A. DefinitionFebrile
seizures or febrile convulsion seizures are occurring at an increase in
body temperature (rectal temperature above 38 ° C) caused by process
ekstrakranium (Ngastiyah, 1997:229).
B. EtiologySeizures in infants and children caused by a rise in body temperature is high and fast, which is caused by infection outside the central nervous system such as: media ostitis acute tonsillitis, bronchitis, etc.
C. Pathophysiology
D. Clinical ManifestationsSeizures usually occur during the first 24 hours of fever, was brief with nature can take the form of seizures tonic-clonic, tonic, clonic, focal or akinetik. Generally seizures stopped himself. Once the child's seizures stopped for a moment did not give any reaction but after a few seconds or minutes the child will be realized without any neurological abnormalities.Children in Sub-section FKUI RSCM Jakarta, Livingstone criteria used as guidelines for making the diagnosis of simple febrile seizures, namely:· Age child when seizures between 6 months and 4 years· Seizures lasted no more than 15 minutes· Seizures are common· Seizures arising in the first of 16 hours after the onset of fever· Neurological examination before and after seizures normal· EEG examination made at least one week after the normal temperature showed no abnormalities· Frequency of seizure generation in one year does not exceed four times
E. Medical TreatmentIn the handling of febrile seizures there are 4 factors that need to be done, namely:· Elimination of seizures as soon as possibleEradication seizure in subsection Child Neurology, Section of Child Health, Faculty of Medicine as follows:If a child comes in a state of spasm, then:1. Immediately given IV diazepam ® average dose 0.3 mg / kgOrdiazepam rectal dose £ 10 kg: 5 mgif seizures are not stopped ≥ 10 kg: 10 mgwait 15 minutescan be repeated in a way / same dose samapai seizures stoppedgiven an initial dose of phenobarbital at a dose:neonates: 30 mg IM1 month - 1 year: 50 mg IM> 1 year: 75 mg IM2. When diazepam is not available, directly using a starting dose of phenobarbital and subsequently forwarded to the rumat dose.· First aid at the time of seizure1. All tight clothing is opened2. The position of the head should be tilted to prevent aspiration of gastric contents3. Try to keep the airway bebasuntuk ensure oxygen demand4. Suctioning should be done regularly and given oxygen· Treatment rumatPhenobarbital maintenance dose: 8-10 mg / kg divided into 2 doses on the first day, the second passed 4-5 mg / kg divided into 2 doses the next day.· Finding and treating the causeCause of febrile seizures are upper respiratory infections and acute astitis media. Adequate antibiotics to treat the disease. In patients with known seizure as long intensive inspection lumbar function, potassium, magnesium, calcium, sodium and liver physiology. If necessary X-ray photograph skull, EEG, ensefalografi, etc..
F. The concept of Nursing Care In Patients With Febrile seizuresThe steps in the nursing process include:1. AssessmentObjective Data1. General Examination (Corry S, 2000 case: 36)First note the general state vital: the level of consciousness, blood pressure, pulse, respiration and temperature. At a simple febrile seizure will get a high temperature while consciousness after a seizure will return to normal as before seizures without neurological abnormalities.2. Physical examinationHeadAre there any signs or makrosepali micro? Are there any head shape dispersion? What are the signs intrakarnial pressure increase, which is the crown of a large convex, how are the crown of a massive cover or not?.HairStarted colors, cover, distribution and other characteristics of hair. Patients with protein-energy malnutrition have a rare hair, red hair like corn and easily removed without causing pain to the patient.Face / face.Facial paralysis caused facial asymmetry; paresis left side when the child cries or laughs, so that their faces to the healthy side. Are there signs rhisus sardonicus, opisthotonos, trimus? Is there a cranial nerve disorder?EyeWhen a seizure occurs dilated pupils, for the pupils, and visual acuity check. Is the state of the sclera, conjunctiva?EarCheck the function of the ear, ear cleaning as well as the signs of infection such as swelling and pain in the area behind the ears, discharge from the ears, decreased hearing.NoseAre there nostril breathing? Polyps are blocking the airway? Is out secretions, how consistency, the numbers?MouthSardonicus there signs? Is there cynosis? How does the state of the tongue? Is there stomatitis? How many teeth are growing? Are there any dental caries?ThroatAre there signs of inflammation of tonsils? Are there signs of pharyngeal infection, fluid exudates?NeckAre there signs of a stiff neck, enlargement of the thyroid gland? Is there a vein enlargement jugulans?ThoraxOn infection, observe chest shape clients, how to respiratory motion, frequency, rhythm, depth, is there a retractionIntercostale? On auscultation, breath sounds are there additional?HeartHow state and cardiac frequency and rhythm? Are there additional sound? Is there bradicardi or tachycardia?AbdomenIs there distensia abdomen and the abdominal muscle stiffness? How skin turgor and intestinal peristalsis? Are there signs meteorismus? Is there an enlarged spleen and liver?SkinWhat is the state of cleanliness and good skin color? Is there edema, hemangioma? What is the state of skin turgor?ExtremityIs there edema, or paralise especially after having a seizure? How does the temperature on acral areas?
