Febrile fit

Foong Wei Jian

Denesha Kaur
Patient Details ICTAL PHASE PRE-ICTAL
The middle of a seizure is The state immediately
called the ictal phase. before the actual seizure,
• Date of Admission 12/06/2019 stroke, or headache.
• Age : 4 years
• Weight 11.8kg
• Height 98cm POSTICTAL STAGE
• Diagnosed simple febrile fit 2° URTI The postictal stage occurs
• C/o fever and fit for 1 day after the ictus or active
stage of the seizure.
• Fitted on admission day:
• Preictal- sleeping
• Ictal- drooling saliva
• Up rolling of eyeball Tonic both hands and leg Urine incontinence
• Fit lasted <5mins
• Post ictal- drowsiness and confuse
• History of visited many houses during raya
• No water activities e.g. swimming
• 1st hospitalization: NNJ @ Kuantan hospital for 4 days
• Past Medical History- Neonatal jaundice
• Past Surgical History- nil
• Family History- Nil
• Plan:
1. Monitor temperature
2. Syrup PCM 177mg (15mg/kg/dose)
3. Fit chart
4. Encourage orally
• Febrile seizures occur in 2% – 5% of children and are the most common
form of childhood seizures.
• Febrile seizures usually occur in children between the ages of 6 months and
6 years and are particularly common in toddlers.
• Approximately one in every 25 children will have at least one febrile
seizure, and more than one-third of these children will have additional
febrile seizures before the age of 5 years.
• Children rarely develop their first febrile seizure before the age of 6 months
or after 3 years of age.
• The older a child is when the first febrile seizure occurs, the less likely that
child is to have recurrent febrile seizures.
Sign and symptoms
• The child often loses consciousness and has jerky movements of all limbs.
• Sometimes the child may become stiff or have jerking of one part or more of the
body, such as an arm or a leg. It can be only on one side.
• Febrile seizures usually spontaneously stopped after 2-3 minutes or less, and
rarely persist beyond 10 minutes. In cases where the seizure lasts longer than 5
minutes, the child needs to be brought to the nearest medical facility.
• During a seizure, the child may be injured by falling or may choke from food or
saliva in the mouth.
• Most children with febrile seizures have temperatures greater than 38.5 Celcius
degree.
• Most febrile seizures occur on the first day of a child’s fever.
• Children with febrile seizures are not considered to have epilepsy, since epilepsy
is characterized by recurrent seizures that are not triggered by fever.
Risk factors for recurrent
• Young age (less than 15 months) during the first seizure.
• Seizure occurs soon after a fever has begun or when the temperature
is relatively low.
• Febrile seizures in a first degree relative.
• Epilepsy in a first degree relative.
• A prolonged (more than thirty minutes) febrile seizure does not
increase the risk of recurrent febrile seizures.
Long term effects
• The vast majority of febrile seizures are harmless.
• There is no evidence that febrile seizures cause brain damage.
• Large studies have found that children with febrile seizures have
normal school achievement and perform as well on intellectual tests
as their siblings who don’t have seizures. Even in the rare instances of
very prolonged seizures (more than 1 hour), most children recover
completely. About 3% of children with febrile seizures go on to
develop epilepsy.
Long term effects
• These include children with:
• Febrile seizures that are prolonged, affect only one part of the body,
or recur within 24 hours.
• Delayed development.
• Other family members who have epilepsy.
• Children without any of these risk factors have only a one percent
chance of developing epilepsy after a febrile seizure (same risk as
general population).
Treatment
• First aid measures
• Control of seizures
• The majority of children do not need medication.
• If seizures last longer than 5 minutes then rectal diazepam (Valium) may
have to be given.
• Control of fever
• Use drugs such as paracetamol or ibuprofen to lower the fever.
• Tepid sponging of the whole body, but do not use icy water.
• Give your child cool liquids to drink. This will help lower the temperature as
well as keep him hydrated.
First Aid During a Seizure
• First aid care may be required if the child has a violent or vigorous
convulsive seizures. In such a seizure, the child rapidly loses
awareness, and develops violent stiffening followed by vigorous
jerking of the limbs.
• Children rarely die from a seizure. A single seizure is not life
threatening.
• There is little you can do to stop the seizure, but you can follow the
DOs and DON’Ts to help the child:
DO
• Keep calm. Don’t panic
• You need to think clearly to help the child.
• Pay attention and observe
• What you observe during the seizure (sequence of events, posture, length of seizure)
• Prevent injury
• Keep the child where he or she is
• Only move them if they are in dangerous situations, like on a road, or in a high place
• Do move things away from the child
• Slowly turn them over onto their sides
• This helps to prevent them from choking on their saliva, or if they should vomit
• Be sensitive and supportive
• Speak calmly and softly. Encourage onlookers not to crowd around the child
DON’T
• Do not hold the person down.
• Allow the seizure to take its course.
• Do not put anything into the mouth, like a spoon or key.
• This is unnecessary and may cause injury to the mouth and tongue.
• Don’t give food, or medicines by mouth.
• Wait until the seizure stops and the child awakens fully before offering food.
• Don’t perform CPR or mouth-to-mouth resuscitation.
• The child is not going to stop breathing, or die from a brief seizure.
• Allow the child to sleep after the seizure.
Admission to hospital
• Children with febrile seizures may need to be admitted to the ward,
although this is not necessary in all cases. Admission will be necessary in
the following situations:
• Fear of recurrent seizures.
• To rule out infection of the brain and other serious illnesses.
• To find out and treat the cause of fever besides infection of the brain.
• To allay parental anxiety.
• There is no need for laboratory investigations to make a diagnosis of febrile
seizures. However, the doctor may decide to perform some tests to find the
source of fever. A spinal tap may be required when infection of the brain is
suspected. (See the topic ‘Lumbar Puncture’).
Prevention of further seizures
• There is no proven method that can effectively prevent further
recurrence of febrile seizures, though doctors may prescribe rectal
diazepam (valium) for children with recurrent febrile seizures.
• The rate of recurrence will eventually be declining as a child’s age
approaching 5-6 years old.
Nursing Care Plan
• Nursing Diagnosis: Altered body temperature related to disease
process
• Goal: Patient will not have fever during hospitalization
Nursing intervention:
1. Assess vital sign especially temperature to act as baseline data.
2. Encourage fluid of 2-3L per day to replenish fluid loss if not
contraindicated
3. Remove excessive clothes and blankets to promote heat loss
4. Provide tepid sponging to encourage heat loss
5. Administer antipyretic as ordered by doctor example syrup
paracetamol 177mg
• Nursing Diagnosis: Knowledge deficit related to care of seizures
• Goal: Caregiver would be able to handle child during episode of
seizure
Nursing intervention
1. Assess level of knowledge and education to ensure proper
information can be given
2. Avoid using medical terms when explaining to the caregiver
3. Provide pamphlets and additional information to aid in teaching
4. Encourage caregiver to ask question if don't understand
5. Demonstrate to the patient what to do during episode of epilepsy
6. Do not insert any thing into the child's mouth during episode of
seizure
7. Place pillow at the corner to ensure patient doesn't injure
themselves during episode of seizure
8. Record the duration and action during episode of seizure
9. Ask patient caregiver for return demonstration