Nursing Child Fever Seizures

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Nursing Child Fever Seizures

Nursing Child Fever Seizures



Definition

Febrile seizure or febrile convulsion is the seizures that occur in an increase in body temperature (rectal temperature above 38oC) caused by the process ekstrakranium (Ngastiyah, 1997:229).

Seizures are uncontrolled electrical liberation from cerebral cortex nerve cells are characterized by attacks that arrive - arrived (marillyn, doengoes. 1999: 252)


Etiology

Causes of fever kejag divided into 6 groups, namely:

Drugs - drugs
toxins, alcohol, drugs taken excessive

Chemical imbalances
hyperkalemia, hypoglycemia and acidosis

Fever
most often occur in children under five

Pathological brain
result from head injury, trauma, infection, increased tick

Eclampsia
prenatal hypertension, toxemia gravidarum

Idiopathic
cause unknown


Signs and Symptoms

There are 2 forms of febrile seizures, namely:

Febrile seizures while
Age between 6 months - 4 years
Old seizures more than 15 minutes
Seizures are common
Seizures occurred within 16 hours after onset of fever
There are no neurological abnormalities, both clinical and laboratory
Normal EEG 1 week after seizures

Complicated febrile seizures
Beyond the above criteria


Complication

Recurrent seizures
Epilepsy
Hemiparese
Mental disorders and learning


Diagnostic Examination

Blood
Blood Glucose: Hypoglycemia is a predisposing seizures (N <> BUN: Increased BUN has seizures and is an indication of potential toxic nepro a result of drug administration.
Electrolytes: K, Na
Electrolyte imbalance predisposing to seizures
Potassium (N 3.80 to 5.00 meq / dl)
Sodium (N 135-144 meq / dl)

Spinal fluid Cerebo: Detecting abnormal pressure from CCS signs of infection, bleeding cause seizures.

Skull Ray: To identify the process chamber and the lesion persisted

Tansiluminasi: A way that is done on infants with UUB still open (under 2 years) in a dark room with special lights to transilluminates head.

EEG: The technique to suppress the brain's electrical activity through the intact skull to determine the focus of seizure activity, the results are usually normal.

CT Scan: To identify cerebral lesions infaik hematoma, cerebral edema, trauma, abscesses, tumors with or without contrast.


Medical Treatment

Giving diazepam
initial dose: 0.3 to 0.5 mg / kg bw / dose iv (slowly)
if the seizure has not stopped can be repeated with dosisi replications after 20 minutes.

Lower fever
anti piretik: the setamol or salicylate 10 mg / kg bw / dose
compress ordinary water

Supportive Treatment
free airway
give oxygen

Assessment

The collection of data on cases of febrile seizures include:

Subjective Data
Bios / Identity
Biodata of children include the name, age, sex.
Biodata parents should be questioned to determine the social status of children include the name, age, religion, ethnicity / nation, education, occupation, income, address.

Hospital chart
History of present illness without convulsions asked: Is there really cramp?
It is expected that mothers or families who take recommended mimicking spastic movements of the child

Are accompanied by fever?
By knowing the presence or absence of fever accompanying the seizure, it is unknown whether infection plays a role of infection in the occurrence of seizures. The distance between the incidence of seizures with fever.

Lama attack
A mother whose child had seizures feel the time prolonged. Old seizures, we can determine the possibility of prognosis and response to treatment.

The pattern of attacks
Should be attempted in order to obtain a complete picture about whether the general pattern of attacks, focal, tonic, clonic?
Are attack without missing a moment of contraction of consciousness such as myoclonic epilepsy?
Whether such attacks for a moment lost muscle tone accompanied by disturbances of consciousness such as epilepsy akinetik?
Was the attack with head and body while his hands held flexi ride along the head, as in infantile spasms?
In simple febrile seizures are seizures are common.

Frequency of attacks
Are patients had seizures before, how old seizure occurred for the first time, and how the frequency of seizures per year. The less good prognosis if seizures occur the first time at a young age and frequent seizures arise.

