Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPIENS

Tamag, Vigan City
2700, Ilocos Sur

In Partial Fulfillment
Of the Requirements in
CLINICAL PRACTICUM 102 B

A CASE STUDY IN
PEDIATRIC FEBRILE CONVULSION

PRESENTED BY:
ARDE, CASEY ANN Q.
BS in Midwifery II-B

PRESENTED TO:
JOVIE MAY ADVERSALO, RM, RN
Clinical Instructor

2023

1|C A S E S T U D Y
 TABLE OF CONTENTS

2|C A S E S T U D Y
 INTRODUCTION

A febrile convulsion is a fit or seizure that occurs in children when they have a high
fever. The fit can last a few seconds or up to 15 minutes and is followed by drowsiness. Most
fits last less than 2 to 3 minutes. Fever in children with febrile seizures is usually caused by
common respiratory viruses, the distributions of which match those of seasonal community-
acquired respiratory tract infections.
According to Yamashiroya V. K. (2001) Febrile seizures are broadly defined as
seizures occurring in the presence of fever, but in the absence of central nervous system
(CNS) infection, in children ages 6 months to 5 years of age. It is the most common reason
for convulsions in children less than 5 years of age, and they occur in 2 to 5% of all children,
although it has been reported to be more frequent in Asian countries.
According to Mosili P. et. Al. (2020) A febrile seizure is a neurological abnormality
that occurs as a result of a peripheral infection, to which the immune system reacts by
producing an inflammatory response thereby, inducing a fever and subsequently increasing
the core temperature of the body. The increase in temperature leads to increased neuronal
excitability resulting in convulsions. Febrile seizures are categorized according to the
duration and the number of times the convulsions occur. Simple febrile seizures have a life
span of approximately 15 minutes and are caused by a distinct infection such as a
gastrointestinal or respiratory infection. Complex febrile seizures have a life span of 15 to 30 
minutes with more than 1 seizure occurring per episode of fever. Status epilepticus lasts
longer than 30 minutes and occurs randomly as well as repeatedly in the brain during an
infection. Simple febrile seizures are benign whilst complex febrile seizure and status
epilepticus are more likely to develop into more critical conditions such as temporal lobe
epilepsy or long term later in life. Currently, febrile seizures affect 3% to 5% of the world’s
population of children aged between 3 months and 5 years.3 Febrile Infection Related
Epilepsy Syndrome (FIRES) is a similar condition to febrile seizures which affects children
between the aged between 3 years to 15 years. The seizures, however, are similar to complex
febrile seizures in that they last between 15 to 30 minutes or status epilepticus lasting longer
than 30 minutes in some cases. Although both febrile seizures and FIRES can occur during
common childhood infections, the increased incidence of febrile seizures specifically in
Africa can be attributed to limited medical resources, poor access to medical attention, as
well as insufficient knowledge of the pathophysiology of febrile seizures.

3|C A S E S T U D Y
 According to Millichap J. (2021) Causes of febrile seizures are infection that can
occur as a result of the fever that accompanies bacterial or viral infections, especially human
herpesvirus-6 (also called roseola or sixth disease). Immunizations that fever can occur as a
side effect of certain vaccines, particularly after measles mumps rubella (MMR) vaccination.
The fever typically occurs 8 to 14 days after the injection. And Risk factors which a family
history of febrile seizures increases a child's risk of febrile seizures.
According to Xixis K. et. Al (2022) There is no specific treatment for simple or
complex febrile seizures other than appropriate treatment for underlying etiologies driving
the ongoing febrile illness. Antipyretics are not shown to prevent a recurrence of febrile
seizures. In patients who have a frequent recurrence of febrile seizures such as seizures with
a majority of febrile illnesses, studies have examined treatment with benzodiazepines as a
bridging measure for a few days during subsequent febrile events.
One in every 20 children will have one or more febrile convulsion. A febrile
convulsion is not epilepsy and does not cause brain damage. Around 30% of babies and
children who have had one febrile convulsion will have another. There is no way to predict
who will be affected or when this will happen.

