Febrile Seizure

INTRODUCTION

The immune system is responsible for knowing the difference between normal bodily substances and foreign ones, as well as protecting the body from infections and foreign substances. Different immune response can be perceived if an opportunistic microorganism is introduced in the body. One common response of the body seen in children from infection is fever. It is a physiologic response of the body that accompany childhood illnesses, especially infections.

Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Less commonly, the child becomes rigid or has twitches in only a portion of the body, such as an arm or a leg, or on the right or the left side only. Most febrile seizures last a minute or two, although some can be as brief as a few seconds while others last for more than 15 minutes. The latter is called complex febrile seizure.

Febrile seizures usually occur in children between the ages of five months and five years and are particularly common in toddlers. Children rarely develop their first febrile seizure before the age of six months or after three years of age. The older a child is when the first febrile seizure occurs, the less likely that child is to have more.

Several factors can contribute to febrile convulsion. Before 5 years of age, the child has not yet fully developed his/her hypothalamic control centre therefore temperature can easily fluctuate. Family history of this particular seizure can also contribute in developing benign febrile convulsion. Infection can be another causative factor in the occurrence of febrile seizure.

This case study features Patient N, 1 year old, lives in 348 Cristobal St., Sampaloc, Manila, was admitted last August 30, 2010, with an admitting diagnosis at Ospital ng Sampaloc of Complex Febrile Seizure without CNS infection.

The researcher has chosen this condition for it is an illness among children. She will be able to provide information from her previous studies regarding of the said illness. In this way, she will be able to demonstrate different management provided and enhance her skills and knowledge as a student nurse for future use.

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OBJECTIVES

A. General Objective

This aims to distinguish and verify the general heath problems and needs of the patient with an admitting diagnosis of Complex Febrile Seizure without CNS infection. This will help enhance the knowledge and skills of the researcher and relate to Pediatric Nursing concepts to her actual related learning experience as a student nurse. This will help the patient know importance of health and its medical understanding of the said condition through the application of nursing skills.

B. Specific Objective

1. To gather pertinent and comprehensive data through interview and medical chart.

2. To perform physical assessment in a head-to-toe approach.

3. To have a review of the anatomy and physiology of the systems affected.

4. To trace the pathophysiology of complex febrile seizure.

5. To determine and understand the different medical and nursing management employed.

6. To interpret the results of the laboratory and diagnostic procedures.

7. To study the drugs prescribed to the patient and its effects to her current condition.

8. To formulate and apply nursing care plan utilizing the nursing process.

9. To learn new clinical skills required in the management of the patient who had suffered

complex febrile seizure.

10. To render nursing care and information through the application of the nursing skills

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NURSING HISTORY

A. Initial Data

Date of Admission: August 30, 2010

Ward: Pediatric Ward

Admitting Diagnosis: Complex Febrile Seizure without CNS infection

B. Demographic Data

Patient Name: Toddler N

Address: 348 Cristobal St., Sampaloc, Manila

Date of Birth: March 18, 2009

Age: 1 year old and 4 months

Gender: Female

Weight: 10 kg

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Source of Data/Information: Patient’s mother

C. Chief Complaint

“Nilagnat siya at nagkaconvulsion” as verbalized by the client’s mother.

D. History of Present Illness

10 days prior to admission, Patient N had episodes of cough and colds. Her mother continues to

breastfeed Baby N.

7 days prior to admission, Patient N does not have a cough anymore but she still has common

colds.

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1 day prior to admission, Patient N is in a febrile state. The temperature was 37.9oC. She showed

signs of irritability and crying. Baby N’s mother gave Tempra syrup to alleviate her fever.

6 hours prior to admission, Patient N appears to still have fever, common colds, and difficulty of

breathing. Patient N’s mother applied tepid sponge bath to decrease Toddler N’s temperature of

38.5oC.

5 hours prior to admission, Patient N’s temperature didn’t lessen.

1 hour prior to admission, Patient N experienced convulsion and difficulty of breathing.

Upon admission, Patient N was irritable and experienced 2x seizure at the Emergency Room of

Ospital ng Sampaloc. She was given O2 therapy via face mask to lessen her difficulty of

breathing. Vital signs were taken with a respiratory rate of 44 breaths per minute, heart rate of

137 beats per minute, and a temperature of 39.7oC. She was later admitted of complex febrile

seizure without CNS infection.

