Febrile seizures are uncontrollable electrical activity that disrupts the normal functioning of neurons due to increased body temperature instead of underlying health issues associated with epilepsy. Temperature above 38.4 increases the risk of experiencing a febrile seizure. Wong (1995) states that it is the rising of the temperature that causes the seizure rather than experiencing prolonged increased temperatures. It occurs commonly under the age of 5 years. The type of seizure that can be induced from high fever is a tonic clonic seizure. Simple seizures usually last up to 15 minutes and complex seizures last longer than 15 minutes (National Institute of Neurological Disorders and Stroke, 2015). Febrile seizures are commonly caused by fevers associated with infection. Viral infections more commonly cause febrile seizures than bacterial infections. The pertussis vaccine has been implicated in initial episode of febrile seizures in children whom already have a high risk of developing them. A child who experiences febrile seizures will not necessarily develop epilepsy nor will they necessarily experience long-term permanent damage. 98% of children who have febrile seizures do not receive neurological damage (Wong, 1995).
When a child experiences a febrile seizure, the nurse would expect a high temperature, usually above 38 degrees. There are two phases to tonic clonic seizures. During the tonic phase the child will loss awareness and stiffen which results in them falling over. The eyes roll back into the head and the chest muscles tighten. This can lead to respiratory distress and bradypnoea or a temporary cessation of breathing which will be evident with cyanosis of the lips and face. This phase usually lasts a minute before the clonic phase initiates. During the phase of the seizure, the child’s muscles will spams and jerk. Bowel and urinary control may be lost (Starship Children’s Health, 2016). After the seizure, there will be a post seizure stage where the child may still experience an ongoing loss of consciousness. The level of confusion, fatigue, and muscle pain the child will experience depends on the severity of the seizure. They may not exhibit all of the signs and symptoms listed but these are commonly experienced (John Hopkins Medicine, 2015).
Nursing care plan
For a child that has presented to the emergency department or ward with an active seizure, it is the nurse’s priority to manage immediate danger to the child. This can be achieved by minimising hazards and removing anything in close proximity to the child that could cause injury. During the seizure, the nurse should observe the appearance, characteristics, and duration of the seizure. Monitoring airway and breathing during this period is essential as respiratory distress and cyanosis can occur. Having oxygen, suctioning, and resus equipment ready is important during this period. Depending on the local hospital policies, diazepam can be administered rectally or intravenously, if IV access is already present, to stop the seizure (Raftery, 2002; Shinner & Gauser, 2002).
Once stopped, vital signs and GCS need to be undertaken. BSL and urine dipstick should also be done (Paul, Rogers, Wilkinson, & Paul, 2015). A fever will be present if this was a febrile seizure. Antipyretics will also be administered to lower the temperature and make the child more comfortable. With airway and breathing managed, IV access needs to be gained. At this time, bloods will be taken to rule out electrolyte imbalances and determine if there is an infection (Raftery, 2002; Shinner & Gauser, 2002). Reassurance and giving comfort to both the child and the family is vital at this point, as the post seizure stage would be occurring. Parents may be distraught as if unfamiliar with seizures; the fear of death or permanent brain damage will be present. The nurse needs to either take time to educate the family or nominate another health professional to undertake this (Starship Children’s health, 2016). A lumbar puncture or CT scan only needs to be done to rule out other causes such as brain tumour, meningitis, or encephalitis, after a period of observation, if GSC and neurological functioning is within normal ranges these do not to be carried out. A full history needs to be carried out as well to determine if this may be evolving epilepsy syndrome. An EEG may need to be carried out if there are recurrent seizures. With all else ruled out, the cause of the fever needs to be investigated and treated to minimise the risk of reoccurrence of febrile seizures (Paul, Rogers, Wilkinson, & Paul, 2015).
A helpful video:
Retrieved from: https://www.youtube.com/watch?v=UgVvavohSe8
John Hopkins Medicine. (2015). Neurology and neurosurgery: Tonic-clonic (grand mal) seizures. Retrieved September 7, 2016, from http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/seizures/types/tonic-clonic-grand-mal-seizures.html
National Institute of Neurological Disorders and Stroke. (2015). Febrile seizures fact sheet. Retrieved September 7, 2016, from http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm
Paul, S. P., Rogers, E., Wilkinson, R., & Paul, B. (2015). Management of febrile convulsion in children. Emergency Nurse, 23(2), 18. doi: 10.7748/en.23.2.18.e1431
Shinner, S., & Glauser, T. (2002). Febrile seizures. Journal of Child Neurology, 17, 44-52. doi: 10.1177/08830738020170010601
Starship Children’s Health. (2016). Convulsions: Febrile. Retrieved September 7, 2016, from https://www.starship.org.nz/for-health-professionals/starship-clinical-guidelines/c/convulsions-febrile/
Wong, D. (1995). Whaley and Wong’s nursing care of children and infants (5TH ed.) St Louis, MO; Mosby.