4|C A S E S T U D Y
 OBJECTIVES

A. General Objective
This case study aims to further describe, understand, and gain extensive knowledge
regarding Pediatric Febrile Convulsion. Furthermore, it aims to analyze case using relevant
theoretical concepts of midwifery.

B. Specific Objective
The following are specific objectives that are centered on patient, student, and family.

a) Patient-centered
1. To completely present the profile of the patient.
2. To determine the necessary midwifery care interventions and therapeutic regimen to
be given.
3. To assist patients’ needs not only physical but also mentally and emotionally.

b) Student-centered
1. To completely understand about the Pediatric Febrile Convulsion
2. To examine the patients’ condition holistically by taking a history of past and
present illness and using the Physical assessment.
3. To compare the findings of diagnostic procedures to their expected values.
4. To review and present the anatomy and physiology in relation to the condition of the
patient.

c) Family-centered
1. To build rapport and a trusting relationship with the patient and to his parents or
family.
2. To provide extended care even after discharge by instructing patient and family for
appropriate health teachings for the patient’s recovery.

5|C A S E S T U D Y
 CLINICAL SUMMARY

A. BIOGRAPHICAL PROFILE

Name: R. J. O
Address: San Clemente, Magsingal, Ilocos Sur
Age: 1 year old
Sex: Male
Date of Birth: March 17, 2022
Place of Birth: Ilocos Sur Provincial Hospital-Gabriella Silang
Civil Status: Child
Nationality: Filipino
Religion: Roman Catholic
Institution Admitted: Ilocos Sur District Hospital- Magsingal
Chief Complaint: Fever and Seizure
Date and Time of Admission: April 30, 2023 at 6:30 PM
Admitting Physician: Dr. Oracion
Admitting Diagnosis: Benign Febrile Convulsion
Source of Information: Grandmother

B. FAMILY HEALTH HISTORY

According to the grandmother of the patient, there is no any history of hypertension,
diabetes mellitus, Asthma, allegies, heart disease and any other diseases.

C. PAST HEALTH HISTORY

As stated by the grandmother of the patient upon interview, that she was fully
vaccinated with COVID-19 Vaccine together with the parents of the child. There is no any
surgical procedure happened and any hospitalization especially there is no seizure happen
before since the child was born, except for having common coughs and colds during cold
weather.

6|C A S E S T U D Y
D. PRESENT HEALTH HISTORY
3 days prior to admission the patient had onset of fever not associated with cough and
colds. On the 30th day of April 2023 the patient was rushed to the Ilocos Sur District
Hospital- Magsingal because of having a high fever, few hours upon the admission of the
patient, above condition persisted associated with episode of seizure described as stiffening
of extremities and up-rolling of eyeballs.
Patient’s data during the admission was weak looking but awake and alert. He has
temperature of 40.5 degree celcius, a heart rate of 177 beats per minute, a weight of 9.8
kilograms. All the assessment and above information was obtained from the patient’s chart
upon admission.

7|C A S E S T U D Y
 ANATOMY AND PHYSIOLOGY

8|C A S E S T U D Y
 PATHOPHYSIOLOGY

RESPIRATORY INFECTION VACCINATION

VIRUSES ETC.

