CASE STUDY ON A YEAR AND 11 MONTHS FEMALE WITH THE DIAGNOSIS OF

FEBRILE CONVULSION

BY

ALAO OLUWADAMILOLA ADEDOTUN

MATRIC NUMBER:

SON0201524

SUBMITTED TO:

BOWEN UNIVERSITY TEACHING HOSPITAL SCHOOL OF NURSING,

OGBOMOSO, OYO STATE.

IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF THE NURSING AND MID

WIFERY COUNCIL OF NIGERIA FOR THE AWARD OF DIPLOMA IN NURSING (RN)
 CERTIFICATION

This is to certify that this care study was written and compiled by ALAO OLUWADAMILOLA
ADEDOTUN with Index Number SON0201524, a student of School of Nursing, Bowen
University Teaching Hospital, Ogbomosho.

_________________ __________________

MRS. T.A AWOTUNDE DATE

Supervisor

_____________________ __________________

MRS M.A. OJO DATE

Principal
DEDICATION

I dedicate this care study to the Almighty God for His unending grace, guidance, protection,
kindness, love, faithfulness and ever sustaining grace which I enjoyed all the time. Also to my
wonderful parents Dr. & Mrs. ALAO and my lovely siblings.
ACKNOWLEDGEMENT

I appreciate God Almighty for His Everlasting love, faithfulness and kindness towards me and
the strength and wisdom he has given me to put up this write-up.

My sincere gratitude goes to my patient, Miss. F.E and her relatives for providing me with the
necessary information and their co-operation during the course of hospitalization in order to
make this care study possible. May God continually grant you good health.

To my supervisor, Mrs. T.A Awotunde, I want to say a big thank you for supervising and putting
me through this care study, you are wonderful.

Special thanks goes to the principal, school of nursing Mrs. M.A. Ojo and all the faculty
members, Mr. S.O Ogunlowo, Mrs. N.S Olupona, Mr. P.O Olaoye , Mrs. E.O Ogunlowo, Mrs.
B.O Akinlabi, Mrs. M.O Ijedinma and Mr. Alagbe, you are the best nursing tutors ever and to all
my seniors who assisted me, you are wonderful.

Also, I greatly appreciate my parents Dr. and Mrs ALAO, for provisions, encouragements,
prayers and love to enhance the success of this write-up.
TABLE OF CONTENT

Title Page i

Certification ii

Dedication iii

Acknowledgement iv

Table Contents v

CHAPTER ONE

Introduction 1

Background of the study 1

Purpose of the study 2

Significance of the study 2

CHAPTER TWO

Literature Review 3

Definition, type, causes and incidence 6

Anatomy and Physiology 7

Patho-physiology 10

Clinical Manifestations, Diagnosis and Prognosis 11

CHAPTER THREE

Demographic Data and History of patient 12

Particulars of Patient 12

Sources of data 12

Nursing history and Assessment using Gordon’s typology 13

Nursing diagnosis 14

CHAPTER FOUR

Management of the Patient 15

Laboratory investigation and result 15

Physician’s diagnosis 15

Medical Management/treatment 15
Pharmacology of drug used 16

Daily nursing care progress 21

Nursing care plan 23

Health Education, rehabilitation and discharge 25

Home Visit 26

CHAPTER FIVE

Summary 27

Conclusion 28

Recommendation 28

REFERENCES
 CHAPTER ONE
INTRODUCTION

BACKGROUND OF STUDY
Nursing Process is a client-centred, goal-oriented care method that provides a foundation
to nursing care. There is indeed a nursing process for any concern the client has. Clients need to
change during their stay in the hospital, as their condition improves or deteriorates depending on
the nurse’s assessment, it may result in improvements in the implementation of the care. In this
case study, Nursing process was used for a more systematic to care for a paediatric client who
has a febrile seizure. Febrile seizure are convulsion that occurs in some children with a high
temperature above 100.4°F. (NATHAN A.S, 2018)

Convulsion is a medical condition where body muscles contract and relax rapidly and
repeatedly resulting in uncontrolled shaking and a can be referred to as a sudden uncontrolled
electrical disturbance in the brain it can causes changes in behaviour, movements or feelings and
in levels of consciousness. Majority of febrile seizures are not serious. Most occur with common
illnesses such as ear infections, colds. Coughs, flu and other viral infections, serious infections
such as pneumonia, kidney infections, meningitis, etc. Full recovery with no permanent damage
is usual. (SAJUN CHUNG 2014).

