Integrated Management of Childhood Illness Case Study on Benign Febrile Seizure

A Written Requirement Submitted to the Faculty of

The College Health and Sciences

Cor Jesu College, Digos City

In Partial Fulfillment of the Requirements

For NCM 109

Submitted by:

Chico, Christian Steeve I.

Dacalos, Precious Mae S.

Javier, Renielle Jade R.

Lausa, Vida Rose G.

Lintua, Daisyre Mae J.

Rosal, Gertie Anne T.

Tan, Claudia Belle S.

May 2021

1
 TABLE OF CONTENTS

CONTENTS PAGE

I. Introduction………………………………………………………………… 1

II. Objectives……………………………………………………….………… 3

III. Assessment

a. Patient’s Profile……………………………………................................ 4

b. Comprehensive Assessment.……….......………....….............................. 5

c. Functional Pattern………………………………….................................. 6

d. System Assessment……………….......…………......…........................ 10

IV. Anatomy and Physiology................................................................................. 12

V. Pathophysiology….......................................................................................... 20

VI.

a. Drug Study…………………………………………………………......... 23

b. Nursing Care Plan……………………………………………………….. 30

c. Management …………………………………………………………… 51

VII. Glossary of Terms............................................................................................ 58

VIII. Bibliography.................................................................................................... 59

i
 CHAPTER I

INTRODUCTION

Febrile seizures are seizures that are caused by a sudden spike in body temperature with

fevers greater than 38C or 100.4 F, with no other underlying seizure-provoking causes or

diseases such as the central nervous system (CNS) infections, electrolyte abnormalities, drug

withdrawal, trauma, genetic predisposition or known epilepsy (Xixis & Keenaghan, 2021).

Moreover, the International League against Epilepsy (ILAE) defines FS as a seizure occurring in

childhood after one month of age, associated with a febrile illness that is not caused by an

infection of the central nervous system (Pellock, 2013). In addition, febrile seizures can be

categorized as either simple febrile seizures or complex febrile seizures. Thus, differentiation

between simple and complex febrile seizures is important in order to give appropriate medical

interventions.

Febrile seizures result from a combination of genetic and environmental factors. Of

children with febrile seizures, 24% have a family history of febrile seizures and 4% have a

family history of epilepsy. (Sadleir & Scheffer, 2007). Moreover, FS can be seen in multiple

family members and there is evidence of genetic and environmental causes. There is a variable

inheritance pattern, with no single accepted mechanism. A positive family history of FS can be

found in 25–40% of cases when a child present with a FS (Pellock, 2013). Children less than 12

months at the time of the first febrile seizure have a 50% chance of having a second seizure

within the first year. This risk drops to 30% the following year (Xixis & Keenaghan, 2021). In

addition, findings from the study of Berg (1997) revealed that, A total of 136 children (31.8%)

experienced recurrent seizures: 73(17.1%) had only 1 recurrence, 38(8.9%) had 2 recurrences,

1
and 25(5.8%) had 3 or more recurrences. This lead them to their conclusion that in children who

have had a first febrile seizure, recurrences are common.

There is no specific treatment for simple or complex febrile seizures other than

appropriate treatment for underlying etiologies driving the ongoing febrile illness (Xixis &

Keenaghan, 2021). Also, There is universal agreement that daily prophylaxis with antiepileptic

agents should never be used routinely in simple febrile seizures, but only in highly selected

cases if at all. Treatment with benzodiazepines during febrile episodes appears to effectively

reduce the recurrence rate, provided adequate doses are given and compliance problems

minimized (Knudsen, 2000). On the other hand, Intermittent diazepam (DZP) prophylaxis at

times of fever may or may not reduce the recurrence rate, but it does not appear to improve the

long-term outcome as compared with short-term seizure control. (Knudsen, 2000).

The BSN-2 Group 2 pesents the case of a 5-year-old previously healthy girl of Kaulo

descent who was born in Brgy. Demoloc, Malita, Davao Occidental who presents with a 12-day

history of high fevers and no other associated signs or symptoms. In connection, this case study

will surely help the group to formualte nursing care plans which are appropriate for the patient.

Furthermore, it will also equip them with knowledge on how to manage future patients with the

similar condition.

2
 CHAPTER II

Objectives

The BSN 2 group 2 aims to describe a particular case and identify the involving issues

regarding the case to gain knowledge. By the use of the given data, the group 2 conduct a

thorough research of the said case and showcase its definition, origin, medication and care plans

to be used.

Specific objectives:

In this case the group 2 have the opportunity to:

1. Build knowledge related to patient’s experience, including mechanism of the disease and

management.

2. Integrate knowledge about benign febrile seizure into existing knowledge associated with

caring for patient’s experiencing seizures.

3. Continue to develop compreshensive assessment and monitoring skills and abilities.

4. Discuss the links between evidence-based knowledge and practice in the care of patient

experiencing seizures.

5. Recommended interventions based on the risk factors, status, and progression of benign

febrile seizures.

6. Define the roles of healthcare professionals and the contribution they make to the health

care team.