E. Past Health and Medical History

1. Immunization

The client had complete immunizations of BCG, DPT, Hepatitis B, Oral Polio and Anti-Measles Vaccine.

2. Allergies

The patient has no allergies to food or non-food protein allergens.

3. Illnesses

The patient had a history of neonatal sepsis and pneumonia when she was 2 weeks old.

4. Injuries/Accidents

On July 2010, the patient’s mother stated that Patient N has fallen from a 2 ½ feet height table.

5. Hospitalizations

As stated by the patient’s mother, Toddler N had a history of hospitalization at Jose R. Reyes Memorial Medical Center last March 2009 with an admitting diagnosis of Neonatal Sepsis

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LEGEND:

Hypertension

Neonatal Sepsis

Neonatal Pneumonia

Asthma Identified Patient

Female Male

and Pneumonia when she was 2 weeks old. The patient stayed 1 week long for treatment at the hospital.

F. Family Medical History

Patient’s mother has a family history of hypertension, and asthma while patient’s father has a family history of hypertension.

Family Genogram

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G. Psychosocial History

Patient N’s father is both a smoker and an alcohol drinker. According to the patient’s mother, they live cohabitually with her mother-in-law in Sampaloc, Manila. The type of housing they lived in is made of mixed materials: cement and wood. The environment they live in is clean, and peaceful. They have a harmonious relationship with their neighbours. They have a good and clean housing condition with an adequate electricity and water supply.

H. Health Maintenance Activities

1. Sleep – According to the patient’s mother, Toddler N sleeps at least 14-16 hours a day.

2. Diet – The patient’s mother continues to breastfeed Toddler N at least 4-6 times a day.

The patient’s food intake is approximately 5-6 tablespoon per meal. Usually, Toddler N

eats rice porridge. They normally eat three times a day.

3. Elimination – Toddler N usually consumes 3 fully used diapers per day. The diaper

weighs approximately 20-30 grams. She defecates at least twice a day. The stool is

watery and yellowish brown in color.

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REVIEW OF SYSTEMS

General: According to the mother, Toddler N is irritable, restless, and cries often upon staying at the

hospital for 1 day.

Integumentary: Toddler N’s skin color is light brown. According to the patient’s mother, Toddler N has

rashes along her extremities and body, both posterior and anterior, upon staying in the hospital for 1

day.

Eyes/Ears/Nose/Mouth/Throat: According to the mother, the patient has no pus or redness seen in the

eyes. There is no problem in getting the child’s attention upon calling her name. Toddler N has clear,

watery secretions seen in her nose.

Cardiovascular: Toddler N, according to the mother, has no previous heart problem.

Respiratory: Toddler N, according to the mother, appears to have difficulty in breathing during

convulsion but without the active seizure, the client has no problem breathing.

Gastrointestinal: The patient’s mother feeds Toddler N through breastfeeding 4-6 times per day and

intake of solid foods, usually rice porridge. The patient doesn’t experience vomiting. Toddler N has an

increased bowel movement at least four times upon staying in the hospital for 1 day. According to the

mother, Toddler N normally defecates twice a day. The patient’s mother has observed that the stool of

Toddler N is watery and yellowish brown in color.

Genitourinary: According to Toddler N’s mother, the patient consumes at least 3 fully used diapers per

day. The diaper normally weighs 20-30 grams per day. The urine is clear and light yellow in color.

Musculoskeletal: Toddler N has no weakness and limitation in movement in her extremities. There was

no swelling, wounds, or injuries observed by her mother on the patient’s joints and muscles.

Neurologic: The patient is awake and appears alert upon getting her attention according to the mother.

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PHYSICAL ASSESSMENT

General Appearance

Toddler N has a weight of 10 kg. The patient is clean and does not have any offensive odor.

Toddler N is irritable, restless, and cries frequently during her stay in the hospital for 1 day.

Vital Signs

Vital signs were taken with a respiratory rate of 39 breaths per minute, heart rate of 137 beats

per minute, and a temperature of 37.1oC upon assessment.

Skin, Hair, and Nails

Toddler N has a uniform light brown skin. She does not have edema, lesions, or nodules present

on her skin. There are rashes present in her upper extremities and body, both posterior and anterior.