Febrile Seizure occur in 2% to 5% of children 6 months to 5 years of age. The peak

incidence occurs at approximately 18 months of age and is low before 6 months or after 3 years
of age. Generally, the incidence of febrile seizure decreases markedly after 4 years of age (and
the condition rarely occurs in children older than 7 years of age2, 12). Febrile seizure occurs
more frequently in the Asian population, affecting 3.4%-9.3% of Japanese children and 5%-10%
of Indian children, but only 2%-5% of children in the United States (US) and Western Europe.
The highest prevalence is 14% in Guam. Males have consistently emerged as having a higher
frequency of febrile seizure (male to female ratio, 1.1:1 to 2:1). Most seizures were simple, and
at least one complex. FS is mostly generalized and convulsive in character, but approximately
5% of FS cases have no convulsive features presenting with unconsciousness, staring, eye
deviation, atonia, or cyanosis. (SAJUN CHUNG 2014).
 During a study period at Wesley Guild Hospital Ilesa, of Obafemi Awolowo Teaching
Hospitals Complex (OAUTHC), Ile-Ife, 880 patients were admitted into the children emergency
room of the Hospital, consisting of 463 males and 417 females, with a male:

Female ratio of 1.1: 1. Of these 880 children, 158 (18.0%) had febrile convulsions. They
consisted of 95 males and 63 females giving a male: female ratio of 1.5: 1 indicating
preponderance of febrile convulsion in male children. (Samuel Adegoke et al 2015)

Although alarming, febrile seizure is not usually dangerous but we should not go easy on
it and be more knowledgeable about it so that it will not cause further damage. In accordance to
these it shows the need of this study in order to provide accurate information and understanding
of this paediatric condition and to provide an appropriate nursing intervention in order to avoid
complications. As we go along to the topic we will have an in-depth understanding with this
paediatric condition.

PURPOSE OF STUDY

1. To widen the knowledge of nursing students and health care providers about the causes of
the febrile convulsion in children
2. To collect significant information regarding febrile seizures to broaden the knowledge of
the student nurses, develop skills regarding its management, and foster the right attitude
in providing proper and quality nursing care.

3. To provide Concrete information with regards to patient’s condition

4. To convey the significance of patient’s response to the rendered nursing intervention

SIGNIFICANCE OF STUDY
  This study will enable the Nurse to expand the knowledge about the cause, signs,
symptoms, prevention, complications and management of febrile convulsion.

 It will help in enlightening and health educating the community on early presentation,
diagnosis and treatment of febrile convulsions.

 It will serve as a guide for other students interested in discovering more about severe
malaria in children and also those that will need it for academic purposes.

CHAPTER 2
DEFINITIONS
 Febrile seizures or also known as febrile convulsions are the seizures associated with the
rapid rise of temperature along with high body temperature at the degree of 38.9°C to 40°C. It is
usually triggered by any illness that causes a high temperature or fever such as bacterial or viral
Infections, roseola which causes the fever to spike quickly, and even vaccinations especially the
one for measles, mumps, and rubella. (Tejani N. R. 2018)

Febrile seizure usually occurs on children between the ages of 6 months to 6 years,
although it can also occur as early as 3 months or as late as 7 years according to. It is usually
manifested by loss of consciousness, twitching, or jerking of arms and legs, foaming at the
mouth, pale or bluish skin color, eye rolling, and unresponsiveness. According to the severity
and manifestation of febrile seizures varies on its type, whether it is simple, complex or a febrile
status epilepticus. Simple febrile seizures are the most common type that lasts from a few
seconds to 15 minutes. It does not recur within 24 hours and are generalized in nature or the
seizures are not specific to one part of the body. On the other hand, complex febrile seizures are
the type of seizures that last longer than 15 minutes. It occurs more than once within 24 hours
and are focal in nature or the seizures are confined to the one side of the child’s body. And lastly,
febrile status epilepticus is the least common type of seizure that last longer than 30 minutes.
While febrile seizures may be very scary and alarming, it is harmless to the child and it doesn’t
cause brain damage, nervous system problems, paralysis, or intellectual disability. (Tejani N. R.
2018)
Febrile seizures can look serious, but most of the time, it stops without treatment and
don't cause other health problems. However, it is still recommended to take safety measures such
as moving the child to a safe place like the floor with the head cushioned, rolling the child onto
its side to prevent choking of the saliva and vomit, not putting anything to the mouth, and not
holding the child down to try to control the convulsions as this can help to prevent risks cause by
seizures such as ineffective airway and injury. It is also recommended to see a doctor to detect
the underlying disease that triggers and caused the febrile seizures to treat the disease as it is
more important to treat the cause of the fever rather than the seizure itself as the febrile seizure is
not the illness, but the physiological response. However, regarding complex febrile seizures that
occurs more than once within 24 hours, diazepam can be given by the doctor to stop the seizures
to ensure the maintenance of airway, breathing, and circulation of the patient. (Jensen, K., & Liu,
N. 2020)
 ANATOMY AND PHYSIOLOGY
Temperature control in children is not completed until approximately five years of age. This
may due to the immaturity of the nervous system. The maintenance body temperature is mainly
coordinated by the hypothalamus, a central control centre 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 C. In response 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.