3
 CHAPTER III

PATIENT’S PROFILE

Name: Chapapi

Address: Brgy. Demoloc, Malita, Davao Occidental

Age: 5 years old

Date of Birth: April 3, 2016

Place of Birth: Malita, Davao Occidental

Sex: Female

Civil Status: N/A

Religion: Born Again

Father: Mr. M

Mother: Mrs. M

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 COMPREHENSIVE ASSESSMENT

A. Personal Data

Name: Chapapi

Age: 5 years old

Civil Status: N/A

Religion: Born Again

Address: Brgy. Demoloc, Malita, Davao Occidental

Occupation: Nursery Student

Admitting Doctor: Delia Panuda, MD

Attending Physician: Dranreb Roigie Guiyab, MD

Date of Admission: May 5, 2021 (11:13 AM)

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 FUNCTIONAL PATTERN

Table1. Functional Pattern

GUIDELINES PATIENT’S NORMAL DAY 1

PATTERN (May 5, 2021)

I. MENTAL STATUS

State of Mental Consciousness Alert, conscious Inactive, Conscious

Orientation Well-oriented to time, place, Well-oriented to time, place,

and person and person

Vocabulary Level Able to speak local dialect Able to speak local dialect

(Cebuano) (Cebuano)

Attention Span 5-10 minutes Partly attentive

Ability to Understand Able to comprehend Able to comprehend

II. STATUS OF SPECIAL SENSES

Audio perception Can hear audibly Can hear audibly

Visual perception Good eyesight Good eyesight

Speech perception Can clearly speak Can clearly speak

Tactile perception Sensitive Sensitive

Olfactory perception Can determine odor Can determine odor

III. MOTOR ABILITY

Current mobility Ambulatory without assistance Ambulatory with assistance

Posture Good body mechanics, normal Good body mechanics, normal

curvature of the spine curvature of the spine

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Range of joint Movements Full range, partial, none at all Full range, partial, none at all

Muscle and nerve status Sensation and motion present Sensation and motion present

Loss of extremities None None

IV. BODY TEMPERATURE

Ranges 36.5ºC-37.5ºC 41ºC

V. RESPIRATORY STATUS

Character Resonant breath sound Resonant breath sound

RR:12-18bpm RR: 28 cycles per minute

Use of respiratory aids None None

Interfaces with respiration None None

Abnormal respiratory opening None None

VI. CIRCULATORY STATUS

Characteristics of arterial Regular, strong and palpable Strong and palpable

pulse

Blood pressure 110/70mmHg 130/90mmHg

Apical-Radical pulse Regular with pulse rate of 75- Strong with pulse rate of 130

110 bpm bpm

VII. NUTRITIONAL STATUS

Condition of buccal activity Intact, able, to chew, swallow Intact, able, to chew, swallow

and drink and drink

Digestion of food Normal Bowel Movement (+) bowel sound

VIII. ELIMINATION STATUS

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Bowel Brown, soft to firm in texture Sluggish bowel output

Regular at least once a day

Bladder Not distended, able to urinate Not distended, able to urinate

Abnormalities None None

IX. STATE OF SKIN AND APPENDAGES

Skin Radiant complexion Smooth, brown skin tone and

Rosy, smooth texture has a poor skin turgor.

Elastic

Hair Shiny, soft and smooth, no Black in color

presence of infestation Shiny, soft and smooth, no

presence of infestation

Nails Translucent, shiny and firm in Translucent, shiny and firm in

texture texture

X. STATE OF PHYSICAL REST AND COMFORT

Sleep/rest patterns 8 hours of sleep Disturbed sleeping pattern due

to difficulty of breathing

Presence of pain and None Presence of discomfort due to

discomfort fever

Use of supportive aids None None

XI. EMOTIONAL STATUS

Emotional reactions Able to react to stimuli Able to react to stimuli

Body Image Sympathetic and well Sympathetic and well

groomed groomed

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Ability to relate others Sociable and approachable to Sociable and approachable to

others others

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 SYSTEM ASSESSMENT

I. Central Nervous System

a) Inactive and oriented

b) Awake and responsive to stimuli

II. Respiratory System

a) Resonant sounds on both lung fields were heard upon auscultation

b) There were no adventitious breath sounds noted

c) RR: 28 cycles per minute

III. Musculoskeletal

a) Arms, thighs and calves were symmetrical in size.

b) Client is able to ambulate but with assistance

c) ROM: Full range on the upper extremities and lower extremities

IV. Gastro-intestinal System

a) Nothing per orem upon admissions

b) (+) Bowel sounds

V. Circulatory System

a) Bp of 130/90 mmHg

b) HR of 130 bpm

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 c) Capillary refill of more 3-4 seconds

VI. Integumentary System

a) Skin is fair and smooth, warm to touch and brown skin color

b) Upon assessing skin turgor, poor skin turgor.

c) Black in color, shiny, soft and smooth. No infestation of parasites is noted.

d) Nails are, round and well-trimmed, translucent, shiny and firm in texture.

Surrounding tissues in the nails are intact.

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 CHAPTER IV

HUMAN ANATOMY AND PHYSIOLOGY

The central nervous system (CNS) consists of the brain and spinal cord. The nervous

system coordinates and controls all body systems to a greater or lesser degree and, together with

the hormones of the endocrine system, fine-tunes a delicate homeostasis. Genetic inheritance is

possibly the only restriction placed on any individual child to use their body for whatever they

wish. Additionally, the anatomy of a child's lung is very similar to that of an adult. The lungs are

a pair of air-filled organs consisting of spongy tissue called lung parenchyma. Three lobes or

sections make up the right lung, and two lobes make up the left lung. The lungs are located on

either side of the thorax or chest and function to allow the body to receive oxygen and get rid of

carbon dioxide, a waste gas from metabolism.

Figure 1. Anatomy of the Brain

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Cerebrum

The cerebrum (front of brain) is composed of the right and left hemispheres. Functions of

the cerebrum include: initiation of movement, coordination of movement, temperature, touch,

vision, hearing, speech and language, judgment, reasoning, problem solving, emotions, and

learning.

Brainstem

The brainstem (middle of brain) includes the midbrain, the pons, and the medulla.

Functions of this area include: movement of the eyes and mouth, relaying sensory messages

(such as, hot, pain, or loud), hunger, respirations, consciousness, cardiac function, body

temperature, involuntary muscle movements, sneezing, coughing, vomiting, and swallowing.