When the skin is pinched, it goes back less than one second. Hair is evenly distributed and does not have

any scalp problem or parasites seen. Her nail convex curvature is in approximate angle of 160 o. The

blanch test has more than 3 seconds return of pink color on her nails.

Skull and Face

Toddler N is normocephalic and has a smooth contour upon palpation. She has symmetric facial

appearance. There were no masses, lesions, nodules, and tenderness present.

Eyes

Toddler N has evenly distributed eyebrows. She can easily close her eyelids. Eyeballs are

symmetrical and the sclera is white. The pupils are equally round, reactive to light and accommodation.

Both palpebral and bulbar conjunctiva is pink in color. No pus, inflammation, or infection seen.

Ears

Both ears are symmetrical. No tenderness or infection present in Toddler N’s ears.

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Nose and Sinuses

Toddler N has a clear, watery discharge seen in her nose. No lesions and tenderness is seen in

the nose. No obstruction is seen in her nose upon inspection. Nasal septum is in the midline. No

tenderness in the sinuses is palpated on her nose.

Mouth and Oropharynx

Toddler N’s oral mucosa is uniformly pink. No inflammation, tenderness, lesions seen.

Neck

No palpable lymph nodes felt. Toddler N’s neck muscles are symmetrical in movement. She

demonstrates a complete head control.

Chest and Lungs

The chest expansion is symmetrical. Toddler N’s spine is vertically aligned. Respiratory rate,

upon assessment, is 39 breaths per minute. No adventitious breath sounds are heard. There is absence

of intercostal retraction.

Cardiovascular and Peripheral Vascular System

Heart rate is 137 beats per minute. S1 and S2 sound are present and no murmurs are heard.

Capillary refill test reveals a slow return of blood when pinched.

Abdomen

Toddler N shows a smooth contour and uniformity in color in the abdomen. The bowel sounds

are heard. When palpated, she doesn’t have any tenderness.

Breast and Axillae

Toddler N has a symmetrical and smooth contour of her breast. There were no masses, nodules,

and lesions seen.

Musculoskeletal System

Both extremities of Toddler N are in equal size. There were no lesions, contractures, and

tenderness seen upon inspection.

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Neurologic System

Toddler N is responsive to touch, sound, and light. She exhibits blink and pupillary reflex.

Genitals and Inguinal Area

Toddler N’s genital has an intact skin. It appears to have no swelling, infection, or discharges. No

nodules and masses are palpated in the inguinal area.

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REVIEW OF ANATOMY AND PHYSIOLOGY

Temperature control in children is not completed until approximately five years of age. This may

be due to the immaturity of the nervous system. The maintenance of body temperature is mainly

coordinated by the hypothalamus, a central control center containing large numbers of heat-sensitive

neurons called thermoreceptors. It is an important homeostatic mechanism which allows the body

enzymes to work efficiently within a narrow range of 36.5–37.5 ºC. In response to a change in

temperature, the peripheral thermoreceptors transmit signals to the hypothalamus, where they are

integrated with the receptor signals from the preoptic area of the brain.

The ‘normal set point’ in childhood reflects a decreasing basic metabolic rate (BMR) as the child

grows. The body temperature of the three-month-old child is 37.5 ºC, whereas at thirteen years it is 36.6

ºC. Even as the temperature regulatory mechanisms mature through childhood, babies and small

children are highly susceptible to temperature fluctuations, as they produce more heat per kilogram of

body weight than older children. Changes in environmental temperature, increased activity, crying,

emotional upset and infections all cause a higher and more rapid increase in the younger child. The

younger the child the less able he or she is to vocalize the feeling of hot or cold or to do something

about it. All children may also become too cold. Small individuals who do not have warm clothes and

warm homes will not grow if the temperature of their environment is consistently low. They will use

much of the energy from their food intake to generate heat (metabolic rate) and leave no spare calories

for tissue growth. The smaller the child, the larger the surface area for heat loss in relation to body

mass. The head of a small child is relatively larger in proportion to the rest of the body, and covering the

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head in a cold environment conserves heat for growth. Schoolchildren may experience a sequence of

small growth spurts and at times be relatively thin with minimal body fat. At the swimming pool, for

example, where children enjoy jumping in and out of the water as they play, thin children may become

cold more quickly than their fatter friends who have an insulation layer beneath their skin.