Changes in environmental temperature, increased activity, crying, emotional upset and

infections all cause a higher and more rapid increased in the younger child. The younger the
child, the less able he or she is to vocalize the feeling of hot or cold. 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 head in a cold
environment conserves heat for growth. School children may experience a sequence of small
growth spurts and at times be relatively thin with minimal body fat.

PATHOPHYSIOLOGY
Febrile Seizure is one of the most common neurologic problems in paediatric patients. There are
lot of factors affecting febrile seizure. The first is the precipitating factors or the factors that
triggers or provokes the disease to happen which are the Infection such as meningitis,
encephalitis, ear infection and etc. If there is an infection there would be inflammation that
causes the infection to happen. Next the Metabolic imbalance such as abnormal level of glucose
or sodium. Third is the Neurodevelopmental such as cerebral palsy, epilepsy, hydrocephalus,
hippocampus malformation. Next is if there is a personal history of febrile seizure because it
might cause reoccurrence. Lastly is the effect of Immunization some vaccine like DPT and
MMR. The next factor is the Predisposing factors which are inherent or puts at risk. First on the
list is age, there is a specific age range where febrile seizure most likely occur this are the child
ages from 6 month- 6 years old due to their not fully developed immune system. Second is the
genetic susceptibility children who have a family history of febrile seizure are most likely to
suffer from them. Third is gender, Males are found to be more susceptible to temporal lobe
seizure due to high level of testosterone there 1.1:1 to 2:1. Maternal lifestyle before birth or
during pregnancy such as drinking, smoking or any type of substance abuse all of this are the
contributing factors to febrile seizure. Now let’s explain the process of febrile seizure due to
infection there will be an increase on concentrations of neopterin on cerebrospinal fluid.
Neopterin is an indicative for pro-inflammatory immune status and if there is an infection
occurring in the body our body will compensate to this by elevating the level of our white blood
cells in order to combat the infection and this will result to decrease level of iron and ferritin.
Another sign of infection occurring in the body is high body core temperature and if our core
body starts to increase greater than what 38 degrees it will also increase the temperature in our
brain. And if there is a high temperature in our brain it will alter neuronal functions via ion
channels that are sensitive to temperature changes. This neuronal change will increase neuronal
firing and synchronized neuronal activities and will cause seizure. After that hyperventilation
will occur due to decrease of carbon dioxide in our blood resulting to blood alkalosis which is a
response to increased metabolic demand or pain. Release of Interleukin – beta and Inflammation
of cytokines will occur. Later on, there will be a reduced level of GABA (which will leave our
central nervous system with too many neuronal signals that will cause febrile seizure. The signs
and symptoms of febrile seizure are Behavioural arrest, Changes
in behaviour including mood changes, Bitter/metallic tastes, Automatisms, Abnormal eye
movements, eye deviation, Drooling, frothing at the mouth, Rhythmic twitching or jerking,
Staring, Eyelid fluttering, Sudden falls, Loss tone/ stiffening of extremities, Teeth clenching and
Temporary stop in breathing. There are three types of febrile seizure, first is the Simple Febrile
Seizure which has only 1 seizure in a 24-hour period, generalized; no focal features and Lasts<
15 minutes. Second is the Complex Febrile seizure which is frequent
(Recurrent seizures in 24 hours), Focal features and Lasts ≥ 15 minutes. And lastly is the Febrile
Status Epilepticus which is prolonged febrile seizure and lasts ≥ 30 minutes.

Clinical Manifestations

According to Jensen (2020), the signs and symptoms for febrile seizures include: a
convulsion within 24 hours of a febrile episode with a temperature of 38°C or higher; with no
previous afebrile seizure history; and in the absence of CNS infection, inflammation, or acute
metabolic abnormalities. Furthermore, specific symptoms for each febrile seizure – simple,
complex, and febrile status epilepticus – are presented below (Wells, 2018):

For simple febrile seizures, the single seizure is generalized and lasts for no more than 15
minutes; the child is otherwise neurologically healthy and without neurologic abnormality by
examination or by developmental history; and the seizure is described as either a generalized
clonic – fast stiffening and relaxing of a muscle that happens repeatedly, referred to as jerking –
or a generalized tonic-clonic seizure – stiffening and rhythmical jerking (Kiriakopoulos, 2017).
The following symptoms are also present: eye rolling; moaning; vomit or urinate during the
convulsions; loss of consciousness; twitching limbs or convulsions (usually in a rhythmic
pattern); confusion or tiredness after the seizure; and have no arm or leg weakness (KidsHealth,
2018; Wells, 2018).