Cerebellum

The cerebellum (back of brain) is located at the back of the head. Its function is to

coordinate voluntary muscle movements and to maintain posture, balance, and equilibrium.

Pons

A deep part of the brain, located in the brainstem, the pons contains many of the control

areas for eye and face movements.

Medulla

The lowest part of the brainstem, the medulla is the most vital part of the entire brain and

contains important control centers for the heart and lungs.

Spinal cord

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 A large bundle of nerve fibers located in the back that extends from the base of the brain

to the lower back, the spinal cord carries messages to and from the brain and the rest of the body.

Frontal lobe

The largest section of the brain located in the front of the head, the frontal lobe is

involved in judgment, decision-making, some language functions, personality characteristics,

and movement.

Parietal lobe

The middle part of the brain, the parietal lobe helps a person to identify objects and

understand spatial relationships (where one's body is compared to objects around the person).

The parietal lobe is also involved in interpreting pain and touch in the body.

Occipital lobe

The occipital lobe is the back part of the brain that is involved with vision.

Temporal lobe

The sides of the brain, these temporal lobes are involved in memory, speech, and sense

of smell.

Nerve growth

The principal cells of the brain are neurones. They have long processes of two types: the

single axon and one or more shorter dendrites. These neurones are the cells that carry messages

throughout the body, and they occupy half of the brain volume. The neurones are supported by a

group of cells called neuroglia, which provide nutrition, defence and repair of the neurons.

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 Figure 2. Brain growth, 30–100 days

Eye

The neural parts of the eye are evident at the fourth week after conception, when optic

grooves develop in the neural folds at the cranial end of the embryo. Eyelids develop from the

folds of the surface ectoderm and fuse at the eighth week of foetal life. Then then remain closed

until about week twenty-six of gestation (Matsumura and England 1992).

Ear

The outer ear, the auricle, grows at the same rate as the bodydeveloping from the dorsal

portion of the branchial groove. The inner ear, the middle ear cavity and the drum are of almost

adult size at birth. The inner ear develops as an otic pit either side of the hindbrain early in the

fourth week after conception, and is complete by the eighth week of embryonic life. The middle

ear develops from the first pharyngeal pouch and soon envelopes the middle ear bones which

develop from the first and second branchial arches.

Brain

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 The two hemispheres of the human brain are not mirror images of each other; the upper

surface of the temporal lobe and the whole occipital region is larger on the left side than on the

right. The left area receives, processes and is concerned with producing language. The right

hemisphere processes spatial information both visual and tactile. There is some debate as to

whether this difference is part of the difference between the brains of males and females. In the

newborn, the brain is 10–12 per cent of body weight and doubles in the first year of life. It

continues this growth spurt begun in mid-pregnancy. By two years the nerve dendrites will have

been pruned of the redundant pathways (Bee 1992).

Figure 3. The most active parts of the brain at birth

Reflexes

Young babies at birth are equipped with a number of primitive instinctive movements

which assist them to survive. These motor responses are extensions of those established during

foetal life. These patterns take the form of reflexes that are either present at birth or appear in

infancy. Some of the reflexes are simple and are mediated at the spinal cord level; others are

more complex and require the integration of brain centres, the labyrinths and other developing

nervous centres.

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Temperature control

The maintenance of body temperature is mainly coordinated by the hypothalamus, which

contains large numbers of heat-sensitive neurones. It is an important homeostatic mechanism

which allows the body enzymes to work efficiently. 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.

Airway

Outside of the thorax (chest cavity) includes the supraglottic (epiglottis), glottic (airway

opening to the trachea), and infraglottic (trachea) regions. The intrathoracic airway includes the

trachea, two mainstem bronchi, bronchi and bronchioles that conduct air to the alveoli.

Figure 4. Parts of the Lungs

Pharynx

Cavity located behind the mouth.

Larynx

Part of the windpipe that contains the vocal cords.

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Trachea

Also referred to as the windpipe, conducts into and out of the lungs

Lungs

A pair of spongy air-filled organs.

Bronchial tubes

Passages that carry the air and divide and branch as the travel through the lungs

Bronchioles

Tiny passages surrounded by bands of muscle that transport air throughout the lungs.

Bronchioles continue to divide into smaller and smaller units until they reach microscopic air

sacs called alveoli

Lung Alveoli

Clusters of balloon-like air sacs. Normal air flow to the lungs

Lung Interstitium

Thin layer of cells between alveoli that contain blood vessels and help support the

alveoli.

Pulmonary Blood Vessels

Tubes that carry blood to the lungs and throughout the body.

Lung Pleura

Thin tissue that covers the lungs.

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Lung Pleural Space

Area lined with a tissue called pleura and located between the lungs and the chest wall.

Diaphragm

A muscle in the abdomen that assist with breathing.

Lung Mucus

Sticky substance that lines the airways and traps dust and other particles inhaled.

Lung Cilia

Microscopic hair-like structures that extend from the surface of the cells lining the

airway. Covered in mucus, cilia trap particles and germs that are breathed in.

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 CHAPTER V
PATHOPHYSIOLOGY OF FEBRILE SEIZURE

A diagram depicting the pathogenesis of febrile seizures: During an infection,

lipopolysaccharide (LPS) is released, resulting in an inflammatory response. This causes

macrophages to release cytokines such as interleukin (IL)-1β, IL-6 and tumour necrosis factor

(TNF-α) which, along with LPS, disrupts the blood-brain-barrier causing it to become leaky.

Cytokines then enter through the blood-brain barrier and activate cyclooxygenase-2 (COX-2)

20
and microglia. The COX-2 then catalyses the formation of prostaglandin-E2 (PGE2) which

induces fever in the hypothalamus. In addition, activation of the microglia releases

proinflammatory and anti-inflammatory cytokines which include Il-1β and interleukin 1 receptor

antagonist (IL-1Ra) causing dysregulation of the glutamatergic and GABAergic circuits resulting

in seizures (Waruiru, et al., 2004. 15).