INFLAMATION

cytokines

FEVER

Ion Channels

cytokines GENETIC
FACTORS
Synaptic
transmission

NEURONAL
HYPEREXCITABILITY

FEBRILE
SEIZURE

9|C A S E S T U D Y
A. PATHOGENESIS OF FEBRILE SEIZURES
Among healthy children experiencing seizures accompanied by fever, as infants and
young children with an immature CNS are more vulnerable to developing seizures than
adolescents and adults with a mature CNS. Notably, myelination occurs rapidly during the
first 5 years of life, and a child’s total brain volume reaches approximately 90% of the
average adult’s brain volume by 6 years of age. Therefore, the prevalent age range of FS
matches the rapid CNS development period. In the vulnerable immature CNS, increased
neuronal excitability promotes seizures, and cytokines produced and released during acute
inflammatory responses accompanying fever play a role in increasing neuronal excitability
(Fig. 1). Inflammatory responses outside the CNS increase cytokine concentrations in the
CNS (neuro-immune network), and the released cytokines trigger neuronal hyperexcitability
in the CNS (cytokine roles in the brain parenchyma) to generate FS. This concept can be
applied to the generation of afebrile seizures or epilepsy accompanied by various types of
inflammation with non-infectious causes, including trauma, toxic injury, hypoxic injury, and
autoimmune reactions. Individual host genetic factors should also be considered, as only a
small proportion of young children experience FS (Fig. 1). In addition, a family history of FS
is consistently reported as a risk factor for FS. Genetic epilepsy with febrile seizures plus
(GEFS+) is representative of genetic epilepsy syndromes initially presenting with a
phenotype of FS. However, the pathogenesis of FS seems theoretical and hypothetical.

10 | C A S E S T U D Y
 PHYSICAL ASSESTMENT

General Survey: The patient appear well developed and nourished, weak looking but awake
and alert, well groomed.

VITAL SIGNS:
Temperature: 40.5 °C
Heart rate: 177 bpm
Weight: 9.8 kgs.

11 | C A S E S T U D Y
 REVIEW OF THE NORMAL TECHNIQU RESULT SIGNIFICANCE
SYSTEMS E USED
(IPPA)

GENERAL Patient appears Inspection Patient appear ASTHENIA

well developed well developed
and nourished in and nourished,
no acute well groomed,
distress. Weak looking but
alert and awake.
HEENT: Head, Head is Inspection, The head of the ESSENTIALY
Eyes Ears. Nose, normocephalic; palpation patient is NORMAL
Throat scalp without normocephalic, no
lessions or lessions or any
masses. tenderness on
Neck supple scalp. The sclera
without is white, has a
adenopathy. pink conjunctiva.
Oropharynx The external ears
clear without has no any
exudate or lessions or any
lesions. masses. The nose
Tympanic is in midline and
membranes there is no any
intact . No discharges . the
nystagmus tongue has no
lessions, the gums
are not swelling or
bleeding.
CV: cardiovascular Regular rate and Auscultation The heart rate of TACHYCARDIC
rhythm with no the patient is 177
murmurs, rubs bpm
or gallops noted
upon precordial
palpation and
auscultation
respectively.
LUNGS: Clear to Auscultation It has a vibratory ABNORMAL
auscultation or harsh breath BREATH
bilaterally sounds SOUNDS
without
wheezes,
rhonchi or rales
heard upon
percussion and
palpation of
chest wall
respectively
ABD: Abdomen Soft flat Inspection There is no any ESSENTIALY
abdomen palpation notable lessions. NORMAL
without The abdomen is
tenderness on soft and flat
palpation at all without any
four quadrants tenderness.
SKIN Hands and nails Palpation The nail beds are ESSENTIALY
are no clubbing pink in color, the NORMAL
or deformities , capillary refill <2
capillary refill sec, the skin is
<2 sec, nail warm when
beds are pink. touched, has a
The temperature smooth texture, no
of the skin is signs of tenting
warm, the and the is no any
12 | C A S E S T U D Y moisture is dry, notable lesions.
smooth in
texture. Good
turgur and no
signs of tenting.
 DIAGNOSTIC PROCEDURE

A. IDEAL

 To diagnose febrile seizures in infants and children, healthcare providers will review a
child's medical history and perform a physical exam. They often test blood and urine
to help pinpoint the cause of the fever. Keep in mind that dehydration from severe
diarrhea or vomiting can cause seizures.

