MEDICAL COLLEGES OF NORTHERN PHILIPPINES

COLLEGE OF NURSING

SIMPLE FEBRILE
SEIZURE Group 12 Cluster B
SCENARIO
 A three-year old boy was brought at CVMC Emergency Department with a
seizure associated with fever. He has a high fever that developed today to about 40
C. When fever started his mother gave him Paracetamol syrup. After 20 minutes,
when the mother was checking up on her child, she noticed stiffening of extremities
and upward rolling of eyeballs. This went on for 3-5 minutes, occured only once in
24 hours. Apart from high fever, patient also had a cough and nasal congestion that
started a day ago.
Just prior to seizure, he was playing with some toys. There is no vomitting,
diarrhea, rashes or fussiness. Past medical history is unremarkable. Family history
is significant for an uncle who has epilepsy. Patient is admitted at the Pediatric
Ward with ongoing IVF of D50.3 NaCl 1/2L to run for 8 hours.
Physical assessment done with the following findings:
- V/S:
T - 40C
PR - 140bpm
RR - 32cpm
BP - 90/60mmHg
O2 sat - 99%
- rales heard in both lungs upon auscultation
- with nasal congestion
Lab results reveal:
- WBC - 9.5
- APC - 320,000
- Hgb - 13 g/L
- Hct - 48%
- Neutrophil - 55%
- Lymphocytes - 52%
Diagnostics reveal:
- normal EEG, Chest Xray and CT scan
Medications are as follows:
- Paracetamol 125mg IV every 4 hours for temp 38C and
above
- Paracetamol 250mg/5ml, 1/2 ml every 4 hours for temp
37.8C and above
- Phenobarbital PRN for seizure
- Phenylephrine HCl + Chlorphenamine Maleate
5mg/1mg/5ml syrup, 2.5ml every 6 hours
- Cefuroxime IV
Diagnosis: SIMPLE FEBRILE SEIZURE
I. GOAL OF THE CASE
PRESENTATION
 With the help of this case presentation, students
will learn more about the types of febrile seizures,
how to recognize them, how to manage them, and
how to apply an appropriate attitude when caring for
young patients who have been diagnosed with
febrile seizures.
II. OBJECTIVES
By the end of the case presentation, the students will:
• List the characteristics of a simple febrile seizure.
• Discuss the management of a child with a simple vs. complex
febrile seizure.
• Discuss the risk factors that correlate with an increased risk
of a subsequent febrile seizure.
• Understand treatment of febrile seizures specific to urgent
care.
• Develop priority nursing care plans with an emphasis on
febrile seizure.
III. INTRODUCTION
 A febrile seizure, a fever fit, or febrile convulsion is
associated with a high body temperature but without underlying
severe health issues. They most commonly occur in children
between 6 months and five years old. There are two types of
seizures simple and complex. Simple febrile seizures are the
most common. Typically, the child loses consciousness and has
a convulsion or rhythmic twitching of the arms or legs.
 Most seizures do not last more than one to two minutes, although
they can last up to 15 minutes. After the seizure, the child may be
confused or sleepy but does not have arm or leg weakness. In
comparison, Complex febrile seizures are less common and can last
more than 15 minutes (or 30 minutes if in a series). The child may
have temporary arm or leg weakness after the seizure.