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 CHAPTER VI

DRUG STUDY
Amoxicillin

Generic Brand Classification Mechanism of Nursing Consideration Contraindication Dosage/Fr Route

Name Name Action equency

Amoxicilli Amoxil Aminopenicilli It is a -Assess the I and O a) Hypersensitivi 20mg/kg PO

n n semisynthetic report of the client since ty to
penicillin that acts penicillin has a high penicillins q8h
by inhibiting the dose of nephrotoxicity. b) Use cautiously
bacterial cell wall with renal
synthesis. disorders
-Assess for evidence of
adverse effects to the
patient.

-Note for any

hypersensitivity reaction

-Instruct clients that

therapeutic regimen
must be completed even
if symptoms subside.

23
-Clients with
Glomerular filtration
rate (GFR) of 10-30
mL/min should receive
250-500mg q12h.

-Monitor CBC, renal

and liver function tests.

-Report: bleeding, sore

throat, rash, diarrhea,
worsening of symptoms,
lack of response.

24
Paracetamol

Generic Brand Classification Mechanism of Nursing Consideration Contraindication Dosage/Fre Route

Name Name Action quency

Paracetam Biogesic Non-narcotic Paracetamol -Do not exceed a) Renal 30 mg/kg PO

ol analgesic, inhibits CNS 4gm/24hr. in adults and Insufficiency
Antipyretic prostaglandin 75mg/kg/day in children. b) Anemia
synthesis with
minimal effects
on peripheral -Do not take for >5days
prostaglandin for pain in children, 10
synthesis. It also days for pain in adults, or
inhibits the more than 3 days for
pyrogen effect on fever in adults.
the hypothalamic-
heat-regulating
centers. -Extended-Release
Paracetamol tablets are not to be
decreases fever by chewed.
a hypothalamic
effect leading to
sweating and
-Monitor CBC, liver and
vasodilation
renal functions.
which makes it an
effective drug for
reducing pain and
-Assess for fecal occult

25
fever. blood and nephritis.

-Take with food or milk

to minimize GI upset.

-Report N&V. cyanosis,

shortness of breath and
abdominal pain as these
are signs of toxicity.

-Report paleness,
weakness, and heartbeat
skips

-Report abdominal pain,

jaundice, dark urine,
itchiness or clay-colored
stools.

-This drug is not for

regular use with any form
of liver disease.

26
Diazepam

Generic Brand Classification Mechanism of Nursing Consideration Contraindicatio Dosage/Fre Route

Name Name Action n quency

Diazepam Valium Anxiolytic, Benzodiazepines, - Assess baseline vital a) Hypersensitiv 10 mg/ Rectal
hypnotic, such as diazepam, signs. ity 2mL
anticonvulsant, bind to receptors b) Preexisting
muscle in various regions CNS
relaxant of the brain and - Assess blood pressure, depression or
spinal cord. This pulse and respiration if coma
binding increases IV administration. c) Severe or
the inhibitory respiratory
effects of gamma- insufficiency
aminobutyric acid - Provide frequent sips of d) Myasthenia
(GABA). GABAs water for dry mouth. gravis
1–2.5 mg
functions include e) Sleep apnea PO
TID-QID
CNS involvement syndrome
in sleep induction. f) Severe
- Provide fluids and fibre
Also involved in hepatic
for constipation.
the control of insufficiency
hypnosis, g) Acute
memory, anxiety, porphyria
epilepsy and - Evaluate therapeutic h) Acute
neuronal response, mental state narrow-angle
excitability and physical dependency glaucoma
after long-term use. i) Chronic
(DrugBank psychosis
Online, 2015)

27
-Check for low blood
sugar, then treat or
prevent it.

-Give oxygen if needed

-If convulsions have not

stopped after 10 minutes
repeat diazepam dose

-Do not administer intra-

arterially; may produce
arteriospasm, gangrene.

-Monitor liver and renal

function, CBC during
long-term therapy.

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 COR JESU COLLEGE

Sto. Rosario, Tres De Mayo DIgos City

Health Sciences Division

NURSING CARE PLAN

Name: Chapapi Room & bed number: 285

Age: 5 yrs. old Attending Physician: Dranreb Roigie Guiyab MD

CC: Hyperthermia Diagnosis: Benign Febrile Seizure

Cues/Evidences Nursing Scientific Basis Objective of Nursing Rationale Evaluation

Diagnosis Care
Intervention

Objective: Hyperthermia Core body After 8 hours of a.) Adjust and a.) Room After 8 hours of
temperature nursing monitor temperature may nursing
a) Fussiness above the intervention the environmental be accustomed intervention the
b) Seizures / normal diurnal patient’s factors like room to near normal patient’s
convulsions range due to thermoregulatio temperature and body thermoregulatio
c) Skin warm failure of n will be back to bed linens as temperature. n is back to its
to touch thermoregulatio its normal state indicated. normal state as
d) Flushed skin n. as evidence by: evidence by:
e) Tachypnea
f) Tachycardia
b.) Give
(Pearson -Patient antipyretic b.) Antipyretic -Patient’s body
medications

29
V/S: Nursing maintains body medications or lower body temperature is
Diagnosis temperature paracetamol as temperature by lowered down
Temp: 41°C Handbook below 39° C prescribed. blocking the from 41°C to
HR: 130 bpm Edition 11) (102.2° F); synthesis of 38°C
prostaglandins
RR: 28cpm that act in the
BP: 130/90 -Patient hypothalamus. -Patient’s BP
mmHg maintains BP and HR within
and HR within normal limits.
normal limits. c.) Hyperthermia
c.) Ready increases the
oxygen therapy metabolic
for extreme demand for
cases. oxygen.

d.) Provide d.) Shivering

diazepam increases the
(Valium) when metabolic rate
excessive and body
shivering occurs. temperature.

e.) encourage e.) If the patient

ample fluid is dehydrated or
intake by mouth. diaphoretic,
fluid loss
contributes to
fever.

