Hair is evenly distributed and does not have
any scalp problem or parasites seen. Her nail convex curvature is in approximate angle of 160 o. The
blanch test has more than 3 seconds return of pink color on her nails.

Skull and Face

Toddler N is normocephalic and has a smooth contour upon palpation. She has symmetric facial
appearance. There were no masses, lesions, nodules, and tenderness present.

Eyes

Toddler N has evenly distributed eyebrows. She can easily close her eyelids. Eyeballs are
symmetrical and the sclera is white. The pupils are equally round, reactive to light and accommodation.
Both palpebral and bulbar conjunctiva is pink in color. No pus, inflammation, or infection seen.

Ears

Both ears are symmetrical. No tenderness or infection present in Toddler N’s ears.

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Nose and Sinuses

Toddler N has a clear, watery discharge seen in her nose. No lesions and tenderness is seen in
the nose. No obstruction is seen in her nose upon inspection. Nasal septum is in the midline. No
tenderness in the sinuses is palpated on her nose.

Mouth and Oropharynx

Toddler N’s oral mucosa is uniformly pink. No inflammation, tenderness, lesions seen.

Neck

No palpable lymph nodes felt. Toddler N’s neck muscles are symmetrical in movement. She
demonstrates a complete head control.

Chest and Lungs

The chest expansion is symmetrical. Toddler N’s spine is vertically aligned. Respiratory rate,
upon assessment, is 39 breaths per minute. No adventitious breath sounds are heard. There is absence
of intercostal retraction.

Cardiovascular and Peripheral Vascular System

Heart rate is 137 beats per minute. S1 and S2 sound are present and no murmurs are heard.
Capillary refill test reveals a slow return of blood when pinched.

Abdomen

Toddler N shows a smooth contour and uniformity in color in the abdomen. The bowel sounds
are heard. When palpated, she doesn’t have any tenderness.

Breast and Axillae

Toddler N has a symmetrical and smooth contour of her breast. There were no masses, nodules,
and lesions seen.

Musculoskeletal System

Both extremities of Toddler N are in equal size. There were no lesions, contractures, and
tenderness seen upon inspection.

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Neurologic System

Toddler N is responsive to touch, sound, and light. She exhibits blink and pupillary reflex.

Genitals and Inguinal Area

Toddler N’s genital has an intact skin. It appears to have no swelling, infection, or discharges. No
nodules and masses are palpated in the inguinal area.

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 REVIEW OF ANATOMY AND PHYSIOLOGY

Temperature control in children is not completed until approximately five years of age. This may
be due to the immaturity of the nervous system. The maintenance of body temperature is mainly
coordinated by the hypothalamus, a central control center containing large numbers of heat-sensitive
neurons called thermoreceptors. It is an important homeostatic mechanism which allows the body
enzymes to work efficiently within a narrow range of 36.5–37.5 ºC. In response to a change in
temperature, the peripheral thermoreceptors transmit signals to the hypothalamus, where they are
integrated 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 child
grows. The body temperature of the three-month-old child is 37.5 ºC, whereas at thirteen years it is 36.6
ºC. Even as the temperature regulatory mechanisms mature through childhood, babies and small
children 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. The
younger the child the less able he or she is to vocalize the feeling of hot or cold or to do something
about it. All children may also become too cold. Small individuals who do not have warm clothes and
warm homes will not grow if the temperature of their environment is consistently low. They will use
much of the energy from their food intake to generate heat (metabolic rate) and leave no spare calories
for tissue growth. The smaller the child, the larger the surface area for heat loss in relation to body
mass. The head of a small child is relatively larger in proportion to the rest of the body, and covering the

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head 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, for
example, where children enjoy jumping in and out of the water as they play, thin children may become
cold 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 serum
bilirubin, metabolic acidosis, and increased metabolic rate. When heat loss occurred, non-shivering
thermogenesis (NST) heat production takes place in the subcutaneous tissue, hypothalamus, and spinal
cord to compensate for the sudden change in temperature.

Heat loss transpires through the contact in a cold environment, vasodilation, sweating where
the preoptic area of the brain stimulates secretion of water to the skin for evaporation. There are
different areas in the body where we can measure the temperature such as axillae, tympanic
membrane, and mouth.