State before, during and after attacks
Before the seizures need to be asked is there a certain aura or stimuli that can cause seizures, such as hunger, fatigue, vomiting, headache and others. Where the seizure started and how spreading. After the seizures need to be asked whether the patient immediately unconscious, asleep, decreased consciousness, there is paralise, crying and so forth?

History of present illness that accompanies
Is vomiting, diarrhea, truma head, stuttering speech (especially in people with epilepsy), kidney failure, heart abnormalities, DHF, ARI, OMA, morbili and others.

History advance disease
Before the patient experienced a seizure was asked whether the patient had experienced seizures before, what age when seizure occurred for the first time?
Is there a history of head trauma, meningitis, KP, OMA and others.

History of pregnancy and childbirth
Kedaan mothers during pregnancy by trimester, whether the mother had experienced an infection or fever during pregnancy. History of trauma, vaginal bleeding during pregnancy, the use of drugs or herbs during pregnancy. Asked whether the difficult history of labor, spontaneous or by action (forceps / vacuum), ante partum hemorrhage, asfiksi and others. The situation during the neonatal whether the baby fever, diarrhea, vomiting, do not want to suck, and convulsions.

Immunization history
This type of immunization has been established and that have not been asked and age of their immunizations and reactions from immunization. In general, after receiving DPT immunization side effect is the heat that can cause seizures.

Historical developments
Asked development capabilities include:
Personal social (personality / social behavior): associated with the ability to independently, socialize, and interact with their environment.
Fine motor movements: associated with children's ability to observe something, doing movements that involve certain body parts only and do small muscles and require careful coordination, such as drawing, holding an object, and others.
Gross motor movements: associated with movement and posture.
Language: ability to respond to the vote, followed orders and speak spontaneously.

Family health history.
Is there any family members who suffer from seizures (+ 25% of patients with febrile seizures have transcription factors)
Is there any family members who suffer from neurological diseases or other?
Is there any family members who suffer from diseases such as ARI, diarrhea or a contagious infectious disease that can trigger the occurrence of febrile seizures.

Social History
To determine the child's behavior and emotional state needs to be studied who yanh parenting?
What about relationships with family members and peers?

Habit patterns and health function
Asked circumstances before and during sick how?
Patterns and functions include:
Pattern perception and healthy living tatalaksanaan
Life style related to health, knowledge about health, prevention and treatment and adherence to any medical treatment?
How is the view of the illness, health services provided, the action for the family member is sick, the use of first aid medicines.

Nutrition patterns
To determine the intake of the nutritional needs of children. Asked how the quality and quantity of food consumed by children?

What foods you like and which not? How does a child's appetite? How many times drink, the type and amount per day?

The pattern of elimination
BAK: asked the frequency, amount, in a macroscopic asked how the color, odor, and whether there is blood? And asked if accompanied by pain when urinating child.
SECTION: Asked when the bowel movement, regular or not? How consistency is soft, hard, liquid or slimy?

The pattern of activity and exercise
Does the child enjoy playing alone or with their peers?
Gather with your family how many hours a day?
What activities are preferred?

The pattern of sleep / rest
How many hours a day sleeping?
Go to bed at what time?
Waking up at what time?
Habit before bedtime, how about a nap?

Objective Data
General Examination
The first time you look at the general state vital: the level of consciousness, blood pressure, pulse, respiration and temperature. In simple febrile seizures will get a high temperature while the consciousness after the seizure will be back to normal like before seizures without neurological abnormalities.

Physical examination
Head
Are there any signs of micro or makrosepali? Is there a dispersion shape of the head? What are the signs intrakarnial pressure rise, ie large convex crown, how the large fontanel closing or not?

Hair
Starting color, heaviness, distribution and other characteristics of hair. Patients with protein-energy malnutrition has a rare hair, reddish hair like corn and easily removed without causing pain to the patient.