30
 f). Eliminate f.) Exposing
excess clothing skin to room air
and covers decreases
warmth and
increases
evaporative
cooling.

g.) Provide a
cooling mattress g.) To help
or cold packs promote cooling
applied to major and lower core
blood vessels or temperature.
give a tepid Alcohol cools
bath; do not use the skin too
alcohol. rapidly, causing
shivering.

31
 COR JESU COLLEGE

Sto. Rosario, Tres De Mayo DIgos City

Health Sciences Division

NURSING CARE PLAN

Name: Chapapi Room & bed number: 285

Age: 5 yrs. old Attending Physician: Dranreb Roigie Guiyab MD

CC: Risk for injury Diagnosis: Benign Febrile Seizure

Cues/Evidences Nursing Scientific Basis Objective of Nursing Rationale Evaluation

Diagnosis Care
Intervention

Objective: Risk for injury Vulnerable to After 4 hours of a.) Assess and a.)Documentatio After 4 hours of
r/t altered level physical damage nursing record seizure n of information nursing
a. Fussiness of consciousness due to intervention the activity and is essential for intervention the
b. Seizures / resulting from environmental patient will be location. Note the prevention of patient is free
convulsions seizure episode conditions free from injury the duration of injury or from injury
c. Skin warm secondary to interacting with when a seizure seizures, parts of complications as when a seizure
to touch benign febrile individual’s occurs and the the body a result of a occurs and the
d. Flushed skin seizure adaptive and parents will be involved, site of seizure. parents know
e. Tachypnea defensive able to know onset and what to do when
f. Tachycardia resources, which what to do when progression of it occurs.
may it occurs. seizure.

32
V/S: compromise
health.
Temp: 41°C
HR: 130 bpm b.) Assess skin b.) Once
(Pearson for pallor, seizures are
RR: 28cpm Nursing flushed, or prolonged and
BP: 130/90 Diagnosis cyanosis; respiration is
mmHg Handbook Monitor compromised,
Edition 11) respiratory rate, this will provide
depth, and signs information on
of respiratory possible signs of
distress. aspiration of
secretions.

c.) Side-lying
c.) Maintain facilitates
side-lying drainage of
position; Keep secretions and
padded side rails maintains airway
up with the bed patency; padding
in lowest protects the
position and child from injury
remove any during a seizure.
clutter from the
child.
d.) Restraining a
child can result
d.) Avoid in trauma due to
restraining the

33
 child or putting the amount of
anything in force exerted;
his/her mouth; inserting an
provide gentle object in mouth
support to head increases
and arms if harm stimuli; Padding
might result. the area helps to
protect the head
from injury.

e.) Stay with the e.) Provides

child during the support and
phase of prevents any
seizures, reorient injury to the
when awake, child.
and allow to rest
or sleep after an
episode.

f.) Advice
parents to f.) Allows
remain calm parents to
during seizure function
activity of the properly to
child. protect the child
from injury.

g.) Educate the

34
 parents g.) Guarantees
regarding safe and
precautionary effective
measures during interventions to
a seizure. avoid the
incidence of
injury.

h.) Teach about

information to
record about h.) Provides
seizure activity physicians with
should it occur important
(specify). information
needed to
prescribe
medical
regimen.
i.) Avoid using
thermometers
that can cause i.) Reduces risk
breakage. Use a of patient biting
tympanic and breaking
thermometer glass
when necessary thermometer or
to take the suffering injury
temperature. if sudden seizure

35
 activity should
occur.
j.) Provide
diazepam
(Valium) when
seizure occurs. j.) This is an
anticonvulsant
drug that can
reduce the risk
of recurring
febrile seizures.

36
 COR JESU COLLEGE

Sto. Rosario, Tres De Mayo DIgos City

Health Sciences Division

NURSING CARE PLAN

Name: Chapapi Room & bed number: 285

Age: 5 yrs. old Attending Physician: Dranreb Roigie Guiyab MD

CC: Imbalanced Nutrition Diagnosis: Benign Febrile Seizure

Cues/ Nursing Scientific Basis Objective of Nursing Rationale Evaluation

Evidences Diagnosis Care Intervention
Subjective Imbalanced The nutritional After 8 hours a. Review a. To obtain After 8 hours of
“Luya Nutrition: requirements of of nursing patient’s baseline nursing
akong Less than the the human body intervention, records. data. intervention, the
pamati sir” body reflect the
the patient patient was able
requirement nutritional b. Assess b. To
as will be able to:
related to intake necessary underlying determine
verbalized economical to maintain to: condition. specific
by the factors. optimal body intervention a. identify
patient function and to a. identify s. measures to
meet the body’s measures to promote
daily energy promote c. Discuss c. To achieve nutrition and
Objective needs. nutrition eating health needs follow the
Malnutrition and follow habits and of the treatment
(literally, “bad the encourage patient with regimen.

37
 nutrition”) is treatment diet for age. the proper
a. Weakness defined as regimen. food diet for b. Be in normal
“inadequate his disease. weight
b. Low nutrition,” and b. Be in
values
weight while most normal d. Note total d. To reveal
people interpret weight daily intake change that
c. Loss of values.
appetite this as includes should be
undernutrition, patterns and made in the
d. Poor falling short of time of client’s
muscle daily nutritional eating. dietary
tone requirements. intake.
The etiology of
malnutrition e. Consult e. For greater
includes factors physician understandi
such as poor for further ng and
food availability assessment further
and preparation, and assessment
recurrent recommend of specific
infections, and ation food.
lack of regarding
nutritional food
education. preferences
and
nutritional
support.

