FEBRILE SEIZURE

Febrile seizures can be frightening for parents though brief febrile seizures do
not cause any long-term health problems.

Contents [hide]
 1 Description
 2 Types
 3 Pathophysiology
 4 Statistics and Incidences
 5 Clinical Manifestations
 6 Assessment and Diagnostic Findings
 7 Medical Management
o 7.1 Pharmacologic Therapy
 8 Nursing Management
o 8.1 Nursing Assessment
o 8.2 Nursing Diagnoses
o 8.3 Nursing Care Planning and Goals
o 8.4 Nursing Interventions
o 8.5 Evaluation
o 8.6 Documentation Guidelines
 9 Practice Quiz: Febrile Seizures
 10 See Also
 11 Further Reading

Description

Pediatric febrile seizures, which represent the most common

childhood seizure disorder, exist only in association with an elevated
temperature.

 Febrile seizures are seizures or convulsions that occur in young

children and are triggered by fever.
  Young children between the ages of about 6 months to 5 years old
are the most likely to experience febrile seizures; this risk peaks
during the second year of life.
 Evidence suggests, however, that they have little connection with
cognitive function, so the prognosis for a normal neurologic function
is excellent in children with febrile seizures.

Types

Epidemiologic studies have led to the division of febrile seizures into 3

groups, as follows:

 Simple febrile seizure. The setting is fever in a child aged 6

months to 5 years; the single seizure is generalized and lasts less
than 15 minutes; the child is otherwise neurologically healthy and
without neurologic abnormality by examination or by developmental
history; fever (and seizure) is not caused
by meningitis, encephalitis, or any other illness affecting the brain;
the seizure is described as either a generalized clonic or a
generalized tonic-clonic seizure.
 Complex, febrile seizure. In complex, febrile seizure, age,
neurologic status before the illness, and fever are the same as for
simple febrile seizure; this seizure is either focal or prolonged (ie,
>15 min), or multiple seizures occur in close succession.
 Symptomatic, febrile seizure. In symptomatic febrile seizure, age
and fever are the same as for simple febrile seizure and the child
has a preexisting neurologic abnormality or acute illness.

Pathophysiology

The pathophysiology remains unknown, but there are theories surrounding

its cause.
  This is a unique form of epilepsy that occurs in early childhood and
only in association with an elevation of temperature.
 The underlying pathophysiology is unknown, but genetic
predisposition clearly contributes to the occurrence of this disorder.
 The rate of body temperature rise as a cause is a frequently held
theory, but this is unsupported by more recent laboratory and
clinical studies.
 A specific neurotropism or CNS-invasive property of certain viruses
(e.g., human herpesvirus-6 [HHV-6], influenza A), and bacterial
neurotoxin (Shigella dysenteriae) has been implicated, but the
evidence is inconclusive.

Statistics and Incidences

Febrile seizures are occurring all over the world in children of all ages.

 Febrile seizures occur in 2-5% of children aged 6 months to 5 years

in industrialized countries.
 Among children with febrile seizures, about 70-75% have only
simple febrile seizures, another 20-25% have complex febrile
seizures, and about 5% have symptomatic febrile seizures.
 Children with a previous simple febrile seizure are at increased risk
of recurrent febrile seizures; this occurs in approximately one-third
of cases.
 Children younger than 12 months at the time of their first simple
febrile seizure have a 50% probability of having a second seizure.
After 12 months, the probability decreases to 30%.
 Children who have simple febrile seizures are at an increased risk
for epilepsy. The rate of epilepsy by age 25 years is approximately
2.4%, which is about twice the risk in the general population.
 The literature does not support the hypothesis that simple febrile
seizures lower intelligence (ie, cause a learning disability) or are
associated with increased mortality.
 Males have a slightly (but definite) higher incidence of febrile
seizures.
  Simple febrile seizures occur most commonly in children aged 6
months to 5 years.