Heat can generated through the metabolism of the liver, muscles, and other chemical activities.

When children are exposed in a cold environment, it can result to hypoglycemia, elevated serum

bilirubin, metabolic acidosis, and increased metabolic rate. When heat loss occurred, non-shivering

thermogenesis (NST) heat production takes place in the subcutaneous tissue, hypothalamus, and spinal

cord to compensate for the sudden change in temperature.

Heat loss transpires through the contact in a cold environment, vasodilation, sweating where

the preoptic area of the brain stimulates secretion of water to the skin for evaporation. There are

different areas in the body where we can measure the temperature such as axillae, tympanic

membrane, and mouth.

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PATHOPHYSIOLOGY

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Non-Modifiable Factors: Underdeveloped hypothalamic

control centre Family history of febrile

convulsion Infection

Modifiable Factors:

Hygiene Diet Environment

Immune response

Endogenous pyrogens

Production of pro-inflammatory cytokines, such as interleukins 1β (IL-1β) and 6 (IL-6), interferon (INF)-α, and

WBC

Hypothalamic circulation

Mucus production

Release of prostaglandin E2

Anterior hypothalamus

Elevated thermoregulatory set-

point

Heat production

Heat conservation

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Fluid conservation

Urine output

Vasoconstriction

Cerebral perfusion

Irritable and restless

Metabolism of the liver

Glucose breakdown

Muscle contraction

Fever

Energy demand

Immature hypothalamic control

Temperature fluctuates to >39 ºC

Neuronal excitability Bronchospasm

Difficulty of breathing

RR

Febrile seizure

LABORATORY AND DIAGNOSTIC PROCEDURES

Hematology Report: August 30, 2010

NORMAL VALUES ACTUAL RESULT

Hemoglobin Male: 14-16 g/dlFemale: 12-14 g/dl

10.2 g/dl

Hematocrit Male: 0.40-0.57Female: 0.37-0.47

0.38

WBC count 4.80-10.80 18

Segmenters 60-70% 60%

Lymphocyte 30-40% 39%

Eosinophil 1-3% 1%

Platelet 130-400 256

Interpretation:

There is a decrease in haemoglobin and an elevated white blood cell count. Other blood

components are within the normal level.

Analysis:

A decrease in hemoglobin is physiologically low normal because of the increasing demands of

the body for iron. An evident increased in white blood cell count indicates that a bacterial infection is

present.

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MEDICAL-SURGICAL MANAGEMENT

Medical Management:

1. Administration of due medications as ordered by the physician.

The following medications are:

Cefuroxime, an anti-infective, cephalosporin – 0.33 g, IV, q8h

Salbutamol, a bronchodilator, sympathomimetics – 1 nebule (1cc + 1cc NSS),

inhalation, q6h

Paracetamol, an antipyretic, nonsteroidal anti-inflammatory drug – 1.2 ml in a

100g/1ml, PO, PRN

Diazepam, an anticonvulsant, benzodiazepine – 2 g, IV, for active seizure

Chloramphenicol, anti-infective – 125 mg, IV, q6h

2. Intravenous Replacement Therapy

IV replacement therapy is the fastest way of replacing fluid loss and electrolyte

imbalances. It can also be used to keep the vein open for the administration of medications.

The following IV solutions administered:

D5 0.3 NaCl, a hypotonic solution, 500 cc x 8° - causes cell shrinkage therefore

reducing body heat.

D5 IMB, a hypertonic solution, 1 L at 41 cc/hr – for cell rehydration.

3. Oxygen Therapy

Oxygen therapy is used during emergency medical services. It is for the difficulty of

breathing during active convulsion. Oxygen inhalation at 2-3 L was given via face mask.

4. Laboratory and Diagnostic Procedures

August 30, 2010

Complete Blood Count – It is used as a broad screening test to check for such disorders

as anemia, infection, and many other diseases. This evaluates the three types of cells in

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the blood which are red blood cells, white blood cell, and platelets. This provides an

overview of the general health of the patient.