 Simple febrile seizures

o Children who are current with their vaccinations who have a first simple febrile
seizure don't need testing. Your doctor can diagnose the febrile seizure based on
history. In children with a delayed vaccination schedule or a compromised immune
system, your doctor may recommend tests to look for severe infections:
 A blood test
 A urine test
 A spinal tap (lumbar puncture), to find out if your child has a central nervous system
infection, such as meningitis

 To diagnose the cause of a complex febrile seizure, your doctor may also recommend
an electroencephalogram (EEG), a test that measures brain activity. Your doctor may
also recommend an MRI to check your child's brain if your child has:
 An unusually large head
 An abnormal neurological evaluation
 Signs and symptoms of increased pressure in the skull
 A febrile seizure that lasted an unusually long time

B. ACTUAL

 The patient has undergone chest x-ray exam to see if there is any complication such as
pneumonia. And he undergoes also to urine tests to help pinpoint the cause of the
fever such as bacterial infection. The result is:

13 | C A S E S T U D Y
 RADIOLOGICAL
MIDWIFERY CARE REPORT
PLAN
Name: R. J. O Age: 1 Sex: Male
SSESTMENT DIAGNOSIS
Address: Magsingal, PLANNING
Ilocos Sur INTERVENTION RATIONALE EVALUATIO
bjective: Hyperthermia
Room: Pedia Short term: 1. Monitor Vital 1.To assist in creating an Goal Met:
agngato met ti related to Upper Within 4 hours of Signs at least accurate diagnosis and
Examination Requested: CHEST APL monitor effectiveness of
igor nan” Respiratory Tract interventions, the every 4 hours Short term:
Clinical Note: BFC medical treatment, Within 4 hours of
balized by the Infection (URTI) as patient will have a 2. Remove
ndmother of the Requested by:
evidenced by high DR. ORACION
stabilized excessive particularly the antibiotics interventions, the
X-ray no: and anti pyretic
ent temperature of950-2023
40.5 temperature from clothing, Date: April 30, 2023
medications administered.
patient is able to
°C, rapid and 40.5 °C to 38.5°C blankets and stabilized
shallow breathing linens, provide 2.To regulate the temperature from
jective: CHEST
and X-RAY
weak looking. Long term: well ventilated temperature of the 40.5 °C to 38.3 °C
Within 8 hours of room. environment and make it
al Signs: Right lower lung hazyinterventions, the seen.
densities are 3. Administer more comfortable for the Long term:
mp- 40.5 °C patient Within 8 hours of
Heart and great vessels arewill have a
unremarkable. prescribed patient
- 177 bpm stabilized anti-pyretic interventions, the
Diaphragm and sulci are intact. 3. Use antibiotic to treat patient is able to
temperature within and antibiotic
The rest of the visualized chestrange.
the normal structures are unremarkable. bacterial infection, which have a stabilized
medications
is the underlying cause of temperature with
4. Offer a tepid
IMPRESSION: the patient’s the normal range
bath hyperthermia. Use the
CONSIDER PNEUMONIA, RIGHT. 5. Elevate the fever reducing medication
CLINICAL CORRELATION IS SUGGESTED.head to bed to stimulate the
hypothalamus and
URINALYSIS normalize the body
temperature.
Name: R. J. O Age: 1 Sex: Male
Service: IN Ward: PEDIA 4.To facilitate
Date: April 30,the body in
2023
Requesting physician: Dr. Oracion cooling down and to
provide comfort.