For complex febrile seizures, the neurologic status is the same with the simple febrile
seizure; and can either be focal (the movement occurs only in one side or one part of the body) or
prolonged (lasting for more than 15 minutes), or multiple seizures occurring in close succession.
The following symptoms are also present: loss of consciousness; twitching limbs or convulsions
and have a temporary weakness usually in one arm or leg.
While for febrile status epilepticus, this is a prolonged febrile seizure lasting for more than 30
minute. (Jensen & Liu, 2020)
 CHAPTER 3
Demographic data and history of patient

PARTICULARS OF PATIENT

NAME: F.E

AGE: 1 YEAR AND 11 MONTHS

DATE OF BIRTH: 2ND OF APRIL 2020

SEX: FEMALE

MARITAL STATUS: SINGLE

RELIGION: CHRISTAIAN

STATE OF ORIGIN: OYO STATE

L.G.A: OGBOMOSO

NATIONALITY: NIGERIAN

HOME ADDRESS: ILE AKOLABA OLOPE MARUN, OGBOMOSO, OYO STATE.

PHONE NUMBER: NIL

OCCUPATION: NIL

OFFICE ADDRESS: NIL

CONSULTANT: DR (MRS.) ODEYEMI

MEDICAL DIAGNOSIS: FEBRILE CONVULSION

DATE OF ADMISSION: 01/03/2022

ALLERGIES: NIL

IMMUNIZATION: BCG, OPV, HBV

L.M.P: NIL

DATE OF DISCHARGE: 4/03/2022

NAME OF NEXT OF KIN: MRS F.J

PHONE NUMBER OF NEXT OF KIN: 09076884234

RELATIONSHIP: MOTHER

OCCUPATION: TRADER

OFFICE ADDRESS: NIL

SOURCES OF DATA: MOTHER

 NURSING ASSESSMENT USING GORDON’S TOPOLOGY

GENERAL DESCRIPTION OF THE PATIENT

Hair is evenly distributed, face is appears normal no sign of oedema and she is not pale, chest
is clear no obvious respiratory distress. Upper and lower limbs present, abdomen moves with
respiration. Conscious, not pale, warm to touch, not dehydrated.

PAST MEDICAL HISTORY

F.E has no past medical history.

PRESENT MEDICAL HISTORY

F.E was apparently well until 27th of February, 2022, when she started running temperature,
the fever continued until she experienced an episode of convulsion which lead to her
presentation in the Hospital.

FAMILY AND SOCIAL HISTORY

F.E is the first child of the family, she was born 2nd of April, 2020. She lives with family in a
monogamous family setting.
 GORDON’S TOPOLOGY

HEALTH PERCEPTION AND MANAGEMENT

The mother feels that health is wealth, she does not take her child’s health for joke, she uses
OTC drugs whenever there is a health issue and doesn’t hesitate to go to the hospital if these
issues are not resolved.

ELIMINATION PATTERN

F.E has regular bowel activity, she does not experience diarrhoea or constipation throughout
hospitalization.

ACTIVITY AND EXERCISE PATTERN

F.E is active, energetic and playful

SLEEP/REST PATTERN

F.E sleeps for about 7hrs at night and about 3hrs during the day. Despite her hospitalization
she sleeps well.

COGNITIVE AND PERCEPTUAL PATTERN

F.E has no problem with her five senses, she makes moves when her name is called and
respond well to activities.

ROLE/RELATIONSHIP PATTERN

F.E relates well with Nurses and relatives; she smiles when she is been played with by
anybody.

SEXUALITY AND REPRODUTIVE PATTERN

Not applicable

COPING/STRESS PATTERN

Not applicable

VALUES AND BELIEFS

Parents believes in God

 NURSING DIAGNOSIS

1. Hyperthermia related to infection evidence by high body temperature reading of

38.6°C
2. Risk of injury related to altered level of consciousness resulting from seizure episode
3. Deficient knowledge related to parent’s experience of a new disease
4. Risk of fall related to altered level of consciousness resulting from seizure episode
 CHAPTER 4
DIAGNOSTIC INVESTIGATIONS AND RESULTS

DATE INVESTIGATIONS NORMAL VALUE RESULT REMARKS

27/02/22 PCV Male: 40-50% 38% Normal

Female: 36-48%
27/02/22 WBC (4-11) × 109 14.0 × 109/L Abnormal

150-450 × 109/L
Platelets 235 × 109/L Normal

27/02/22 NUET 15-80% 63% Normal

Lymphocytes 30-95% 32% Normal

Monocytes 2-8% 5% Normal

27/02/22 Blood group A, B, AB, O O Rh D+ Normal

28/02/22 Glucose 40-80mg/dl 80mg/dl Normal

Protein 20-40mg/dl 20mg/dl Normal

28/02/22 Malaria Parasite Negative Ring form + Abnormal

PHYSICIAN DIAGNOSIS: FEBRILE CONVULSION SECONDARY TO MALARIA

INFECTION
 MEDICAL MANAGEMENT/TREATMENT

F.E was placed on the following drugs during the course of her treatment in the hospital