Clinical Manifestations

Children with febrile seizure exhibits the following:

 Generally healthy child. Children with simple febrile seizures are

neurologically and developmentally healthy before and after the
seizure.
 Seizures. They do not experience a seizure in the absence of fever;
the seizure is described as either a generalized clonic or a
generalized tonic-clonic seizure.
 Occurrence of less than 15 minutes. Febrile seizure activity does
not continue for more than 15 minutes, although a postictal period
of sleepiness or confusion can extend beyond the 15-minute
maximum.

Assessment and Diagnostic Findings

No specific studies are indicated for a simple febrile seizure.

 The focus. Physicians should focus on diagnosing the cause of

fever.
 Underlying conditions. Other laboratory tests may be indicated by
the nature of the underlying febrile illness; for example, a child with
severe diarrhea may benefit from blood studies for electrolytes.

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.
 Antipyretics. Although it does not prevent simple febrile seizures,
antipyretic therapy is desirable for other reasons, for instance,
comfort.

Nursing Management

Nursing care for a patient with febrile seizure include the following:

Nursing Assessment

Assessment is necessary in order to identify potential problems that may

have lead to the condition as well as name any episode that may occur
during nursing care.

 Identify underlying cause. Identify the triggering factors;

determination and management of the underlying cause are
necessary to recovery.
 Assess patient’s vital signs. Monitor the patient’s HR, BP, and
especially the tympanic or rectal temperature.
 Assess age and weight. Extremes of age or weight increase the
risk for the inability to control body temperature.
 Assess I&O status. Monitor fluid intake and urine output; fluid
resuscitation may be required to correct dehydration.
Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses are:

 Hyperthermia related to antigens or microorganisms that cause

inflammation.
 Imbalanced nutrition related to an inability to meet the body’s
daily energy needs.
 Ineffective tissue perfusion related to failure to nourish the
tissues at the capillary level.

Nursing Care Planning and Goals

The goals for a patient with febrile seizure are:

 Patient’s temperature will decrease from [39°C] to normal range of

[36.5°C to 37°C].
 Patient will be free of complications and maintain normal core
temperature.
 Patient will identify measures to promote nutrition and follow the
treatment regimen.
 Patient weight will be within normal values.
 Patient will demonstrate behavior lifestyle changes to improve
circulation.
 Patient’s S.O. will verbalize understanding of the condition.

Nursing Interventions

Nursing interventions appropriate for the patient are:

 Check underlying factors. Assess underlying condition and body

temperature.
 Monitor vital signs. Monitor and record vital signs.
 Provide cold compresses. Provide a description of the family
regarding the provision of compress; cold compresses can reduce
body temperature.
  Wear light clothing. Give light clothing that can absorb sweat to
facilitate the release of heat into the air.
 Regulate activity. Promote adequate rest periods to reduce
metabolic demands or oxygen.
 Increase fluid intake. Advice to increase fluid intake to help
decrease body temperature.
 Discuss diet. Discuss eating habits and encourage diet for age to
achieve health needs of the patient with the proper food diet for his
disease.
 Improve tissue perfusion. Elevate head of bed at night to
increase gravitational bloodflow.

Evaluation

Goals for the patient are achieved as evidenced by:

 Patient’s temperature decreased from [39°C] to normal range of

[36.5°C to 37°C].
 Patient is free of complications and maintain normal core
temperature.
 Patient identified measures to promote nutrition and follow the
treatment regimen.
 Patient’s weight is within normal values.
 Patient demonstrated behavior lifestyle changes to improve
circulation.
 Patient’s S.O. verbalized understanding of the condition.

Documentation Guidelines

Documentation for a patient with febrile seizure include:

 Individual findings, including factors affecting, interactions, nature

of social exchanges, specifics of individual behavior.
 Cultural and religious beliefs, and expectations.
 Plan of care.
 Teaching plan.
 Responses to interventions, teaching, and actions performed.
 Attainment or progress toward desired outcome.