The common signs and symptoms of a febrile seizure include loss

of consciousness, shaking limbs or convulsions (usually in a
rhythmic pattern), confusion or tiredness after the seizure, and no arm
or leg weakness.
 Febrile seizures generally happen when a child has an illness, but
they often occur before realizing that the child is sick. Because they
usually occur on the first day of an illness, a child may not show
any other symptoms yet.
Seizures brought on by fever have a variety of reasons, including
febrile seizures that may result from a fever that develops following
vaccines, particularly the MMR (mumps, measles, rubella) vaccine.
8-10 days after a child has received an inoculation, a high fever is
most frequently experienced.
 Although extremely uncommon, the advantages of the vaccine
Trusted Source greatly exceed the hazards. If there have any
worries, consult your doctor. Frequent febrile seizures can be
brought on by viral or bacterial infections that induce a fever. The
most frequent cause of febrile is roseola. The likelihood of a child
experiencing febrile seizures will increase if there are risk factors,
such as family members who have experienced them.
 LABORATORY/
DIAGNOSTIC EXAMS
• Complete Blood Count (CBC) - also known as a total
blood count, is a set of medical laboratory tests that
provide information about a person's blood cells. The
CBC indicates the counts of white blood cells, red
blood cells, and platelets, the concentration of
hemoglobin, and the hematocrit.
• Electroencephalogram (EEG) -a test that measures
electrical activity in the brain using small metal discs
(electrodes) attached to the scalp. Brain cells
communicate via electrical impulses and are always
active, even during sleep. This activity shows up as
wavy lines on an EEG recording. An EEG is one of the
main diagnostic tests for epilepsy. It also plays a role in
diagnosing other brain disorders.
• CT Scan - A computerized tomography (CT) scan
combines a series of X-ray images from different angles
around your body. It uses computer processing to create
cross-sectional images (slices) of the bones, blood
vessels, and soft tissues inside your body. CT scan
images provide more detailed information than plain X-
rays do.
• Chest X-ray – produces images of your heart,
lungs, blood vessels, airways, and the bones of
your chest and spine. Chest X-rays can also
reveal fluid in or around your lungs or air
surrounding a lung.
STATISTICS
 About 5 in 100 children have a febrile seizure
sometime before their 6th birthday. They most commonly
occur between the ages of 18 months and 3 years. They are
rare in children aged under 3 months and over the age of 6
years.
Simple febrile seizure: the most common type –
occurs in about 15 out of 20 cases Febrile seizures most
often occur early in the illness when the child’s
temperature is starting to rise.
 Complex febrile seizure – occurs in about 4 out of 20
cases. This is similar to a simple febrile seizure but has one or
more of the following features:
• The seizure lasts more than 15 minutes; and/or
• The seizure recurs within 24 hours or the same febrile illness;
and/or
• The child is not fully recovered within one hour. This does
not mean the seizure lasts more than an hour but that it takes
more than an hour for the child to look and behave more like
their normal self; and/or
 • The seizure has focal (used to be called partial) features.
This means that rather than a generalized twitch or
shaking, only a part of the body may shake – for
example, just one arm or just one leg
Febrile status epilepticus – occurs in less than 1 out of
20 cases This means the febrile seizure lasts for longer than
30 minutes.
The incidence elsewhere
in the world varies
between 5% and 10%
for India, 8.8% for
Japan, 14% for Guam,
0.35% for Hong Kong,
and 0.5-1.5% for China.
 • Mortality/Morbidity
Children with simple febrile seizures do not have
increased mortality risk. However, seizures that were
complex, occurred before age 1 year, or were triggered
by a temperature of less than 39°C were associated
with a 2-fold increased mortality rate during the first 2
years after seizure occurrence.
 Children with febrile seizures have a slightly
higher incidence of epilepsy compared with the
general population (2% vs 1%). Risk factors for
epilepsy later in life include complex febrile seizure,
family history of epilepsy or neurologic abnormality,
and developmental delay. Patients with 2 risk factors
have up to a 10% chance of developing afebrile
seizures.
Medical Management
Medical Management on the basis of risk/benefit analysis,
neither long-term nor intermittent anticonvulsant therapy is
indicated for children who have experienced 1 or more simple
febrile seizures.
• Therapy
Continuous therapy with phenobarbital or valproate
decreases the occurrence of subsequent febrile seizures.
 • Pharmacologic Therapy
The following medications can be given to a child with febrile seizure:
• Benzodiazepine
These agents have antiseizure activity and act rapidly in acute seizures;
oral diazepam can decrease the number of subsequent febrile seizures when
given with each febrile episode; many practitioners will prescribe rectal
diazepam, particularly to patients who have had prolonged febrile seizures, in
order to prevent future episodes of febrile status epilepticus.
2. Antipyretics
Although it does not prevent simple febrile seizures, antipyretic therapy is
desirable for other reasons, for instance, comfort.
IV. ANATOMY AND
PHYSIOLOGY
 Neurons are the primary cells of the nervous system. They
comprise a cell body with all the cell’s organelles and nerve
fibers, which are projections extending out from the neuron cell
body. Nerve fibers are either dendrites that receive signals from
other neurons or axons that send signals called action potentials
to other neurons. A synapse is where two neurons come together,
where one end of an axon sends neurotransmitters to the
dendrites or directly to the cell body of the next neuron in the
series.
 Some neurotransmitters bind to the receptors and tell
the cell to open up the ion channels and relay an
electrical message, these are called excitatory
neurotransmitters. Nevertheless, others can close the ion
channels and prevent an electrical message from going
through, and these are called inhibitory
neurotransmitters.
• Generalized seizures. These are seizures that happen on
both sides (hemispheres) of your brain side. These seizures
tend to cause more severe effects and symptoms.
• Focal seizures happen in only one hemisphere, also known
as partial seizures. That means symptoms only happen in a
specific part or on one side of your body. But focal seizures
can sometimes spread and become generalized seizures.
IV. PATHOPYSIOLOGY
V. LABORATORY
 Test Done Result Normal Values Analysis