38
 COR JESU COLLEGE

Sto. Rosario, Tres De Mayo Digos City

Health Sciences Division

NURSING CARE PLAN

Name: Chupapi Room & bed number: 285

Age: 5 yrs. old Attending Physician: Dranreb Roigie Guiyab MD

CC: Difficult breathing pattern Diagnosis: Benign Febrile Seizure

Cues/Evidences Nursing Scientific Basis Objective of Nursing Rationale Evaluation

Diagnosis Care
Intervention

Objective: Ineffective After 4hrs of a) Place patient a) A sitting After 4hrs of

breathing pattern When the nursing with proper position nursing
a) Fussiness as evidenced by abdominal wall intervention the body permits intervention the
b) Seizures / respiration rate excursion during pt can: alignment maximum pt:
convulsions of 28 bpm. inspiration, for lung
c) Skin warm expiration, or maximum excursion a) maintained
to touch both do not breathing and chest an effective
d) Flushed skin a) maintains breathing
maintain an effective pattern. expansion.
e) Tachypnea optimum pattern, as
f) Tachycardia breathing evidenced by
ventilation for the pattern, as b) Encourage
individual, the sustained b) These relaxed
evidenced techniques breathing at

39
V/S: nursing diagnosis by relaxed deep breaths promote normal rate
Ineffective breathing at by: deep and depth
Temp: 41°C Breathing Pattern normal rate • Using inspiration, and absence
HR: 130 bpm is one of the and depth demonstr which of dyspnea.
issues nurses and absence ation: increases b) Patient’s
RR: 28cpm need to focus on. of dyspnea. highlight oxygenation respiratory
BP: 130/90 It is considered Patient’s ing slow and prevents rate
mmHg the state in which respiratory rate inhalatio atelectasis. remained
the rate, depth, remains within n, Controlled within
timing, and established holding breathing established
rhythm, or the limits. end methods may limits.
pattern of inspiratio also aid slow d) Patient
breathing is a) Patient’s respirations indicated
n for a
altered. When the respiration in patients verbally and
few
breathing pattern rate return who are through
seconds,
is ineffective, the to and tachypneic. behavior,
and
body is most remain Prolonged feeling
passive
likely not getting within expiration comfortable
exhalatio
enough oxygen to established prevents air when
n
limits.
the cells. • Utilizing trapping. breathing.
Respiratory b) Patient e) Patient
incentive
failure may be indicates, reported
spiromet
correlated with either feeling
er
verbally or
variations in
through • Requirin rested each
respiratory rate, g the day.
abdominal, and behavior,
feeling patient to
thoracic pattern yawn
(Nurseslabs.com). comfortable GOAL MET!
when
breathing.

40
c) Patient
reports
feeling c) Encourage c) This method
rested each diaphragmati relaxes
day. c breathing muscles and
for patients increases the
with chronic patient’s
disease. oxygen
d) Evaluate the level.
appropriaten d) This training
ess of improves
inspiratory conscious
muscle control of
training. respiratory
muscles and
inspiratory
muscle
strength.

e) Beta-
e) Provide adrenergic
respiratory agonist
medications medications
and oxygen, relax airway
per doctor’s smooth
orders. muscles and
cause
bronchodilati
on to open

41
 air passages.
f) Avoid high f) Hypoxia
concentratio triggers the
n of oxygen drive to
in patients breathe in
with COPD. the chronic
CO2 retainer
patient.
When
administerin
g oxygen,
close
monitoring is
very
important to
avoid
uncertain
risings in the
patient’s
PaO2, which
could lead to
apnea.

42
 g) Maintain a g) This
clear airway facilitates
by adequate
encouraging clearance of
patient to secretions.
mobilize
own
secretions
with
successful
coughing.
h) Suction h) This is to
secretions, as clear
necessary. blockage in
airway.
i) Stay with the i) This will
patient reduce the
during acute patient’s
episodes of anxiety,
respiratory thereby
distress. reducing
oxygen
demand.

j) Ambulate j) Ambulation
patient as can further
tolerated break up and
with doctor’s move
order three secretions
times daily. that block

43
 the airways.

k) Encourage k) Extra
frequent rest activity can
periods and worsen
teach patient shortness of
to pace breath.
activity. Ensure the
patient rests
between
strenuous
activities.

l) Avail a fan l) Moving air

in the room. can decrease
feelings of
air hunger.

44
 COR JESU COLLEGE

Sto. Rosario, Tres De Mayo DIgos City

Health Sciences Division

NURSING CARE PLAN

Name: Chapapi Room & bed number: 285

Age: 5 yrs. old Attending Physician: Dranreb Roigie Guiyab MD

CC: Unfamiliarity of the condition Diagnosis: Benign Febrile Seizure

Cues/Evidences Nursing Scientific Basis Objective of Nursing Rationale Evaluation

Diagnosis Care
Intervention

Subjective: Deficient Febrile seizures After 3 hours of a) Assess a) Provides After 3 hours of
Knowledge are seizures that nursing parents’ information nursing
“We need more related to lack of happen in intervention perceptions regarding the intervention
information exposure to children between Parents will and long-term Parents obtained
regarding with information the ages of 6 obtain knowledge care of a information
my daughter’s about ongoing months and 5 information about disease child with a regarding care of
condition” as care as years, that is regarding care of condition, seizure the child.
verbalized by evidenced by associated with the child. fears, and disorder and
the mother of the expressed high fever but misconceptio how to deal
patient. request for with an absence ns about with seizures GOAL MET!
Objective: information of intracranial disorder, and the