5.Head elevation helps

MACROSCOPIC EXAMINATION MICROSCOPIC EXAMINATION
improve the expansion of
Result Normal the lungs, enabling
Result Normalthe
patient to breathe more
COLOR: Light Light/Pale RBC 0-2/hpf
effectively. <3/hpf
Yellow to dark
yellow
CHARACTER: Hazy Clear or PUS CELLS 1-3/hpf <2-5/hpf
cloudy
REACTION 5.0 4.5-8.0 CASTS -------- --------
SPECIFIC 1.010 1.005- CRYSTALS Rare/lpf Occasionall
GRAVITY 1.025 y
PROTEIN Negative <150 SQUAMOUS Occasional/hpf <15-20
mg/d EPITHELIAL
CELLS
SUGAR Negative BACTERIA Occasional/hpf None
BILIRUBIN ------- ------- OTHER Mucus None
EXAMINATION: threads:
few/lpf

14 | C A S E S T U D Y
 ASSESTMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Subjective: Hyperthermia Long term: 1. Monitor the 1.Most febrile seizures Goal met:
happen when the
“nag seizure met related to antigens After 8 hours of child’s temperature is greater than
toy ubingen” of microorganism shift the child will temperature 49°c. It usually occurs Long term:
verbalized by the that cause have a stabilized 2. Asses for within the first 24 hours of After 8 hours of
illness and close shift the child will
grandmother of the inflammation as temperature within hydration monitoring of temperature
patient evidenced by high the normal range status is essential have a stabilized
temperature 40.5 and will not 3. Eliminate temperature within
Objective: °C, Flushed skin, experience any excess 2.High body temperature the normal range
increases the metabolic
warm to touch and complications. clothing rate and hence increases and will not
Vital Signs: experience any
tachycardia 4. Administer an the insensible fluid loss.
Temp- 40.5 °C complications.
tepid sponge
HR- 177 bpm 3.Exposing skin to room
bath air decreases warmth and
5. Advise the increase evaporative
grandmother cooling.
to avoid 4.External sponging
applying cold reduces the body
water or temperature and increase
comfort
alcohol to the
child 5.Extreme cooling can
6. Administer result in a shock to a child
with an immature nervous
antipyretic system; while applying
medicine as alcohol can cause dry skin.
prescribed.
6.Lowers fever by directly
acting on the
hypothalamic heat
regulating centers that
promote the distribution of
body heat through
sweating and vasodilation.

15 | C A S E S T U D Y
 ASSESTMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Objective: Risk for Injury Short Term: 1. Explore 1.Help the family of the Goal Met:
patient identify specific
related to After 1 hour patient seizure times or triggers of seizure
> stiffening of Convulsion will remain safe patterns activity and how to Short Term:
extremities and free from recognize symptoms so After 1 hour patient
>up-rolling of 2. Ensure a they can keep the patient is remain safe and
injury when safe.
eyeballs. experiencing a patent free from injury
seizure. airway 2. Turn the patient into when experiencing
their side if lying to a seizure.
3. Remove maintain an open airway
Long Term: and prevent aspirating.
After 8 hours of hazardous Loosen clothing around Long Term:
shift family items the neck. Do not place any After 8 hours of
objects in the mouth. shift family
members will Apply oxygen if the
verbalize how to 4. Do not patient displays members is able to
keep the patient restrain, respiratory distress. verbalize how to
safe during a monitor keep the patient
3. Remove unnecessary
seizure closely furniture or sharp objects safe during a
that could cause injury seizure
during a fall. Keep their
bed in the lowest position.

4. A patient who is
actively seizing should
never be restrained as this
can further increase injury.
Keep them safe by
providing pillows or
padding if on a hard
surface. Patients in the
hospital often have their
bed rails padded and a mat
on the floor.