Complete Blood WBC - 9.5 WBC: 5.0-10.0 X Normal

Count  

APC - 320,000 APC: 150,000-450,000 Normal

Hgb:
Hgb - 13 g/dL Male: 13.0-18.0 g/dL Normal
  Female: 12.0-16.0 g/dL
 
Hct:
Hct - 48% Male: 40-55%
  Female: 36-48% Normal
 

Neutrophil - 55% Neutrophil: 35-71% Normal

 
Lymphocytes- 52% Lymphocytes:24-44% High. The immune system reacts by producing an
  inflammatory response thereby, inducing fever and
  subsequently increasing the core temperature of
the body.
Diagnostics Exam Result

Electroencephalogram Normal
(EEG)

Chest X-Ray Normal

CT Scan Normal
VI. NURSING CARE
PLAN
ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Fever r/t After 8 hours of • Administer antipyretics as ordered by • To reduce the pyrogens After 8 hours of
• febrile seizure respiratory thorough the physician causing fever rendering care, the
infection as management, the (Paracetamol 125mg IV q4 and patient’s fever subsided
OBJECTIVE: evidenced by patient’s fever will Paracetamol 250mg/5mL, 1/2mL q4) from 40 degrees celsius
• T:40degree 40degrees subside from to 37 degrees celsius
celsius celsius body 40degrees celsius to • Provide heat loss by undressing the
• RR:32cpm temperature normal range (36.5- patient, cool environment and/or fans, • To decrease body heat
HR: 140bpm 37.5 degrees celsius) and tepid sponge baths or immersions

• instruct the SO to encourage the

patient to maintain bed rest • To reduce metabolic
demand and oxygen
consumption.
• Discuss to the SO the importance of
adequate fluid intake at all times and
ways to improve hydration when ill • To prevent dehydration
•Note the presence and absence of
sweating as the body attempts to
increase heat loss
• Administer anticonvulsant as ordered
by the physician
(Phenobarbital PRN)
• Administer antibiotic as ordered by
the physician
(Cefuroxim IV)
• Administer replacement of fluids and
electrolytes as ordered by the physician
(D50.3 NaCl 1/2L to run for 8h)
• Evaporation is decreased
by environmental factors of
high humidity and high
ambient temperature, as
well as body factors
producing loss of ability to
sweat
• To treat convulsion/seizure
brought by high grade fever
• To treat the underlying
cause of high grade fever
• To support circulating
volume and tissue perfusion
ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Ineffective After an hour of • Monitor respirations and breath sounds, • As it may be an indicative After an hour of nursing
•ineffective airway nursing noting rate and sounds of respiratory distress and/or manegement, the patient
cough clearance r/t management, the accumulation of secretions was bale to demonstrate
•nasal nasal allergy patient will absence of congestion
congestion as evidenced demonstrate absence • As the mucus membrane with clear breath sound,
by nasal of congestion with produces excessive mucus noiseless respiration, and
OBJECTIVE: congestion breath sound clear, • Keep the environment allergen free and causes nasal congestion improved oxygen
rales sound on noiseless respiration, according to individual situation as allergic reactions exchange
both lungs and improved
oxygen exchange •To report in changes in color
and amount in the event that
• Provide the SO information about the medical intervention may be
necessity of raising and expectorating needed to prevent or treat
secretions versus swallowing them infection
• Encourage deep breathing exercise •to maximize effort in
and coughing exercises secreting the secretions

•Suction the nose, mouth, and trachea • To clear airway when

PRN using correct size for child excessive or viscous
secretion are blocking airway
or patient is unable to cough
effectively

•Administer antihystamine as ordered • To relieve congestion and

by the physician stop excessive mucus
(Chlorphenamine Maleate secretion
5mg/1mg/5mL syrup, 2.5mL q6)
ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Risk for injury After 20 minutes of • Maintain patient’s bed and chair in • To reduce the distance of a After 20 minutes of
r/t febrile management, the lowest position with wheels locked fall from bed to floor management, the goal is
seizure patient’s environment met as the patient’s
will be modify as environment is modified
indicated to enhance • Always raise the patient’s bed rails • Side rails will serve as and the patient’s safety in
safety and to be free barrier for patient to prevent enhanced.
from injury from falling out of bed

• Provide the SO with information • To identify the signifant

regarding the condition of the patient that other’s role in reducing the
may result in increased risk for injury risk or preventing the
incidence of injury during
the event of seizure

• Administer medication as ordered by • To treat the episodes of

the physician, observing the 10 R’s of the
seizure
patient (Phenobarbital PRN)
VII. DRUG STUDY
NAME OF DRUG DRUG MECHANISM OFACTION ADVERSE EFFECT/ NURSING RESPONSIBILITIES
CLASSIFICATION SIDE EFFECT

• Paracetamol Analgesic (nonopioid) Antipyretic: reduces fever by CNS: headache • Do not exceed the
Antipyretic acting directly on the recommended dosage.
hypothalamic heat-regulating CV: chest pain dyspnea,
center to cause vasodilation and myocardial damage when doses • Reduce dosage with hepatic
sweating, which helps dissipate of 5-8g/day are ingested daily impairment.
heat for several weeks or when doses
of 4g/day are ingested for 1 year. • Avoid using multiple
preparations containing
acetaminophen.