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 PATHOPHYSIOLOGY

Non-Modifiable Factors: Modifiable Factors:

 Underdeveloped hypothalamic
control centre  Hygiene
 Family history of febrile  Diet
convulsion  Environment
 Infection

Immune
response

Endogenous pyrogens

Production of pro-
 Mucus
inflammatory cytokines,  WBC
production
such as interleukins 1β (IL-
1β) and 6 (IL-6), interferon
(INF)-α, and tumor necrosis

Hypothalamic
circulation

Release of
prostaglandin E2

Anterior
hypothalamus

Elevated
thermoregulatory set-
point

Heat Heat
conservation production

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 Urine output  Metabolism
 Fluid
conservation of the liver

Vasoconstriction  Glucose
breakdown
Irritable and  Energy
restless
 Cerebral demand
perfusion Muscle
contraction

Fever

Immature
hypothalamic control

Temperature fluctuates
to >39 ºC

 Bronchospasm Neuronal excitability

Difficulty of Febrile seizure

breathing

 RR

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 LABORATORY AND DIAGNOSTIC PROCEDURES

Hematology Report: August 30, 2010

NORMAL VALUES ACTUAL RESULT

Hemoglobin Male: 14-16 g/dl 10.2 g/dl

Female: 12-14 g/dl
Hematocrit Male: 0.40-0.57 0.38
Female: 0.37-0.47

WBC count 4.80-10.80 18

Segmenters 60-70% 60%

Lymphocyte 30-40% 39%

Eosinophil 1-3% 1%

Platelet 130-400 256

Interpretation:

There is a decrease in haemoglobin and an elevated white blood cell count. Other blood
components are within the normal level.

Analysis:

A decrease in hemoglobin is physiologically low normal because of the increasing demands of

the body for iron. An evident increased in white blood cell count indicates that a bacterial infection is
present.

MEDICAL-SURGICAL MANAGEMENT

Medical Management:

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1. Administration of due medications as ordered by the physician.

The following medications are:

 Cefuroxime, an anti-infective, cephalosporin – 0.33 g, IV, q8h

 Salbutamol, a bronchodilator, sympathomimetics – 1 nebule (1cc + 1cc NSS),
inhalation, q6h
 Paracetamol, an antipyretic, nonsteroidal anti-inflammatory drug – 1.2 ml in a
100g/1ml, PO, PRN
 Diazepam, an anticonvulsant, benzodiazepine – 2 g, IV, for active seizure

 Chloramphenicol, anti-infective – 125 mg, IV, q6h

2. Intravenous Replacement Therapy

IV replacement therapy is the fastest way of replacing fluid loss and electrolyte
imbalances. It can also be used to keep the vein open for the administration of medications.

The following IV solutions administered:

 D5 0.3 NaCl, a hypotonic solution, 500 cc x 8 ° - causes cell shrinkage therefore

reducing body heat.

 D5 IMB, a hypertonic solution, 1 L at 41 cc/hr – for cell rehydration.

3. Oxygen Therapy

Oxygen therapy is used during emergency medical services. It is for the difficulty of
breathing during active convulsion. Oxygen inhalation at 2-3 L was given via face mask.

4. Laboratory and Diagnostic Procedures

August 30, 2010

 Complete Blood Count – It is used as a broad screening test to check for such disorders
as anemia, infection, and many other diseases. This evaluates the three types of cells in
the blood which are red blood cells, white blood cell, and platelets. This provides an
overview of the general health of the patient.

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Nursing Management:

 Vital signs monitoring every 1 hour

 Input and Output of Fluid Measurement
 Administer medication due as ordered by the physician
 Patient, a toddler, has developed a stranger anxiety as manifested by “white coat
syndrome.” A nursing intervention would be is to establish rapport by playing with the
patient.
 Encourage the mother to increase and continue breastfeeding for faster recovery of the
patient.
 Provide opportunity for the patient to rest from time to time.

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 DRUG STUDY

CLASSIFICATION DOSAGE AND PHARMACOLOGIC INDICATIONS SIDE EFFECTS NURSING

ADMINISTRATION ACTION CONSIDERATIONS

Cephalosporins Parenteral (IV)Cephalosporin Treatment of Nausea and Check for signs

inhibits bacterial infection vomiting, and symptoms of
Dosage: 0.33 g wall synthesis, diarrhea, superinfection
rendering cell wall
nephrotoxicity,
*q8h – 12am, osmotically bone marrow Assess for
8am, 4pm unstable, leading
to cell death by depression, anaphylaxis:
binding to cell wall rashes, fever, rashes, urticaria,
membrane. urticuria chills, fever,
dyspnea

Monitor the
urine output,
bowel movement,
and for bleeding.
Generic Name: Cefuroxime

