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FEBRILE SEIZURE
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Definition:Febrile seizure is associated
with high fever
(38.9 C 40.0 C). Seizures showan active tonic-clonic
pattern, which lasts for 15-20seconds.
It usually occur due to thesudden spike of
temperature.It happen most often when a
child develops a fever atnight, when a parent is not
aware of it.
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Febrile seizure are divided into 2 types:
Simple febrile seizures which are generalized,
last
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Pathophysiology:
Febrile seizures occur in young children at atime in their development when the seizure
threshold is low. This is a time when a youngchildren are susceptible to frequent
childhood infections such as upper
respiratory inf ection, otitis media, viral
syndrome, and they respond with
comparably higher temperature. Animalstudies suggest a possible role of endogenous
pyrogens such as interleukin 1beta, that by
increasing neuronal excitability, may link
fever and seizure activity.
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Diagnostic evaluation:
Physical examination with special attention
to neurologic status.
Cerebrospinal fluid examination Complete blood count and urinalysis
Cultures of nasopharynx , blood, or urine as
appropriate to determine cause of fever. Blood sugar, calcium and electrolyte levels.
EEG
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EEG, with or without video monitoring,
locates epileptic focus, spread, intensity,and duration, helps classify seizure type.
CT scanning or MRI identifies lesion that
may cause of seizure.
Single photon emission CT scanning(SPECT) or positron emission tomography
(PET) identifies seizure foci.
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Therapeutic Management:
Teach parents that, afterthe seizure subsides,they should sponge thechild with tepid water to
reduce the fever quickly.
Advice them not to putthe child in the bathtub,however, because itwould be easy for thechild to slip underwatershould a second seizure
occur.
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Applying alcohol or cold water is not
advisable.
Parents should not attempt to give oral
medications such as acetaminophen, because
the child will be in a drowsy, stare after theseizure and might aspirate the medicine.
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Advise parents to put a cool washcloth on the
childs forehead, axillary, and groin areas andtransport the child, lightly clothed, to a healthcare facility for immediate education.
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Do not try to restrain your child or try to stop
the seizure movements.
Focus your attention on bringing the fever
down.
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Teach the parents to loose any tight clothing,
especially around the neck. If possible, open
or remove clothes from the waist up.
Do not force anything into the babys mouth
to prevent him from biting the tongue, as thisincreases the risk of injury.
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Nursing Management:
Increase the childs fluidintake to prevent
dehydration.
Rationale:
Fever increases the childsfluid requirements by
increasing the
metabolic rate.
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Expose the skin to the air
by leaving the childlightly dressed in anabsorbent material.
Rationale:
Loss of heat from the skin
by radiation in the maintemperature regulatingmechanism available to
the infant or small child.
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Administer a tepid
sponge bath.
Rationale:The temperature is
lowered by evaporation
of water from the
surface of the skin.
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Administer antipyretic drugs.
Rationale:
Although effective in reducing fever,antipyretic drugs may obscure the clinical
picture and cause numerous side effects
including diaphoresis, skin eruptions,nausea, vomiting, hematologic changes
and fever.
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Use tub or a hypothermia blanket.
Rationale:
A tub bath is less frightening and is the preferredmethod for reducing fever if the child is able tocooperate.
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Medication:
Antipyretic drugs should be used in patientswho appear uncomfortable secondary to the
fever. Antipyretics do not appear to preventrecurrence of febrile seizures.
Acetaminophen (tylenol)
Reduces fever by acting directly on hypothalamic
heat-regulating centers, which increasesdissipation of body heat via vasodilation andsweating.
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Some children who have repeated episodes of
multiple febrile seizures are treated with
Phenobarbital or Dekote (Valproate) Other medications can be given at the time of a
febrile seizure. Diastat (diazepam) gel or liquid
diazepam can be given by rectum.
Klonopin (clonazepam) wafers can be placed on
the tongue or a tablet form of diazepam orlorazepam can be crushed and put between the
cheek of the gum.