45
a) Fussiness about infection, nature, and stigma
b) Seizures / medication metabolic frequency of attached to
convulsions treatment conditions, or seizures. this disorder.
c) Skin warm previous history b) Educate b) Understandi
to touch of febrile parents that a ng this
d) Flushed skin seizures. It is febrile information
e) Tachypnea subdivided into seizure is can help the
f) Tachycardia 2 classifications: more of a parent
A simple febrile symptom of understand
seizure is brief, fever than a the
V/S: isolated, and long-term responsibilit
Temp: 41°C generalized condition. y to take for
while a complex future care.
HR: 130 bpm febrile seizure is c) Advise c) These are the
RR: 28cpm prolonged parents and side effects
(duration of child to of
BP: 130/90 more than 15 report anticonvulsa
mmHg minutes), focal dizziness, nts and
(occurs in one drowsiness, sedatives.
part of the gastrointesti
brain), or nal upset,
multiple (occurs nausea,
more than once vomiting,
within 24 hours). photosensitiv
ity, and rash.
d) Inform d) Prevents
parents about toxicity and
the need for other severe
follow up side effects
laboratory of drug

46
 studies such therapy by
as blood adjusting the
count and dosage or
liver changing
function test medications.
as indicated. e) Increases
e) Inform that knowledge
seizures may and
be provoked understandin
by an illness g of causes
or infection, of increased
hyperactivity frequency of
, lack of seizures.
sleep, abrupt
discontinuati
on of
medication,
emotional
stress, or
other causes
specific to
the child. f) Provides
f) Advise precautions
parents to to prevent
supervise the injury as a
child in the result of a
bathroom, seizure.
avoid
exposure to
incidents that

47
 trigger a
seizure,
avoid
dangerous
play and
toys, pad
areas in bed,
or wear
protective
clothing if
g) Promotes
needed.
knowledge
g) Encourage
and
parents to
understandin
notify school
g to prevent
nurse and
injury and
teach of
embarrassme
disorder and
nt to the
actions to
child.
take
including a
telephone
number to
call. h) Promotes
h) Discuss any knowledge
activity of activity
restrictions based on
such as individual
sports, rough child and
play, need seizure
for someone activity and

48
 in response to
attendance. therapy.

i) Indicates
i) Alert parents effects of
of possible anticonvulsa
changes in nts on
behavior, behavior and
activity, or learning.
personality
or changes in
school
performance
or
interactions
with family
and peers.

49
 MANAGEMENT

Name: Chapapi Munyan Age: 5 yrs. old Weight (kg): 18 kg

Height/Length (cm): 110 cm Temperature: 41°C

A. ASSESSMENT

ASSESS

CLASSIFY

CHECK FOR GENERAL DANGER SIGN General danger

sign
● NOT ABLE TO DRINK OR BREASTFEED

● VOMITS EVERYTHING present?

● CONVULSIONS
Yes _🗸 No ___
● LETHARGIC OR UNCONSCIOUS

● CONVULSING NOW

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes No _🗸

● For how long? ___ Days

● Count the breaths in one minute: _28_ breaths per minute. Fast
Yes
breathing?

● Look for chest indrawing

● Look and listen for stridor No

● Look and listen for wheezing

No

No

51
DOES THE CHILD HAVE DIARRHOEA? Yes No _🗸

● For how long? ___ Days

● Is there blood in the stool?

● Look at the child's general condition. Is the child:

Lethargic or unconscious?

Restless and irritable?

● Look for sunken eyes.

● Offer the child fluid. Is the child:

Not able to drink or drinking poorly?

Drinking eagerly, thirsty?

● Pinch the skin of the abdomen. Does it go back:

Very slowly (longer than 2 seconds)? Slowly?

DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature Yes _🗸 No ___

37.5 degrees celsius or above)

Decide malaria risk: High ___ Low ___ No_🗸

● If more than 7 days, has fever been present every day?

No
● Has the child had measles within the last 3 months?
No
● Look or feel for stiff neck

● Look for runny nose

● Look for signs of MEASLES:

52
 Generalized rash and No

One of these: cough, runny nose, or red eyes

● Look for any other cause of fever None

Do a malaria test, if NO general danger sign in all cases in

None

high malaria risk or NO obvious cause of fever in low

malaria risk:

Test POSITIVE? P. falciparum P. vivax NEGATIVE?

NEGATIVE

DOES THE CHILD HAVE AN EAR PROBLEM? Yes No _🗸

● Is there ear pain?

● Is there ear discharge? If Yes, for how long? ___ Days

● Look for pus draining from the ear

● Feel for tender swelling behind the ear

CHECK THE CHILD'S IMMUNIZATION STATUS Completely

vaccinated

53
 B. CASE DATA

The table below shows the numbers of days, a brief description about the specific day,

and findings related to the client’s health..

DAY BRIEF DESCRIPTION FINDINGS

5 -Had a consultation at the

barangay health station and

was managed

symptomatically.

9 - Was again evaluated - completed 7 days of therapy and had no

because of persistence of improvement of her fevers.

fever

-5-day course of amoxicillin

LAB RESULT:
was prescribed
CBC - normal

chest radiography - normal

12 -Persistent fever V/S: Temp - 105.8°F (41°C)

-Got hospitalized Physical Examination Finding: fussy

-Continues to spike daily LAB RESULT:

fevers
● WBC count - 12,340/μL (12.34×109/L)

54
-Examination results remain (75% neutrophils, 18% lymphocytes, and

unchanged 7% monocytes)

● Hemoglobin (hbg) Â level - 12.4 g/dL

-Remains in the hospital for
(124 g/L)
monitoring of fever and a
● Hematocrit(HCT) value - 37.4%
stepwise approach to
● Platelet count - 53×103/μL
evaluate the cause of
● Erythrocyte sedimentation rate - 49
her fever.
mm/hour