Nursing Management:

Vital signs monitoring every 1 hour

Input and Output of Fluid Measurement

Administer medication due as ordered by the physician

Patient, a toddler, has developed a stranger anxiety as manifested by “white coat

syndrome.” A nursing intervention would be is to establish rapport by playing with the

patient.

Encourage the mother to increase and continue breastfeeding for faster recovery of the

patient.

Provide opportunity for the patient to rest from time to time.

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DRUG STUDY

CLASSIFICATION DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS

Cephalosporins Parenteral (IV)

Dosage: 0.33 g

*q8h – 12am, 8am, 4pm

Cephalosporin inhibits bacterialwall synthesis,rendering cell wallosmoticallyunstable, leadingto cell death bybinding to cell wallmembrane.

Treatment of infection

Nausea and vomiting, diarrhea, nephrotoxicity,bone marrow depression, rashes, fever, urticuria

Check for signs and symptoms of superinfection

Assess for anaphylaxis:rashes, urticaria,chills, fever,dyspnea

Monitor the urine output, bowel movement, and for bleeding.

Generic Name: Cefuroxime

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Generic Name: Salbutamol

CLASSIFICATION DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS

Sympathomimetics, Bronchodilator

Inhalation

Dosage: 1 nebule (1cc + 1cc NSS)

*q6h – 12am, 6am, 12pm, 6pm

Salbutamol is a direct-acting sympathomimetic with selective action on β2 receptors, producing bronchodilating effects.

To relieve bronchospasm associated with active convulsion

Tachycardia, tremors, palpitation, paradoxical bronchospasm, hypotension

Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 60–90 min after drug administration.

Monitor signs and symptoms of fine tremor in fingers; CNS stimulation, particularly in children 2–6 y, (hyperactivity, excitement, nervousness, insomnia), tachycardia, GI symptoms. Report promptly to physician.

Lab tests: Periodic ABGs, pulmonary functions, and pulse oximetry.

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Generic Name: Diazepam

CLASSIFICATION DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS

Benzodiazepines, Anticonvulsant

Parenteral (IV)

Dosage: 2 g

*For active seizure

Diazepam is a long-acting benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.

Adjunct management of seizure

Hypotension, muscle weakness, respiratory depression, tachycardia, incontinence, constipation

Monitor for adverse reactions. Most are dose related. Physician will rely on accurate observation and reports of patient response to the drug to determine lowest effective maintenance dose.

Monitor I&O ratio, including urinary and bowel elimination.

Observe patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression may occur.

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Generic Name: Paracetamol

CLASSIFICATION DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS SIDE EFFECTS

NURSING CONSIDERATIONS

Nonsteroidal anti-inflammatory drugs,

Anti-pyretic

PO

Dosage: 1.2 ml in a 100g/1ml

*PRN, for temperature more than 37.8oC

Paracetamol produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.

To alleviate fever

Nausea, allergic reactions, skin rashes, liver damage

Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days.

Advise patient or caregiver that many over the counter products contain acetaminophen; be aware of this when calculating total daily dose.

Warn patient’s mother that high doses or unsupervised long term use can cause liver damage.

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Generic Name: Chloramphenicol

CLASSIFICATION DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS

Anti-infective drugs Parenteral (IV)

Dosage: 125 mg

*q6h – 12am, 6am, 12pm, 6pm

Chloramphenicol inhibits bacterial protein synthesis by binding to 50s subunit of the bacterial ribosome, thus preventing peptide bond formation by peptidyl transferase. It has both bacteriostatic and bactericidal action against H. influenzae, N. meningitidis and S. pneumonia.

Treatment of infection

Bleeding, visual impairment, confusion, rashes, fever, bone marrow suppression

Monitorhematologicdata carefully, especially withlong-termtherapy by anyroute ofadministration.

Do not givethis drug IMbecause it isineffective.

Check for signs and symptoms of superinfection.

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NURSING CARE PLAN

CUES NURSING DIAGNOSIS

INFERENCE GOALS NURSINGINTERVENTIONS

RATIONALE EVALUATION

Objective: Recurrent seizure of more than 15 mins.

