Febrile Seizure Nursing Care Planning and Management

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

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:

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 blood flow.

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.

Practice Quiz: Febrile Seizures


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1. A 2-year-old is to be admitted to the pediatric unit. He is diagnosed with febrile seizures. In preparing for his admission, which of the following is the most important nursing action?

A. Order a stat admission CBC.
B. Place a urine collection bag and specimen cup at the bedside.
C. Place a cooling mattress on his bed.
D. Pad the side rails of his bed.

1. Answer: D. Pad the side rails of his bed.

The child has a diagnosis of febrile seizures so precautions to prevent injury and promote safety should take precedence.

  • Options A and B: Preparing for routine laboratory studies is not as high a priority as preventing injury and promoting safety.
  • Option C: A cooling blanket must be ordered by the physician and is usually not used unless other methods for the reduction of fever have not been successful.

2. A 12-year-old boy was admitted in the hospital two days ago due to hyperthermia. His attending nurse, Dennis, is quite unsure about his plan of care. Which of the following nursing intervention should be included in the care of plan for the client?

A. Room temperature reduction.
B. Fluid restriction of 2,000 ml/day.
C. Axillary temperature measurements every 4 hours.
D. Antiemetic agent administration.

2. Answer: A. Room temperature reduction.

For a patient with hyperthermia, reducing the room temperature may help decrease the body temperature.

  • Option B: Fluids should be encouraged, not restricted to compensate for insensible losses.
  • Option C: Oral or rectal temperature measurements are generally accepted and are more accurate than axillary measurements.
  • Option D: Antipyretics, and not antiemetics, are indicated to reduce fever.

3. Nurse Ryan is aware that the best initial approach when trying to take a crying toddler’s temperature is:

A. Talk to the mother first and then to the toddler.
B. Bring extra help so it can be done quickly.
C. Encourage the mother to hold the child.
D. Ignore the crying and screaming.

3. Answer: A. Talk to the mother first and then to the toddler.

When dealing with a crying toddler, the best approach is to talk to the mother and ignore the toddler first.

  • Option B: Bringing more healthcare givers could only fuel the child’s fear.
  • Option C: Holding the child is correct, but talking to the mother first is essential.
  • Option D: Ignoring the crying and screaming would not help at all.

4. Janae has a febrile seizure; which of the following would be the lowest priority when caring for her?

A. Observing and taking down data on all seizures.
B. Assuring safety and protection from injuring.
C. Assessing for signs and symptoms of increased intracranial pressure (ICP).
D. Educating the family about anticonvulsant therapy.

4. Answer: C. Assessing for signs and symptoms of increased intracranial pressure (ICP).

Signs and symptoms of increased intracranial pressure (ICP) are not associated with seizure activity and therefore would be the lowest priority.

  • Option A: Careful observation and documentation of seizures provide valuable information to aid prevention and treatment.
  • Option B: Safety is always a priority in the care of a child with febrile seizures because seizures may occur at any given time.
  • Option D: Improper administration of and incomplete compliance with anticonvulsant therapy can lead to status epilepticus; thus education is a priority.

5. A nurse is giving discharge instructions to a client who will be taking phenobarbital (Luminal). The nurse would educate the client in which of the following that directly correlates with the safety of the client?

A. Take the medication at the same time each day.
B. Take the medication with meals only.
C. Avoid using sleep aids while taking the medication.
D. Decrease the dosage once with symptoms of dizziness and lightheadedness.

5. Answer: C. Avoid using sleep aids while taking the medication.

Phenobarbital (Luminal) is an anticonvulsant and hypnotic drug; the client should avoid the use of medicines that may cause drowsiness (eg, sleep aids, muscle relaxers).

  • Option A: Taking the medication at the same time daily improves compliance and maintains more stable blood levels of the medication.
  • Option B: The medication is taken without regard to meals.
  • Option D: Decreasing the dosage is not done without the approval of the physician.

See Also


Related topics to this study guide:

Further Reading


Recommended resources and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care