Intravenous fluid 4.3% Dextrose saline at 350mls 12hourly

Intravenous Paracetamol 100mg 8hourly

Intravenous Ocexone 500mg 12hourly

Intravenous Artesunate 30mg 12 hourly 1/7

Intravenous Phenytoin 200mg stat 25mg hourly in case of other episode of convulsion

PHARMACOLOGY OF DRUGS

PARACETAMOL

GROUP: It is an Antipyretic and Analgesic Drug.

MODE OF ACTION: The Paracetamol acts as a pain- perception apparatus of the Thalamus
and Hypothalamus in the Central Nervous System, thereby increasing dissipation of body
heat by increasing peripheral blood flow and perspiration and thereby reducing fever.

INDICATION: Prevention of febrile convulsion, fever, and pain in Tonsillitis, Pyrexia of

unknown origin, Post immunization reaction, after tonsillectomy and conditions where
patient is unable to take oral analgesic drugs.

DOSAGE: Intravenous and Intramuscular injection for Children and Adults of 10 years and
above= 2-3 mils

 Children up to 10 years – 1-2 ml

 Infants - ½ml
 Tablet for Adults- 500 mg- 1g 4 – 6 hourly to a maximum of 4g
 Children between 5-12 years =250- 500mg 4-5hourly when necessary (maximum of 4
does in 24 hours)
 The Syrup for children= 125mg per 5mls
 For age 1-5 years = 125mg- 250mg (1-2 teaspoonful i.e. 5-10mls).
 Children up to 1 year = 50- 125mg (½-1 teaspoonful i.e. 2.5-5mls).
ROUTE OF ADMINISTRATION: Intravenous, Intramuscular, Orally.

SIDE EFFECTS: Liver damage due to prolonged use of paracetamol, Allergic reaction (rash
and swelling), Dark urine, Jaundice, Low blood pressure.

CONTRAINDICATIONS: Hepatic and Renal impairment.

NURSING RESPONSIBILITY:

 Depending on severity of condition, dose may be repeated 4 hours until the Pyrexia
returns to Normal
 In severe cases, dose maybe given intravenously very slowly.
 Patients should not exceed maximum recommended dose of 4g (8 tablet) daily for
more than 72 hours.
 Nurse the patient in a quiet and dark room to prevent headache. (R.O, Mustapha
2017)

CEFTRIAXONE (Ocexone)

Group: It is an antibiotic

Mode of Action: It inhibits the synthesis of bacterial cell wall, mitosis and growth of bacteria

Indications: Infectious fevers, Gonococcal infection, meningitis, urinary tract infection,

preoperatively

Dosage: 1-2g daily or 500mg -1g twice daily

Route of Administration: Intramuscularly, Intravenously

Side effects: Diarrhoea, Abdominal pains, mouth soreness, Body rashes, pruritus,
Hypersensitivity to reactions.

Contraindication: History of hypersensitivity to penicillin

Nursing Responsibilities:

 Use with caution if client is hypersensitive to penicillin

 Instruct client to take full course of the drug to maintain therapeutic blood levels
 Instruct not to drink alcoholic beverages or alcohol containing medication to avert
abdominal pain, nausea, vomiting, hypotension, tachycardia, sweating. (Mustapha
2017)
ARTESUNATE (Arsumax, Gsunate, or Malasunate)

Group: it is an anti-malarial drug

Mode of Action: it has effect on chloroquine resistant falciparum malaria having a

remarkable inhibitory and gametocidal effect on falciparum gametocyte.

Indications: falciparum malaria, vivax malaria

Dosage: Adults= Day 1 = 2tablets of 100mg/ tablet

Day 2-5 = One tablet of 100mg daily. OR Adult = Day 1= 2 tablets of 50mg / tablet in the
morning and 2 tablets in the evening. Days 2-5 = One tablet of 50mg in the morning and
one tablet of 50mg in the evening.

Children= Day1 = 2mg tablet/kg in the morning and 2mg tablet/kg in the evening. Days
2-5= 1mg tablet/kg in the morning and 1mg tablet/kg in the evening.

Route of Administration: Orally

Side Effects: No side effect where recommended doses are taken and followed strictly

Contraindication: Pregnancy, Lactation

Nursing Responsibilities:

 Avoid over dosage

 Consult the Doctor before using this drug during pregnancy and lactation
especially during the first 3months of pregnancy.
 Inform the Doctor if any mild and transient side effects occur at all (Mustapha
2017)
PHENYTOIN (Epanutin, Dilantin)

Group: it is an anticonvulsant drug.