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 Generic Name: Salbutamol

CLASSIFICATION DOSAGE AND PHARMACOLOGIC INDICATIONS SIDE EFFECTS NURSING

ADMINISTRATION ACTION CONSIDERATIONS

Sympathomimetics, Inhalation Salbutamol is a To relieve Tachycardia,  Monitor

Bronchodilator direct-acting bronchospasm tremors, therapeutic
Dosage: 1 nebule sympathomimetic associated with palpitation, effectiveness
(1cc + 1cc NSS) with selective active
paradoxical which is indicated
action on convulsion
*q6h – 12am, β2 receptors, bronchospasm, by significant
6am, 12pm, 6pm producing hypotension subjective
bronchodilating improvement in
effects. pulmonary
function within
60–90 min after
drug
administration.

 Monitor signs
and symptoms of
fine tremor in
fingers; CNS
stimulation,
particularly in
children 2–6 y,
(hyperactivity,
excitement,
nervousness,
insomnia),
tachycardia, GI
symptoms. Report
promptly to
physician.

 Lab tests:
Periodic ABGs,
pulmonary
functions, and
pulse oximetry.

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 Generic Name: Diazepam

CLASSIFICATION DOSAGE AND PHARMACOLOGIC INDICATIONS SIDE EFFECTS NURSING

ADMINISTRATION ACTION CONSIDERATIONS

Benzodiazepines, Parenteral (IV) Diazepam is a long- Adjunct Hypotension,  Monitor for

Anticonvulsant acting benzodiazepine management muscle adverse reactions.
Dosage: 2 g with anticonvulsant, of seizure weakness, Most are dose
anxiolytic, sedative,
*For active seizure respiratory related. Physician
muscle relaxant and
depression, will rely on accurate
amnestic properties. It
increases neuronal tachycardia, observation and
membrane incontinence, reports of patient
permeability to constipation response to the
chloride ions by drug to determine
binding to lowest effective
stereospecific
maintenance dose.
benzodiazepine
receptors on the
postsynaptic GABA  Monitor I&O
neuron within the CNS ratio, including
and enhancing the urinary and bowel
GABA inhibitory elimination.
effects resulting in
hyperpolarisation and  Observe patient
stabilisation.
closely and monitor
vital signs when
diazepam is given
parenterally;
hypotension,
muscular weakness,
tachycardia, and
respiratory
depression may
occur.

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 Generic Name: Paracetamol

CLASSIFICATION DOSAGE AND PHARMACOLOGIC INDICATIONS SIDE NURSING

ADMINISTRATION ACTION EFFECTS CONSIDERATIONS

Nonsteroidal anti- PO Paracetamol To alleviate Nausea,  Advise patient that

inflammatory drugs, produces fever allergic drug is only for short
Anti-pyretic Dosage: 1.2 ml in a antipyresis by reactions, term use and to consult
100g/1ml inhibiting the the physician if giving
skin rashes,
hypothalamic heat- to children for longer
*PRN, for liver damage
regulating centre. than 5 days or adults
temperature more Its weak anti- for longer than 10 days.
than 37.8oC inflammatory
activity is related to  Advise patient or
inhibition of caregiver that many
prostaglandin over the counter
synthesis in the products contain
CNS. acetaminophen; be
aware of this when
calculating total daily
dose.

 Warn patient’s
mother that high doses
or unsupervised long
term use can cause
liver damage.

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 Generic Name: Chloramphenicol

CLASSIFICATION DOSAGE AND PHARMACOLOGIC INDICATIONS SIDE EFFECTS NURSING

ADMINISTRATION ACTION CONSIDERATIONS

Anti-infective drugs Parenteral (IV) Chloramphenicol Treatment of Bleeding,  Monitor

inhibits bacterial infection visual hematologic
Dosage: 125 mg protein synthesis impairment, data carefully,
by binding to 50s especially with
*q6h – 12am, 6am, subunit of the confusion,
long-term
12pm, 6pm rashes, fever,
bacterial therapy by any
ribosome, thus bone marrow route of
preventing suppression administration.
peptide bond
formation by  Do not give
peptidyl this drug IM
transferase. It has because it is
both ineffective.
bacteriostatic and
bactericidal action  Check for signs
against H. and symptoms of
influenzae, N. superinfection.
meningitidis and
S. pneumonia.

