NCP for Febrile Convulsions : Assessment and Nursing Diagnosis

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NCP for Febrile Convulsions : Assessment and Nursing Diagnosis


Nursing Care Plan for Febrile Convulsions


Definition

Febrile Seizures is an occurrence in infants or children who usually occurs between the ages of 3 months to 5 years was associated with fever but never proven the existence of intra-cranial infection or a particular cause . ( Consesnsus Statement On Febrile Siezures , 1980).



Classification

1. Simple febrile seizures :
  • Age 6 months to four years.
  • Long seizures are not more than 15 minutes.
  • Seizures are common.
  • Seizures occurred 16 hours after the onset of fever.
  • EEG normal one week after the seizure.
  • Neurological examination before and after abnormal spasm.
  • Seizure frequency generation in a single year is not more than four times.

2. Complex febrile seizures :
  • Seizure time more than 15 minutes.
  • Seizure frequency more than once in 24 hours.
  • Children have a neurological disorder or a history of febrile seizures before.
  • Seizure frequency generation in one year more than four times.

3. Epilepsy provoked by fever.
  • Is that not all febrile seizures above criteria.


Originator or Risk Factors :
  • High fever caused by upper respiratory tract infection, pneumonia, gastroenteritis and urinary tract infections.
  • History of febrile seizures in parents or siblings.
  • Developmental delay.
  • Problems in the newborn period.
  • Children in special care.
  • Children with low levels of Na.
  • Family history of epilepsy.


Pathophysiology

In a state of fever 1oC temperature rise will lead to increased basal metabolism 10-15 % and oxygen demand increased by 20%, resulting in a change in the balance of cell membranes of neurons and in a short time, diffusion of sodium and potassium ions through the membrane before, with the result of off an electric charge. Remove the charge is so large that it can spread throughout the cell and surrounding cell membrane with the aid of the so-called "neurotransmitters" and there was a seizure.


Differential diagnosis

  • Another cause febrile seizures should be removed, especially meningitis and encephalitis.
  • Children with high heat can arise delirium, chills and fever, cyanosis so as to resemble seizures.


Prognosis
Dependent factors :
  • A history of seizures without fever disease in the family.
  • Families with neurological disorders.
  • Prolonged seizures or convulsions locally.
If there are two of these three factors will then later on febrile seizures is approximately 13%.



Nursing Care Plan for Febrile Convulsions

Nursing Assessment

1. Client identity
  • Age is usually six months to four years, male gender women with a ratio of 2 : 1 , the highest incidence in children aged two years.
2. The main complaint
  • Seizures because of the fever.
3. History of present illness
  • Time of occurrence of seizures less than five minutes.
  • Seizures are general.
  • Seizures occurred within 16 hours after the onset of fever.
  • No neurological abnormalities both clinical and laboratory.
4. Past medical history
  • The presence of predisposing factors of febrile seizures among other head trauma, infection, and reactions to immunization.
5. Family history of disease
  • 25-50 % of febrile seizures have a heredity factor families affected by the presence of febrile seizures, neurological diseases or other diseases.
6. Previous history
  • History of pregnancy : maternal illness, bleeding, and medications used.
  • Labor History : spontaneous birth or by action, antepartum hemorrhage, premature rupture of membranes, Aspixia.


Activity Daily Live

1). Food or liquids
  • Patients will complain sensitive to foods that stimulate seizure activity, tooth decay, the presence of gingival hyperplasia , as a result of side effects of drugs.
2). Activity and Rest
  • Patients complain of fatigue, general weakness, limitation of activities and changes in muscle tone.
3). Elimination
  • Incontinensia
  • Ictal face : an increase in pressure and tone springter blader.
  • Post- ictal : muscle relaxation.

4). Psycho - social history
  • Psycho : anamnesis of the child's temperament, cognitive abilities, and the response of pain conditions as well as hospitalization.
  • Social : anamnesis the source of economic status and family, and the family response patterns of daily childcare.

Test and Diagnosis

1). Vital signs
  • Decreased awareness
  • Ictal phase : Increased pulse, respiration, blood pressure and temperature.
  • Post ictal : normal V5 sometimes depression.
2. Physical Examination
  • Head : head shape disproportion, generalized seizures, tonic clonic seizures and headaches.
  • Eyes : Dilated pupils, eye movements and rapid eyelid, and conjunctival reflexes down red light.
  • Mouth : Excessive production of saliva, vomiting and Cyanosis oral mucosa.
  • Nose : The existence nostril breathing, Cyanosis.
  • Neck : the tetanus occurs stiff neck.
  • Chest : Ictal phase : Cyanosis, decreased respiratory movement and the pull intercostae. Post ictal : Apnoe or breath deep and slow.
  • Abdomen : Ictal phase : Improved muscle tone blader and spingter. Post ictal : relaxation and hyper peristaltic muscles.
  • Extremities : Ictal phase : spasms in upper and lower extremities and cyanosis of the fingers and toes. Post ictal : muscle relaxation and pain and weakness in the muscles.
3. General examination
  • Electrolytes : Electrolyte imbalance predispose to seizures.
  • Glucose : Hypoglycemia predispose to seizures.
  • BUN : Increased BUN is a potential seizure.
  • CBC : Aplastic Anemia can occur as a side effect of drug administration.
  • LP : to detect the presence of abnormal pressure and signs of infection.
  • Skull X - ray : the existence of space and lesions persisted.
  • EEG : The focus of seizure activity.
  • CT scan : Local cerebral abscess detect tumor lesions with or without contrast.


Nursing Diagnosis for Febrile Convulsions

1. Increased body temperature relation : the presence of pyrogens which disrupt the thermostat, the average increase in metabolism and disease dehydration.
2. Risk for Ineffective airway clearance related to neuromuscular damage and obstruction tracheo - broncial.
3. Knowledge Deficit : family related to misinterpretation and lack of information.
4. Self-concept Disturbance (low self esteem) related to epilepsy and wrong perceptions and uncontrolled.

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