● C-reactive protein level - <0.5 mg/dL

(<4.8 nmol/L)

● Serum electrolyte levels - essentially

normal

● Low Carbon dioxide levels - 17 mEq/L (17

mmol/L)

● Urine and blood culture - no growth

● Tuberculin skin test (TST) - non reactive

● NEGATIVE: polymerase chain reaction

(PCR) studies for influenza, respiratory

syncytial virus, parainfluenza, adenovirus,

and human metapneumovirus

● Chest Radiograph: no cardiopulmonary

55
 abnormalities

19 -Client becomes LAB RESULT:

encephalopathic
( 7th day of ● CT scan of head - normal

admission) -Develops seizures and is ● MRI - shows multifocal areas of

transferred to the ICU hyperintense flair signal and restricted

diffusion suggestive of encephalitis

○ no evidence of cerebral abscess

Cerebrospinal fluid (CSF) has the ff:

● WBC count - 150/μL (0.15×109/L) (85%

lymphocytes, 5% neutrophils, and 10%

monocytes)

● RBC count - 4/μL (0.04×109/L)

● CSF glucose level - 23 mg/dL (1.28

mmol/L)

● Blood glucose level - 120 mg/dL (6.66

mmol/L)

● Protein level - 0.118 g/dL (1.18 g/L)

OTHER FINDINGS:

● CSF Gram-stain and acid-fast bacilli

(AFB) smear - NEGATIVE

● Herpes simplex virus in CSF -

56
 NEGATIVE

● Enterovirus PCR in the CSF - NEGATIVE

20 -Blood test was conducted POSITIVE for Benign Febrile Seizures

C. REMARKS

The client was assessed in order to come up with the diagnosis. The

parents were asked about certain activities, the locations they went to and what

the client consumed for the past few days before the symptoms arose. With the

help of the IMCI booklet and guidelines, the group was able to know the danger

signs of a specific illness or diseases commonly present in rural areas and to

children. In this case, the client has been diagnosed of benign febrile seizures as

evidenced by the persistent high fever, convulsions and the lab results. The case

of the client is classified as a very severe febrile disease as it was known that the

client had convulsions which later on developed into encephalopathy which can

cause temporary or permanent brain damage if left untreated. As we go further to

this topic, the management of the problem and the drug studies will be shown in

this chapter.

57
 CHAPTER VII

GLOSSARY OF TERMS

Benign Febrile Seizure - is a convulsion in a child that's caused by a fever, often from

an infection. Febrile seizures occur in young, healthy children who have normal

development and haven't had any neurological symptoms before.

Encephalopathy - is a term for any diffuse disease of the brain that alters brain function

or structure.

Polymerase Chain Reaction (PCR) - a technique used to make numerous copies of a

specific segment of DNA quickly and accurately.

Tuberculin Skin Test - a test that determines if someone has developed an immune

response to the bacterium that causes tuberculosis (TB).

Gram Stain - a test that checks for bacteria at the site of a suspected infection or in

certain body fluids, such as blood or urine.

AFB Smear - a microscopic examination of a person's sputum or other specimen that is

stained to detect acid-fast bacteria.

58
 CHAPTER VIII

BIBLIOGRAPHY

Berg, A. T. (1997). Predictors of Recurrent Febrile Seizures. Archives of Pediatrics &

Adolescent Medicine, 151(4), 371.

https://doi.org/10.1001/archpedi.1997.02170410045006

Febrile seizure - Symptoms and causes. (2021, February 24). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/febrile-seizure/symptoms-

causes/syc-

20372522#:%7E:text=A%20febrile%20seizure%20is%20a,had%20any%20neuro

logical%20symptoms%20before

John M. Pellock, S. S. D. (2013). Recent Research on Febrile Seizures: A Review.

Journal of Neurology & Neurophysiology, 04(04). https://doi.org/10.4172/2155-

9562.1000165

Knudsen, F. U. (2000). Febrile Seizures: Treatment and Prognosis. Epilepsia, 41(1), 2–9.

https://doi.org/10.1111/j.1528-1157.2000.tb01497.x

Marieb, E. (2003). Essentials of Human Anatomy and Physiology (7th ed.). Pearson

Education.

Ninia, J. G. (2000). Inherited coagulopathies in OB/GYN. Primary Care Update for

OB/GYNS, 7(2), 70–73. https://doi.org/10.1016/s1068-607x(00)00024-x

Practical Bee Anatomy: with Notes on the Embryology, Metamorphoses and Physiology

of the Honey Bee. (1924). Nature, 113(2829), 79.

https://doi.org/10.1038/113079b0

59
Sadleir, L. G., & Scheffer, I. E. (2007). Febrile seizures. BMJ, 334(7588), 307–311.

https://doi.org/10.1136/bmj.39087.691817.ae

The Editors of Encyclopaedia Britannica. (2019, April 18). polymerase chain reaction |

Definition & Steps. Encyclopedia Britannica.

https://www.britannica.com/science/polymerase-chain-reaction

The Editors of Encyclopaedia Britannica. (2020, May 20). Mammary gland | anatomy.

Encyclopedia Britannica. https://www.britannica.com/science/mammary-gland

the Healthline Editorial Team. (2020, July 14). Circulatory. Healthline.

https://www.healthline.com/human-body-maps/circulatory-system

Tuberculosis Skin Test (PPD): Reading, Results, Side Effects & Risks. (2019, September

11). MedicineNet.

https://www.medicinenet.com/tuberculosis_skin_test_ppd_skin_test/article.htm

Xixis, K. L. (2021, January 23). Febrile Seizure - StatPearls - NCBI Bookshelf. Febrile

Seizure. https://www.ncbi.nlm.nih.gov/books/NBK448123/

60