Febrile seizures are febrile seizures (temperatures above 38.4 ° C per rectal) in the absence of central nervous system infection or acute electrolyte disturbance, occurring in children older than 1 month, and no prior seizure seizure history.
Seizures Fever is a seizure upset that occurs in the rise in body temperature (rectal temperature over 38˚C) caused by an extracranium process. (Kapita selekta Medicine, 2000)
Simple Fever Seizures are common, short, and only occur within 24 hours.
Complex Fever Seizure is a focal seizure, duration of more than 10-15 minutes or repeated in 24 hours. (IDAI, 2004)
Risk Factors and Etiology
1. Risk Factors
b. History of febrile seizures of parents or siblings
c. The development is late
d. Problems with neonates
e. Children in special care
f. Sodium content is low
Until now not known with certainty. Fever is often caused by upper respiratory tract infections, medical otitis, pneumonia, gastroenteritis, UTI. Seizures do not always arise at elevated temperatures. Sometimes a fever that is not so high can cause seizures.
Generally febrile seizures occur briefly, in the form of clonical seizures or bilateral clonic tonics. Other forms of seizures may also occur like upside-down eyes with stiffness or weakness, repetitive jerking without prior stiffness, or merely a focal twitch or rigidity.
Some seizures last less than 6 minutes and less than 8% lasts more than 15 minutes. Often the seizure stops itself. After the seizure stops the child does not give any reaction for a moment, but after a few seconds or minutes, the child wakes up and regains consciousness without a neurologist deficit.
Seizures may be accompanied by temporary hemiparesis lasting several hours to several days. Old unilateral seizures may be followed by persistent hemiparesis. The prolonged seizure spasms are more common in the first febrile seizures. (Kapita Selekta Medicine, 2000)
1. 5 Ways of Nursing
a. Monitor fever
b. Lowering fever: warm compress
c. Immediately provide oxygen when seizures occur
d. Managing antipyretics, anticonvulsants
2. Medical Treatment
a. Treatment of the acute phase
Often the seizure stops itself. At the time of the seizure the client is tilted to prevent aspiration of saliva or vomit. The airway should be free so that oxygenation is assured. Pay attention to vital circumstances such as consciousness, blood pressure, temperature, breathing and heart function. High body temperature is lowered by compress and antipyretics.
The fastest medication to stop a seizure is an intravenous or intrarectal diazepam. Intravenous diazepam dose of 0.3-0.5 mg / kgBW / time with a rate of 1-2 mg / min with a maximum dose of 20 mg. If the seizure stops before diazepam runs out, stop the injection, wait a moment, and if no more seizures the needle is revoked. If intravenous diazepam is not available or administration is difficult, use an intra rectal diazepam of 5 mg (BB <10 kg) or 10 mg (BB> 10 kg). If the seizure does not stop dapoat repeated intervals 5 minutes later. If not stopped also, give phenytoin with a starting dose of 10-20 mg / kgBW intravenously slowly 1 mg / KgBB / min. After phenytoin administration, rinsing with physiological NaCl should be alkaline and cause venous irritation.
If the seizure stops with diazepam, continue with phenobarbital given immediately after the seizure stops. Initial dose for infants 1 month – 1 year 50 mg and age 1 year and over 75 mg intramuscularly. Four hours later give feobarbital a dose of formula. For the first 2 days at a dose of 8-10 mg / kg BW / day divided into 2 doses, for the following days at a dose of 4-5 mg / kg BW / day for 2 doses. As the condition has not improved, the drug is given by injection and after it has improved orally. Note that the total dose does not exceed 200 mg / day. Side effects are hypotension, decreased consciousness, and respiratory depression.