Face / face
Facial paralysis causing facial asymmetry; side paresis left behind when the child was crying or laughing, making faces attracted to the healthy side. Is there any sign of rhisus sardonicus, opistotonus, trimus? Is there a cranial nerve disorder?

Eye
When a seizure occurs pupil dilation, to check that the pupil and visual acuity. Did the sclera, conjunctiva?

Ear
Check the function of the ear, ear cleaning as well as signs of infection such as swelling and tenderness in the area behind the ear, discharge from the ear, decreased hearing.

Nose
Is there a nostril breathing? Polyps that obstruct the airway? Whether out secretions, how consistency, the numbers?

Mouth
Are there signs sardonicus? Is there cynosis? How was the tongue? Is there stomatitis? How many teeth are growing? Is there dental caries?

Throat
Are there signs of inflammation of the tonsils? Are there signs of pharyngeal infection, fluid exudate?

Neck
Are there signs of a stiff neck, enlargement of the thyroid gland? Is there an enlarged vein jugulans?

Thorax
On infection, observe the chest form the client, how the breathing motion, frequency, rhythm, depth, there intercostale retraction? On auscultation, breath sound is there any extra?

Heart
What about the circumstances and frequency of the heart and its rhythm? Is there any extra noise? Is there bradicardi or tachycardia?

Abdomen
Is there distensia abdominal and abdominal muscle stiffness? How skin turgor and intestinal peristalsis? Is there any sign of meteorismus? Is there an enlarged spleen and liver?

Skin
How good state of cleanliness and skin color? Is there edema, hemangioma? How the state of skin turgor?

Extremity
Is there edema, or paralise especially after a seizure? How is the temperature in the area akral?

Genetalia
Is there any deformity edema, secretions from the vagina, the signs of infection?



Appears Possible Nursing Diagnosis

Risk of physical trauma associated with lack of muscle coordination / seizures

Hyperthermia associated with the infection process



Intervention

Nursing Diagnosis I:
Risk of physical trauma associated with lack of muscle coordination / seizures

Objective: Risk detection.

Criteria Results:

There were no physical trauma during treatment.
Maintain control measures seizure activity.
Identify actions that must be given when the seizures.
Knowledge of risk
Monitoring of environmental risk factors


Action Plan: NIC: Prevention of falls

Give a safety at the bedside and use of a low bed.
Rational: to minimize injury during seizures

Let's stay with the client during the phase of seizures ..
Rational: improving client security.

Give spatel tongue between the upper and lower teeth.
Rational: reducing the risk of trauma to the mouth.

Put in place a soft client.
Rational: to help reduce the risk of physical injury on ekstimitas when voluntary muscle control is reduced.

Record the type of seizures (location, duration) and frequency of seizures.
Rational: to help reduce the cerebral area of ​​disturbed locations.

Record vital signs after the seizure phase
Rational: early detection of abnormal conditions.



Nursing Diagnosis II:
Hyperthermia associated with the infection process

Objective: Thermoregulation

Criteria Results:

Body temperature within normal range
Nadi and RR within the normal range
No change in skin color and no headache


Action Plan: NIC: Fever Treatment

Kaji factors - factors of hiperthermi.
Rationale: Knowing the cause of the hiperthermi because the addition of clothing / blankets can inhibit the decrease in body temperature.

Observation sign - vital signs every 4 hours
Rationale: Regular monitoring of vital signs to determine the further development of nursing.

Maintain a normal body temperature
Rationale: The body temperature can be influenced by the level of activity, environmental temperature, humidity, heat or cold tinggiakan affect the body.

Teach the family gave a cold compress on the head / arm.
Rationale: The process of conduction / heat transfer by an intermediary material.

Suggest to use a thin shirt and made of cotton fabric
Rational: the process of heat loss will be impeded by heavy clothing and can not absorb sweat.

Set the room air circulation.
Rationale: The provision of clean air.

Give extra fluids to advise patients to drink a lot
Rationale: The need to increase because of evaporation of body fluids increases.

Limit your physical activity
Rational: activity increases metabolismedan increase the heat.

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