Mode of Action: It inhibits paroxysmal discharge from epileptogenic foci or areas within the
brain by modifying ionic activities of sodium, potassium and calcium, thereby preventing or
blocking seizure activity within the motor cortex.

Indications: Grand mal epilepsy, status epilepticus, Digitalis induced Arrhythmias, head
trauma, post-surgery on brain.

Dosage: 50-100mg twice or thrice daily with or after meals. Maintenance is 5-8mg per kg
body weight once daily orally.

Route of Administration: Orally, Intravenously, and Intramuscularly

Side effects: Gingival hyperplasia (swelling), Ataxia, Diplopia, blood dyscrasia (e.g.
megaloblastic anaemia), Dermatitis, vomiting, constipation, nausea, headache,
lymphadenopathy, hepatic damage, Nystagmus, Hyperglycaemia, osteomalacia, peripheral
neuropathy, tremor, rashes, drowsiness, mental confusion, insomnia.

Contraindications: hepatic disorder, hypersensitivity to hydantoin products, hypoglycaemia

seizure, first trimester of pregnancy.

Nursing Responsibility:

1. If given intravenously, it should run at a rate of 50mg per minutes in normal saline.
2. Monitor the patient’s blood pressure and pulse rate.

Daily Nursing Care Progress

First Day of Admission (01/03/22)

Child was brought into the unit by her mother on account of high grade fever which has
lasted for about 3 days and an episode of convulsion which occurred about 3 hours prior to
presentation at the unit, the episode is characterized as a continuous jerky movement of all
her limbs which lasted for about 2 minutes. There was also an account of urinary
incontinence during this episode of convulsion. Child was stable before arrival to the unit.
On arrival, child was conscious, febrile, not pale, and not dehydrated. IV access was secured,
samples were taken for laboratory investigations FBC, MP, RVS, BG, LP

Vital signs were checked and recorded as:

TIME TEMP RESPIRATION WEIGHT HEIGHT PULSE SPO2 RBS

1:02pm 38.6°C 80c/m 9.8kg 81cm 168b/m 96% 102mg/dl

Child had I.M paracetamol given (98mg) and was admitted into paediatric ward.

On arrival to the ward, IV fluid 4.3% dextrose saline was commenced and IV artesunate
30mg was given

Second Day of Admission (28/02/22)

At 6am and 6pm IV ocexone 500mg and IV artesunate 30mg was given

Child had bed bath done, intravenous line Insitu, bed linen was changed.

At 6pm child had a temperature spike with a reading of 38 oC tepid sponging was done, and
fan was put on to reduce the temperature.

Time Temperature Pulse Respiration

6am 37.8oC 153b/m 30c/m
10am 36.7oC 154 b/m 56 c/m
12:30pm 37oC 156 b/m 48 c/m
2:50pm 36.8oC 158 b/m 36 c/m
4:55pm 37.1oC 147 b/m 36 c/m
6pm 38oC 152 b/m 36 c/m
10pm 37oC 138 b/m 40 c/m

Third Day of Admission (1/03/22)

Child was met sleeping on bed. Patient had bed bath done, bed linen changed, patients feed
well, nil fresh complaints. Patient had IV Artesunate 30mg and IV ocexone 500mg given at
12am, 6am and 6pm, fever had subsided and the parents were informed that the child will be
discharged the following day if there is no spike in the child’s temperature. Vital signs were
checked and recorded.

Time Temperature Pulse Respiration

6am 36oC 120b/m 40c/m

10am 36 0C 138 b/m 32 c/m

1pm 37 0C 150 b/m 46 c/m

6pm 37.2 0C 162 b/m 44 c/m

10pm 37 0C 152 b/m 32 c/m

Fourth Day of Admission (02/03/22)

Child was met on mother’s hand, afebrile, hydrated, conscious, and alert, nil complaints,
Child had bed bath done. Parents are ready for discharge. Discharge drugs were given and the
mother was instructed on how to use them, her discharged bills were made and was given to
the Father.

Time Temperature Pulse Respiration

6am 37oC 139b/m 64c/m

12pm 36.8 0C 136 b/m 48 c/m

2:15pm 37.0C 160 b/m 40 c/m

 NURSING CARE PLAN OF A CHILD WITH THE DIAGNOSIS OF FEBRILE
CONVULSION.

S/N NURSING OBJECTIVE INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
1 Hyperthermia After 4 hours of  Removed excess  Exposing skin After 3 hours of
related to decreases
nursing clothing from the nursing
infection warmth and
evidence by high intervention, the child’s body increases intervention, the
body temperature evaporative
client client temperature
reading of cooling.
38.6°C temperature will decreased by 1°C
decrease by 1°C  Tepid sponging was  External
carried out sponging reduces
the body
temperature and
increases
comfort.