Risk for injury related to neuromuscular dysfunction

Endogenouspyrogens

Immune response

Release of chemical

mediators

Fever greater than 39 oC

Neuronal excitability

Febrile seizures

Impaired coordination of

movement

Risk for injury

Within 8 hours of nursing intervention, the client will be free of injury as manifested by:

Intact skin

No pain, bruises, or fractures present

No limitation in movement

Independent: Raise the side rails always

Maintain bed in lowest position with wheels locked

Monitor environment for potentially unsafe conditions and modify as needed

Encourage bed rest.

Ensure that the floor is unobstructed and properly lighted

To avoid injuries.

To promote client safety

To promote safe and physical environment and individual safety

To prevent fatigue and promote healing.

To prevent errors resulting in client injury

Goal was met after 8 hours of nursing intervention as manifested by:

Intact skin

No pain, bruises, or fractures present

Able to move freely

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CUES NURSING DIAGNOSIS

INFERENCE GOALS NURSINGINTERVENTIONS

RATIONALE EVALUATION

Objective: Recurrent seizure of more than 15 mins.

Risk for aspiration related to bronchospasm

Endogenouspyrogens

Immune response

Release of chemical

mediators

Fever greater than 39 oC

Neuronal excitability

Febrile seizures

Bronchospasm

Risk for aspiration

Within 8 hours of nursing intervention, the client will experience no aspiration as manifested by:

Noiseless respirations

Clear breath sounds

Clear, odourless secretions

Independent: Elevate client to highest or best possible position for eating and drinking

Provide soft foods

Offer very warm or very cold liquids

Determine best resting position with the head of bed elevated at 30o angle

To reduce risk for aspiration

To aid in swallowing effort

Activates temperature receptors in the mouth that help stimulate swallowing

Upper airway patency is facilitated by upright position

Goal was met after 8 hours of nursing intervention as manifested by:

Noiseless respirations

Clear breath sounds

Clear, odourless secretions

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CUES NURSING DIAGNOSIS

INFERENCE GOALS NURSINGINTERVENTIONS

RATIONALE EVALUATION

Objective: Difficulty of breathing during active convulsion

RR=39 cpm

Ineffective airway clearance related to neuromuscular dysfunction

Endogenouspyrogens

Immune response

Release of chemical

mediators

Fever greater than 39 oC

Neuronal excitability

Febrile seizures

Bronchospasm

Ineffective airway clearance

Within 8 hours of nursing intervention, the client will be able to maintain airway patency as manifested by:

Decrease RR=39 cpm to 36cpm

Improve clear airway

Absence of strenuous breathing during active convulsion

Independent: Monitor child for feeding intolerance, abdominal distention, and emotional stressors

Position patient on high back rest

Prepare emergency kit especially for oxygen therapy

Keep environment allergen free

To determine if airway is compromised

Upper airway patency is facilitated by upright position

To maintain adequate airway during active convulsion

To clear open airway

Goal was met after 8 hours of nursing intervention as manifested by:

Decrease RR=39 cpm to 36cpm

Improve clear airway

Absence of strenuous breathing during active convulsion

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DISCHARGE PLAN

Medications

Instruct and explain to the mother that the medication, especially the antibiotics, is important to

continue depending on the duration that the doctor ordered for the total recovery of the

patient.

Inform the mother of the side and adverse effects of the drugs she is giving to her daughter.

Instruct to report immediately any side or adverse effects when taking the prescribed drug such

as nausea, vomiting, diarrhea, rashes.

Take the entire course of any prescribed medications. After a patient’s temperature returns to

normal, paracetamol is administered if fever occurs. Avoid using paracetamol more than 5 days.

Instruct the mother to avoid over-the-counter drugs without the consultation of the physician to

avoid any drug-drug interaction.

Exercise

Encourage the mother to have her daughter rest from time to time for faster recovery.

Treatment

Comply with the established treatment regimen given by the doctors including prescribed

medications.

Encourage the mother to expose the patient to early morning sunlight

Advise the mother to provide tepid sponge bath when fever occurs

Provide oxygen therapy during active convulsion to alleviate the difficulty of breathing.

Hygiene

Encourage and explain to the mother that it is vital to maintain proper hygiene by frequently

washing her hands.

Out-patient

It’s important for the toddler to have her follow-up check up to ensure and have the patient’s

progress monitored.

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Diet

Encourage the mother to continue breastfeeding the patient. Instruct the mother that the head

must be in upright position when breastfeeding to avoid aspiration and let the baby burp after

feeding.

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