16 | C A S E S T U D Y
 DRUG STUDY

DOSE,
NAME AND FREQUENCY,
MECHANISM ADVERSE MIDWIFE
CLASSIFICATION ROUTE, DURATION INDICATIONS CONTRAINDICATIONS
OF ACTION EFFECT RESPONSIBLITY
OF THE DRUG OF
ADMINISTRATION
BRAND NAME: DOSE: 100 mg To include It is used to relief Contraindicated in patient The most 1.Ensure right
Paracetamol IV inhibition of of mild to moderate with known hypersensitivity commonly patient, drug, route,
(Pfizer) prostaglandin pain and the to paracetamol, or any other reported adverse frequency, dose and
synthesis, primarily reduction of fever component of the reactions have time, assessment,
GENERIC NAME: within the central where an formulation included nausea, approach,
Paracetamol nervous system. intravenous route vomiting, evaluation,
Pharmacokinetics: of administration is constipation. education,
CLASSIFICATION: Paracetamol is considered documentation,
Miscellaneous rapidly and almost clinically refusal, principle of
analgesics completely necessary. care, prescription
absorbed from the and nurse clinician.
FREQUENCY: every 4 gastrointestinal 2. Store the medicine
hours tract. Binding to at temperatures not
the plasma proteins exceeding 30°C.
is minimal at Keep out of direct
therapeutic light exposure.
ROUTE: intravenous concentrations. 3.administer by slow
(infusion) injection Paracetamol is injection technique
DURATION: until the metabolized in the 4.After
fever is stabilized to liver and excreted administration,
normal range. in the urine mainly monitor closely for
as glucuronide and adverse effect
sulfate conjugates.
Less than 5% is
excreted as
unmodified
paracetamol.

17 | C A S E S T U D Y
 DOSE,
NAME AND FREQUENCY,
MECHANISM MIDWIFE
CLASSIFICATION ROUTE, INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT
OF ACTION RESPONSIBLITY
OF THE DRUG DURATION OF
ADMINISTRATION
BRAND NAME: DOSE: 2 mg Diazepam is a To treats status Contraindicated in patients The adverse reactions 1.Ensure right
Valium benzodiazepine epilepticus, with a known of diazepam include patient, drug, route,
that exerts convulsions due hypersensitivity to this CNS and respiratory frequency, dose and
GENERIC NAME: anxiolytic, to poisoning, and drug; acute narrow angle depression, time, assessment,
Diazepam sedative, muscle- febrile glaucoma; and open angle dependence, and approach,
relaxant, convulsions; to glaucoma unless patients benzodiazepine evaluation,
CLASSIFICATION anticonvulsant treat tetanus; as a are receiving appropriate withdrawal syndrome. education,
: Antianxiety and amnestic pre-operative therapy. documentation,
Agents; Anxiolytics, effects. Most of medication or Serious adverse effects refusal, principle of
Benzodiazepines; these effects are premedication. of diazepam include: care, prescription
Skeletal Muscle thought to result  Respiratory and nurse clinician.
Relaxants; FREQUENCY: 3 to 4 from a facilitation depression 2.Monitoring
Anticonvulsants, hours as needed. of the action of  Suicidality respiratory and
Benzodiazepine. gamma  Dependency cardiovascular
aminobutyric acid and abuse status, blood
(GABA), an  Withdrawal pressure, heart rate,
inhibitory symptoms and anxiety
neurotransmitter  Cardiovascular symptoms in
in the central collapse patients taking
nervous system.  Bradycardia diazepam is crucial.
ROUTE: IV  Hypotension 3.Store the
 Syncope Diazepam at room
temperature and
 Paradoxical
away from excess
CNS
heat and moisture
stimulation
DURATION: if the 4.administer by slow

seizure occurs or as injection technique,
Common adverse
needed and monitor for the
effects of diazepam
adverse effect.
include:

 Sedation
 Fatigue

18 | C A S E S T U D Y
  Confusion
 Anterograde
amnesia
 Depression
 Ataxia
 Irritability
 Disinhibition
 Local injection
site reaction
 Headache
 Tremor
 Dystonia
 Urinary
retention
 Incontinence
 Nausea
 Constipation
 Diplopia
 Libido
changes
 Rash
 Menstrual
irregularities

DOSE,
NAME AND
FREQUENCY,
CLASSIFICATION MECHANISM ADVERSE MIDWIFE
ROUTE, DURATION INDICATIONS CONTRAINDICATIONS
OF THE DRUG OF ACTION EFFECT RESPONSIBLITY
OF
ADMINISTRATION