If the seizure stops with phenytoin, continue phenytoin at a dose of 4-8 mg / kg / day, 12-24 hours after the initial dose.
b. Seek and treat causes
A cerebrospinal fluid examination is performed to rule out the possibility of meningitis, especially in the first febrile seizure patient. However most doctors perform lumbar puncture only in suspected cases of meningitis, for example if there are symptoms of meningitis or if febrile seizures last long.
c. Prophylactic treatment
1) intermittent prophylaxis
Given given diazepam orally at a dose of 0.3-0.5 mg / kgBW / day divided in 3 doses when the patient had a fever. Diacepam can also be given intrarectally every 8 hours as much as 5 mg (BB <10 kg) and 10 mg (BB> 10 kg) each patient showing a temperature greater than 38.5 ° C. Side effects of diazepam are ataxia, drowsiness and hypotonia.
2) Prophylaxis continuously.
Given to prevent recurrence of severe febrile seizures that can cause brain damage but can not prevent the occurrence of epilepsy later in life. Daily prophylaxis with phenobarbital 4-5 mg / kgBW / day divided into 2 doses. Another drug that can be used is valproic acid at a dose of 15-40 mg / kgBW / day. Prophylactic anticonvulsants are continuously administered for 1-2 years after the last seizure and are terminated gradually for 1-2 months.
Continuous prophylaxis may be considered when there are 2 criteria (including points 1 and 2):
a) Before the first febrile seizures there is already a neurologic or developmental disorder (eg cerebral palsy or microcephaly)
b) Febrile seizures last longer than 15 minutes, focal, or followed by temporary or persistent neurologic abnormalities.
c) There is a history of seizures without fever in the elderly or siblings
d) If a febrile seizure occurs in infants younger than 12 months or multiple seizures occur in a single episode of fever.
If you only meet one criteria and want to provide long-term treatment, give intermittent prophylaxis when the child fever with diazepam oral or rtektal every 8 hours in addition to antipyretics.
a. Identity: age, address
b. Medical history
1) Main complaints (complaints felt by clients during assessment): fever, irritability, chills, seizures)
2) Current medical history (history of illness suffered by the client during hospital admission): when is it getting hot?
3) Past medical history (history of the same illness or other illness that the client has suffered): have seizures with or without fever?
4) Family health history (history of the same disease or other illnesses experienced by other family members whether genetic or not): parents, siblings ever seizures?
5) History of flower: is there any delay in growing flowers?
6) Immunization history
c. Physical examination
1) General circumstances: awareness, vital sign, nutritional status (weight, body length, age)
2) Persistent examination
a) Sensory perception system:
Ø Sight: tears exist / not, concave / normal
Ø Tasting: increased thirst / no, moist / dry tongue
b) The nervous system: consciousness, chills, convulsions, dizziness
c) Respiratory system: dispneu, kusmaul, cyanosis, nasal lobe,
d) Cardiovascular system: tachycardia, weak and rapid / palpable pulse, slow capillary refill, warm / cold acral, peripheral cyanosis
e) Gastrointestinal system:
Ø Mouth: moist / dry mucous membrane
Ø Abdomen: turgor ?, bloating / meteorismus, distension
Ø Information about feces: color (red, black), volume, odor, consistency, blood, melena
f) Integumentary system: dry / moist skin
g) Urinal system: last 6 hours tub, oliguria / anuria
d. Health Function Pattern
1) Patterns of perception and health care: sanitation ?,
2) Pattern of nutrition and metabolism: anorexia, nausea, vomiting
3) The pattern of elemination
a) Chapter: frequency, color (red, black?), consistency, smell, blood
b) Bak: frequency, color, last 6 hour tub?, oliguria, anuria
4) The pattern of activities and exercises
5) Sleep patterns and rest
6) Cognitive and perceptual patterns
7) Pattern of tolerance and koping stress
8) Patterns of values and beliefs
9) Pattern relationship and role
10) Sexual and reproductive patterns
11) Pattern of confidence and self-concept
1) Hypertermi b.d viremia, metabolic enhancement
2) PK: Seizures b.d hypertermi
3) Risks of aspiration b.d accumulation of secret, vomiting, decreased consciousness