 Monitored the child’s  Close

temperature. monitoring of
temperature is
essential for
prompt
intervention to
prevent future
seizures.
 Administer antipyretic
(acetaminophen) as  Antipyretics
prescribed. Rationale: alters the
response to pain
and lowers
fever.

S/N NURSING OBJECTIVE INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
 2 Deficient  After 2 hours of  Assess parents’  This help to After 1 hours of
knowledge nursing perceptions and provide nursing intervention,
related to intervention, knowledge about information Parents obtained
parent’s Parents will disease condition, regarding the necessary
experience of a obtain fears, and long-term care information
new disease necessary misconceptions about of the child. regarding the
evidence by information disorder, nature, and condition, cause of
parents’ request regarding the frequency of seizures. seizure and care of
for information condition, cause  Educate parents that a  Understanding the child
about the of seizure and febrile seizure is more this information
condition, cause care of the of a symptom of fever can help the
of seizure and child. than a long-term parent
medication condition understand the
treatment responsibility to
take for future
care.

 Inform parents about  Increases

the need for follow up knowledge and
laboratory studies understanding
such as blood count of causes of the
and Malaria parasite seizures
test etc. as indicated

.
S/N NURSING OBJECTIVE INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
3 Risk of injury  After 3 hours of  During the hospital  Padding protects  After 2 hours of
the child from
related to altered nursing stay, ensure that the nursing
injury during a
level of intervention, side rails are padded seizure. intervention, clients
consciousness clients will and are raised up. regained
resulting from regain consciousness
seizure episode consciousness  Stay with the child  This will provide without injury.
without injury. during the phase of support and
prevent any
seizures, reorient injury to the
when awake, and child.
allow to rest or sleep
after an episode.

Documentation
 Assess and record
of information is
seizure activity and
essential for the
location. Noting the
prevention of
duration of seizures,
injury or
parts of the body
complications as
involved, site of onset
a result of a
and progression of
seizure.
seizure.

 Administer  Anticonvulsants
medications, as drug is required
indicated. for recurrent
seizures

S/ NURSING OBJECTIVE INTERVENTION RATIONALE EVALUA

N DIAGNOSIS
4. Risk of fall related to  After 3 hours of  During the  Padding  After 2 h
protects the
altered level of nursing intervention, hospital stay, nursing
consciousness resulting clients will regain ensure that the child from intervent
injury during a
from seizure episode consciousness side rails are clients re
seizure.
without falling. padded and are consciou
raised up. without i

 Stay with the  This will

child during the provide support
and prevent any
phase of seizures, injury to the
reorient when child.

awake, and allow

to rest or sleep
after an episode.

 Assess and record

Documentation
seizure activity
of information
and location.
is essential for
Noting the
the prevention
duration of
of injury or
seizures, parts of
complications
the body
as a result of a
involved, site of
seizure.
onset and
progression of
seizure.

 Anticonvulsant
 Administer
s drug is
medications, as
required for
indicated.
recurrent
seizures

HEALTH EDUCATION, REHABILITATION AND DISCHARGE

F,E was discharged on the 4th of March 2022 on oral drugs and Mother was health educated
on the prevention of Febrile convulsion under the following;

Medication

1. Mother was encouraged to adhere to the treatment regimen that the doctor prescribes
such as the antibiotics or antiviral medications as febrile seizures are treated based on
the underlying illness that triggers or caused the seizures and to prevent bacterial or
viral resistance.
2. Mother was educated that antipyretics such as Paracetamol works by promoting
comfort especially to those patients who appears uncomfortable secondary to the
fever, but it does not guarantee to prevent recurrence of febrile seizures.

Exercise

Encourage mother to have her child rest from time to time for fast recovery.

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.

Health Teaching
The parents of the child were educated about the following points:
1. The baby or child having a febrile seizure may arch their back, stiffen their body and
clench their fists. They will look red-faced, be hot to the touch and sweating. Their
eyes roll upwards and they may hold their breath.
2. Protect the child from injury but do not restrain them. Move things that could injure
the baby or child while they are having a seizure. Use a blanket or clothing to protect
their head.
3. Take off their outer clothing to help cool them. Febrile seizures are caused by a
raised temperature, so it is important to cool the baby or child. If the room is hot,
open doors and windows to ensure there is a flow of fresh air.
4. Do not give the child cold baths in an attempt to cool him/her down. The cold water
would be distressing and may cause hypothermia.
5. They should remain calm. This is why it is important that the parents be educated
about the benign nature of febrile seizures, and this also helps them to focus on
keeping their child safe during a seizure.
6. Keep track of how long the seizure lasts
7. Roll the child onto his or her side (to avoid choking on their saliva or vomit).
8. Remove any nearby objects that the child might hit, causing additional injury.
9. Stay with the child until the seizure is over.
10. Seek immediate medical help if the seizure lasts longer than 5 minutes.
11. They should not put anything in the child’s mouth
12. Do not give anything to eat or drink until the child is awake and alert.
13. Do not put or force anything in the child’s mouth.
14. Do not give anything to eat or drink until the child is awake and alert.