• Check carefully all OTC.

• Treatment of dosage:
Monitor serum levels
regularly, N- acetylcysteine
should be available as a
specific antidote.
NAME OF DRUG DRUG MECHANISM OFACTION ADVERSE EFFECT/ NURSING RESPONSIBILITIES
CLASSIFICATION SIDE EFFECT

• Phenobarbital • Antiepileptic • General CNS depressant; • CNS: Agitation, confusion, • Monitor Vital Signs
• Barbiturate it work by controlling the hyperkinesias, ataxia, including Blood Pressure
Anticonvulsant / abnormal electrical vertigo, CNS depression, carefully.
Hypnotics activity in the brain that nightmares, lethargy,
occur during seizure. residual sedation, • Do not reduce dosage or stop
psychiatric disturbances, drugs unless consulted by the
hallucinations, anxiety, health care provider.
dizziness, thinking
abnormality. • Report severe dizziness,
weakness, fever, drowsiness,
• CV: Bradycardia, rash sore throat, easy
hypotension, abnormality. bruising or bleeding, mouth
sore.
NAME OF DRUG DRUG MECHANISM OFACTION ADVERSE EFFECT/ NURSING RESPONSIBILITIES
CLASSIFICATION SIDE EFFECT

• Phenylephrine • Nasal Decongestant • It works by reducing the • Loss of appetite. • Monitor the pulse rate, BP,
HCI swelling of the blood and central venous pressure
vessels in the nasal • Warmth, tingling, or during IV administration.
passages to relieve redness under the skin.
congestion. • Observe for congestion or
• Sleep problems such as rebound miosis after topical
insomnia. administration to eye.

• Skin rash or itching.

NAME OF DRUG DRUG MECHANISM OFACTION ADVERSE EFFECT/ NURSING RESPONSIBILITIES
CLASSIFICATION SIDE EFFECT

• Chlorphenamine • Antihistamines • works to relieve or control • Drowsiness, dizziness, • Avoid excessive dosage.
Maleate the sign ang symptoms of constipation, stomach
allergy such as red, itchy, upset, blurred vision, or • Avoid alcohol, serious
watery eyes, sneezing, mouth, nose, throat may sedation may occur.
itching nose or throat, and occur.
runny nose, but it will not
treat the cause of the
allergy or speed the
recovery.
NAME OF DRUG DRUG MECHANISM OFACTION ADVERSE EFFECT/ NURSING RESPONSIBILITIES
CLASSIFICATION SIDE EFFECT

• Cefuroxime IV • Cephalosporin, • Bind to bacterial cell wall • ·GI: diarrhea, nausea, • observe 10R's of
antibiotic membrane, causing cell vomiting, abdominal paid. administering medication
death.
• CNS: headache, dizziness, • Take note the side effects:
lethargy. stomach upset or diarrhea

• Report severe diarrhea,

difficulty of breathing and
unusual tiredness or fatigue,
pain at injection site.
VIII. DISCHARGE CARE
PLAN
MEDICATION:
• lnstruct the patient to take medications regularly at a similar time each
day and make sure he follows the correct dosage.
• Advise the patient together with the mother about the importance of the/
taking medication at the proper time
• Advise the mother to recognize and report symptoms of adverse drug
reaction.
• Educate the mother about the medication’s negative effects.
• Advise the patient with his mother to take medications as prescribe by
the doctor.
EXERCISE:
• Encourage mother to let the child to activities such walking and running.
• Advise the mother to maintain clean and quite environment to promote relaxation.

TREATMENT:
• Instruct the patient together with the mother to take his medicines regularly at the same time
each day and instruct don’t miss it for better recovery.
• Instruct the patient together with the mother to check with the doctor first before taking/giving
OTC drugs.
• Instruct the mother to place the child on their side but do not try to stop their movement.
• Encourage the patient together with the mother to follow doctor or other healthcare
professionals advise
HYGIENE:
• Encourage the patient to maintain good hygiene by regular bathing.
• Monitor oral health

OUT PATIENT:
• Instruct mother to follow appointments for the child even if
seizures are controlled.
• Instruct the mother to go the patient follow up checkup as ordered
by the physician on the scheduled date
 DIET:
• Instruct the mother for specific diet to be fed is high fat, low carbs
diet.

SPIRITUAL:
• Continuous praying and attending for church masses for good health
THANK YOU FOR
LISTENING!