19 | C A S E S T U D Y
 BRAND NAME: DOSE: 225 mg Cefuroxime is a is used to treat certain Cefuroxime is contraindicated Adverse Reactions: 1.Ensure right patient,
Ceftin, Zinacef bactericidal agent infections caused by in patients with known allergy Vomiting, drug, route, frequency,
that acts by inhibition bacteria including to the cephalosporin group of abdominal pain, dose and time,
GENERIC NAME: of bacterial cell wall pneumonia and other antibiotics. colitis, vaginitis assessment, approach,
Cefuroxime synthesis. lower respiratory including vaginal evaluation, education,
Cefuroxime has tract (lung) candidiasis, toxic documentation, refusal,
CLASSIFICATION: activity in the infections; meningitis nephropathy, principle of care,
cephalosporin presence of some (infection of the hepatic dysfunction prescription and nurse
antibiotics beta-lactamases, both membranes that including clinician.
FREQUENCY: every 8 penicillinases and surround the brain cholestasis, aplastic 2.administer by slow
hours cephalosporinases, of and spinal cord); anemia, hemolytic injection technique,
Gram-negative and gonorrhea (a sexually anemia, and and monitor for the
Gram-positive transmitted disease); hemorrhage. adverse effect.
ROUTE: IV bacteria. and skin, blood, bone, 3.Store the drug in the
joint, and urinary dry state should be
tract infections. stored at 20° to 25°C
Cefuroxime injection (68° to 77°F) and
may also be used protected from light.
DURATION: 5 days before, during, and 4.should dilute and
sometimes for a brief shake the vial well.
period after surgery
in order to prevent
the patient from
getting an infection.
Cefuroxime injection
is in a class of
medications called
cephalosporin
antibiotics. It works
by killing bacteria.

20 | C A S E S T U D Y
 DISCHARGE PLAN

MEDICATIONS 1.Instructed the grandmother of the patient to give to

the patient the following prescribed medicine for the
continuity of care:
 Ascobic Acid drops 1ml once a day
 Cefaclor drops 1 ml thrice a day
 Ambroxol drops 1 ml twice a day

Additional information:
All the prescribed medicine should be taken for 4
days. Should take each dose after meals. Should
keep the patient take the medicine for the full
treatment time, even if the patient feels better after
the first few doses. If the patient missed a dose of
this medicine, should give it as soon as possible.
However, if it almost time for the next dose, skip the
missed dose and go back to the regular dosing
schedule. Do not give double doses.

2.Instruct the grandmother of the patient not to give

any other medicines beside from the prescribed
dose.

EXERCISE Advise the family of the toddlers, that they try to

encourage the child to have exercise, the toddler
should be physically active every day for at least 180
minutes (3 hours). The more the better. This should
be spread throughout the day, including playing
outdoors.

The 180 minutes can include light activity such as

standing up, moving around, rolling and playing, as
well as more energetic activity like skipping,
hopping, running and jumping.

TREATMENT Instruct the grandmother to give the medication

prescribed to the patient by following the right time
and right dosage.
HEALTH TEACHINGS Educate the family of the patient about the
febrile seizure. By teaching them this step:
 Place your child on his or her side on a soft,
flat surface where he or she won't fall.
 Start timing the seizure.
 Stay close to watch and comfort your child.
 Remove hard or sharp objects near your
child.
 Loosen tight or restrictive clothing.
 Don't restrain your child or interfere with
your child's movements.
 Don't put anything in your child's mouth.

Call for emergency medical attention if:

 Your child has a febrile seizure that lasts

more than five minutes.
 Your child has repeated seizures.
 Your child's seizure lasted less than five
minutes but your child isn't improving
quickly.