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 NURSING CARE PLAN

CUES NURSING INFERENCE GOALS NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTIONS
Objective: Risk for injury Endogenous Within 8 hours of Independent: Goal was met
 Recurrent related to pyrogens nursing  Raise the side  To avoid after 8 hours of
seizure of more neuromuscular intervention, the rails always injuries. nursing
than 15 mins. dysfunction client will be free intervention as
 Immune of injury as  Maintain bed  To promote manifested by:
response manifested by: in lowest position client safety
with wheels  Intact skin
 Intact skin locked
Release of  No pain,
chemical  No pain,  Monitor  To promote bruises, or
mediators bruises, or environment for safe and physical fractures present
fractures present potentially unsafe environment and
Fever greater conditions and individual safety  Able to move
than 39 oC  No limitation modify as needed freely
in movement
 Encourage bed  To prevent
Neuronal rest. fatigue and
excitability promote healing.

 Ensure that  To prevent

Febrile seizures the floor is errors resulting in
unobstructed and client injury
properly lighted
Impaired
coordination of
movement

Risk for injury

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 CUES NURSING INFERENCE GOALS NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS
Objective: Risk for aspiration Endogenous Within 8 hours of Independent: Goal was met
 Recurrent related to pyrogens nursing  Elevate client  To reduce risk after 8 hours of
seizure of more bronchospasm intervention, the to highest or best for aspiration nursing
than 15 mins. client will possible position intervention as
 Immune experience no for eating and manifested by:
response aspiration as drinking
manifested by:  Noiseless
Provide soft  To aid in respirations
Release of  Noiseless foods swallowing effort
chemical respirations  Clear breath
mediators  Offer very Activates sounds
 Clear breath warm or very cold temperature
Fever greater sounds liquids receptors in the  Clear,
than 39 oC mouth that help odourless
 Clear, stimulate secretions
odourless swallowing
Neuronal secretions
excitability  Determine  Upper airway
best resting patency is
position with the facilitated by
Febrile seizures head of bed upright position
elevated at 30o
angle
Bronchospasm

Risk for
aspiration

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 CUES NURSING INFERENCE GOALS NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS
Objective: Ineffective airway Endogenous Within 8 hours of Independent: Goal was met
 Difficulty of clearance related pyrogens nursing  Monitor child  To determine after 8 hours of
breathing during to neuromuscular intervention, the for feeding if airway is nursing
active convulsion dysfunction client will be able intolerance, compromised intervention as
 Immune to maintain abdominal manifested by:
 RR=39 cpm response airway patency as distention, and
manifested by: emotional  Decrease
stressors RR=39 cpm to
Release of  Decrease 36cpm
chemical RR=39 cpm to  Position  Upper airway
mediators 36cpm patient on high patency is  Improve clear
back rest facilitated by airway
Fever greater  Improve clear upright position
than 39 oC airway  Absence of
 Prepare  To maintain strenuous
 Absence of emergency kit adequate airway breathing during
Neuronal strenuous especially for during active active convulsion
excitability breathing during oxygen therapy convulsion
active convulsion
 Keep  To clear open
Febrile seizures environment airway
allergen free

Bronchospasm

Ineffective airway
clearance

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 DISCHARGE PLAN

Medications

 Instruct and explain to the mother that the medication, especially the antibiotics, is important to
continue depending on the duration that the doctor ordered for the total recovery of the
patient.
 Inform the mother of the side and adverse effects of the drugs she is giving to her daughter.
 Instruct to report immediately any side or adverse effects when taking the prescribed drug such
as nausea, vomiting, diarrhea, rashes.
 Take the entire course of any prescribed medications. After a patient’s temperature returns to
normal, paracetamol is administered if fever occurs. Avoid using paracetamol more than 5 days.
 Instruct the mother to avoid over-the-counter drugs without the consultation of the physician to
avoid any drug-drug interaction.
Exercise

 Encourage the mother to have her daughter rest from time to time for faster recovery.

Treatment

 Comply with the established treatment regimen given by the doctors including prescribed
medications.
 Encourage the mother to expose the patient to early morning sunlight
 Advise the mother to provide tepid sponge bath when fever occurs
 Provide oxygen therapy during active convulsion to alleviate the difficulty of breathing.

Hygiene

 Encourage and explain to the mother that it is vital to maintain proper hygiene by frequently
washing her hands.

Out-patient

 It’s important for the toddler to have her follow-up check up to ensure and have the patient’s
progress monitored.

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Diet

 Encourage the mother to continue breastfeeding the patient. Instruct the mother that the head
must be in upright position when breastfeeding to avoid aspiration and let the baby burp after
feeding.

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