CHAPTER FIVE
SUMMARY
Miss F.E a 1 year and 11 months girl who was admitted on the 1st of March, 2022. She was
brought into the ward, accompanied by parents and relative, with a diagnosis of febrile
convulsion.
She was placed on Paracetamol, Artesunate, Antibiotic (Ocexone) to treat the cause of fever
which led to convulsions.
One the fourth day of admission her condition was noticed to have improved, so preparations
for discharge were made and health teaching was given. Hospital bills were settled and she
was discharged on the afternoon of 4th of March 2022.
Patient has not showed up since discharge.

CONCLUSION
In conclusion it is important to understand that febrile convulsion is not usually dangerous
but should take serious so it won’t cause other injury or damage. And if there is any children
showing the signs and symptoms of febrile convulsions or fever, they should report to the
nearest hospital for proper check-up and treatment.

RECOMMENDATION
Febrile convulsion are frequent and benign disorder of infancy and early childhood, parental
education, reassurance and prophylactic AED when needed constitute the main modality of
treatment. Any children found with signs and symptoms of this condition should report to the
nearest hospital for investigation and prompt management.
References

Baumann, R. J. (2018). Paediatric Febrile Seizures. Retrieved from Medscape:

https://emedicine.medscape.com/article/1176205-overview
Bankole, K. P., & Adegoke, S. (2015). Prevalence, Aetiology and Outcome of
Febrile Convulsions at the Wesley Guild Hospital, Ilesha, South-West Nigeria.
British Journal of Medicine and Medical Research.
Belleza, M. (2017). Pediatric Health and Physical Assessment. Retrieved from
Nurselabs: https://nurseslabs.com/pediatric-health-assessment/#neurologic://

Emdex. (2020-2021). Emdex 2020-2021 edition based on WHO model formulary

and Nigeria's essential drug list.
Ellis, H., & Mahadevan, V. (2018). Clinical Anatomy: Applied Anatomy for
Students and Junior Doctors (14th ed.). Wiley-Blackwell.
Farell, K., & Goldman, R. (2011). The management of febrile seizures. British
Medical Journal.
Hunstead, S. (2020). [Video]. Retrieved from https://www.youtube.com/watch?
v=MlsReSWDJiI&t=170s
Jensen, K. (2020). Febrile Seizures. Retrieved from PedsCases:
http://www.pedscases.com/febrile-seizures-0
Jensen, K., & Liu, N. (2020). [Video]. Retrieved from PedsCases:
http://www.pedscases.com/febrileseizures0?
fbclid=IwAR2zUdSc1E67YHfjgdbAgwtBuFy4L6QDMHNjGpKuVabsWVDrFi5xz_
R74sI
Kiriakopoulos, E. (2017). Types of Seizures. Retrieved from Epilepsy:
https://www.epilepsy.com/learn/types-seizures/tonic-clonic-seizures
Nathan, A. S. (2018). Febrile Seizure. Retrieved from Medscape:
https://emedicine.medscape.com/article/801500-treatment
Mustapha, R. O. (2019). The easiest approach to Pharmacology for all health
professionals (4th ed.). Adewunmi Printing Press.
Martin, P. (2019). 4 Febrile Seizure Nursing Care Plans. Retrieved from Nurselabs:
https://nurseslabs.com/4-febrile-seizure-nursing-care-plans/3/
Pillitteri, A. (2010). Maternal and Child Nursing.
RNspeak. (2020). Paracetamol (Biogesic) Drug Study. Retrieved from RNspeak:
https://rnspeak.com/paracetamol-biogesic-drug-study/
Standring, S. (Ed.). (2021). Gray's Anatomy: The Anatomical Basis of Clinical
Practice (41st ed.). Elsevier/Churchill Livingstone.
Tejani, N. R. (2018). Retrieved from Medscape:
https://emedicine.medscape.com/article/801500-treatment
Vera, M. (2020). Complete Head-to-Toe Physical Assessment Cheat Sheet. Retrieved
from Nurselabs: https://nurseslabs.com/nursing-assessment-cheat-sheet/
Wells, D. (2018). What Is a Febrile Seizure? Retrieved from Healthline:
https://www.healthline.com/health/febrile-seizure