21 | C A S E S T U D Y
 OUT-PATIENT APPOINTMENT Instructed a family of the patient on the follow up
check up 1 week later upon discharge at 9:00 AM, to
the Out Patient Department of ISDH-Magsingal
DIET 1.instruct the grandmother of the patient to feed the
toddler with solid foods including healthy snacks for
examples are fruits, vegetables, yogurt and other
nutritious foods, these are now the child’s main
source of energy and nutrition.

2.instruct the family that the toddler can take

between three quarters to one cup of food three to
four times a day, plus one to two snacks between
meals.

3. advise the mother to continue breastfeeding as

much as the child wants, until he is at least 2 years
old.

4.advise the mother or the family to avoid junk food

and soft drinks.
SAFETY/SPIRITUALITY 1.Advise the family of the toddler that the child need
to sleep in a low positioned bed.

2.Advise the family of a toddler to provide the child

a calming and stress-free environment.

3.Remind the family to always trust God throughout

the child’s recovery.

22 | C A S E S T U D Y
23 | C A S E S T U D Y
CONCLUSION

A child who has a febrile seizure should be seen by a health professional as soon as possible
(in an emergency department or medical clinic) to determine the cause of the fever. Some
children, particularly those less than 12 months of age, may require testing to ensure that the
fever is not related to meningitis, a serious infection of the lining of the brain. (See "Patient
education: Meningitis in children (Beyond the Basics)".)
In conclusion, inflammation, though a defence response against invaders and
pathogens during an infection in children, has been shown to have adverse effects in the
central nervous system. The pro-inflammatory cytokines, especially Interleukin-1-beta, are
the main factors that induce fever. The increase of Interleukin-1-beta in the CNS also results
in an imbalance in glutamate and Gamma-aminobutyric acid causing an imbalance in
excitation and inhibition transmission in the brain resulting in convulsions which accompany
the fever, giving rise to the onset of febrile seizures. The aim of this review was to highlight
the increased susceptibility of young offspring to the development of febrile seizures, or other
infections; as well as to raise awareness of the dire need for further investigations into
producing an affordable, easily accessible treatment for febrile seizures, especially in low
income areas that are also affected by other underlying socio-economic factors, in which
febrile seizures are of growing concern.

The pathogenesis of FS is multifactorial and heterogeneous. There are no consistent

and definite results regarding the connection between systemic or local inflammation and the
CNS or on the mechanisms for increasing neuronal excitability in the CNS during fever. It is
impossible to predict and prevent seizures in febrile children infected by a specific respiratory
virus. However, life-threatening infections are very rare, and the underlying genetic disorders
associated with subsequent epilepsy and neurodevelopmental disabilities are rare. In addition,
the outcomes were generally good and not associated with the infected virus in children with
FS. Therefore, intensive searches for the virus and vigorous neurologic and genetic
evaluations are neither necessary nor helpful for affected patients.

24 | C A S E S T U D Y
 REFERENCES

 Better Health Channel (2021). Febrile seizures. The Royal Children's Hospital
Melbourne. www.betterhealth.vic.gov.au/health/conditionsandtreatments/fever-
febrile-convulsions

 Yamashiroya V. K. (2001). Chapter XVIII.3. Febrile Seizures. Case Based Pediatrics

For Medical Students and Residents.
www.hawaii.edu/medicine/pediatrics/pedtext/s18c03

 Mosili P. et. Al. (2020). The Pathogenesis of Fever-Induced Febrile

Seizures.https://journals.sagepub.com/doi/full/10.1177/2633105520956973

 Yoon Han J. (2023).Pathogenetic and etiologic considerations of febrile seizures.

https://www.e-cep.org/journal/view.php?number=20125555595

 Xixis K. et. Al (2022).Febrile Seizure.Management. www.ncbi.nlm.nih.gov/books/

 Millichap J. (2021). Patient education: Febrile seizures (Beyond the Basics). Febrile
seizure overview. https://www.uptodate.com/contents/febrile-seizures-beyond-
the-basics

25 | C A S E S T U D Y