GenetaliaIs there any deformity edema, secretions coming out of the vagina, signs of infection?2. Examination SupportDepending on available facilities where patients are treated, the examination includes:1. BloodComplete blood count, TT, WidalBlood Glucose: Hypoglycemia is a predisposition to seizures (N <200 mq / dl)BUN: BUN Increased seizures and is potentially toxic due Nepro indication of drug administration.Electrolytes: K, Na: Electrolyte imbalance predisposes to seizures.Potassium (N from 3.80 to 5.00 meq / dl)Sodium (N 135-144 mEq / dl)2. Cerebral Spinal Fluid: Detecting abnormal pressure of CCS signs of infection, bleeding cause seizures.3. Skull Ray: To identify the process chamber and the lesions persisted4. Tansiluminasi: A way done in infants with Uub is still open (under 2 years) in a dark room with a special lamp for transillumination head.5. EEG: Techniques to suppress the electrical activity of the brain through the intact skull to determine the focus of seizure activity, the results are usually normal.6. CT Scan: To identify lesions infaik cerebral hematoma, cerebral edema, trauma, abscesses, tumors with or without contrast.3. Nursing diagnoses that appear are:1. Ineffective breathing pattern related to neuromuscular damage.2. The risk of recurrent seizures related to hiperthermi.- Respiration 40-60 x / mnt- Not of aspirationIntervention:1. patient's mouth clear of objects such terentu dentures and food during the seizure phase2. tilt the patient's head during the seizure phase3. Put your clothes on the neck or chest and abdomen4. Put spatel tongue or artificial airway or soft object rolls5. Suction as indicatedCollaboration:Give supplemental oxygen
DX 2: Risk of seizures associated with hyperthermia reObjective: The client does not have seizures during intercourse with hiperthermiOutcomes:1. Seizure does not occur again.2. Temperature from 36.5 to 37.5 º C (baby), 36 to 37.5 º C (children)
24-28 x / min (child)5. Awareness composmentisPlan of Action:1. Loosen clothing, give light clothing that easily absorbs sweat.2. Give cold compress3. Give extra fluids (milk, juice, etc.).4. Observation seizures and vital signs every 4 hours5. Limit activity bsp;: No physical trauma during treatment.Criteria results:1. Physical trauma does not occur during treatment.2. Maintaining control measures seizure activity.3. Identify actions that must be given when having a seizure.Plan of Action:1. Give safety on the side of the bed and use a low bed.2. Tinggalah with clients during the seizure phase ..3. Give spatel tongue between the upper and lower teeth ..4. Place the client in a soft spot.5. Record seizure types (location, time) and the frequency of seizures ..6. Record vital signs after seizure phase
DX 4: Nursing Diagnosis / Concern: Impaired sense of comfort associated with hiperthermi.Objective: Feeling comfortable fulfilledExpected outcomes: body temperature 36 to 37.5 º C, N; 100-110 x / min,
RR: 24-28 x / min, Awareness composmentis, not fussy child.Plan of Action:1. Assess factors - factors hiperthermi occurrence.
Observation of signs - vital signs every 4 hours
Maintain normal body temperature2. Teach the family gave a cold compress on the head / armpit.
Suggest to use a thin shirt and made of cotton fabric3. Leave the room window open4. Give extra fluids to drink a lot of patient advocate
Limit physical activity.
Dx 5: Lack of knowledge of the family in relation to lack of informationObjective: increase family knowledge about her illness.Outcomes:1. Families do not often ask about his illness.2. Families are able to participate in the nursing process.3. family obeying all the nursing process.Plan of Action:1. Assess the level of knowledge of family2. Give an explanation to the family of the causes and consequences of febrile seizures3. Describe any maintenance action to be performed.4. Provide Health Education on how to help children prevent seizures and febrile seizures, among others:1. Do not panic when seizures2. Lay the child flat and gentle place.3. Head tilted.4. Put the spoon handles have wrapped a wet cloth, and then put into the mouth.5. After the seizures stopped and the patient unconscious drug soon Drinks wait until things calm.6. If the high temperature during seizures do cold compresses and give a lot of drinking7. Immediately brought to the hospital when a long seizures.5. Provide Health Education in order to be on hand febrifuge, when children heat.6. If the child recovers, keep children not exposed to infectious diseases by avoiding people or friends who suffer from infectious diseases that do not trigger an increase in temperature.7. Tell the family if the children will be immunized in order to inform the officer that her son had suffered immunization febrile seizures.
REFERENCES
MOH. , 1989. Baby And Child Care. Ed 1. Jakarta: Center for Health Manpower Education.
Lumbantobing, SM.1989.Penatalaksanaan Muthakhir Seizures In Anak.Jakarta: FKUI
Sachann, M Rossa. , 1996. Pediatric Nursing principle. Jakarta: EGC.
Suriadi, dkk2001. Askep In Children. Jakarta. Interpratama Dawn Pt.
Sataf Instructor of Pediatrics School of Medicine. 2000. Lecture Two books of Pediatrics. Jakarta: Jakarta Medika Printing Info
Ngastiyah. , 2005. Sick Child Care, ed 2. Jakarta: EGC.
Hidayat, aziz alimun. 2006. Introduction to Nursing Children. Jakarta: Salemba.
B. EtiologySeizures in infants and children caused by a rise in body temperature is high and fast, which is caused by infection outside the central nervous system such as: media ostitis acute tonsillitis, bronchitis, etc.
C. Pathophysiology
D. Clinical ManifestationsSeizures usually occur during the first 24 hours of fever, was brief with nature can take the form of seizures tonic-clonic, tonic, clonic, focal or akinetik. Generally seizures stopped himself. Once the child's seizures stopped for a moment did not give any reaction but after a few seconds or minutes the child will be realized without any neurological abnormalities.Children in Sub-section FKUI RSCM Jakarta, Livingstone criteria used as guidelines for making the diagnosis of simple febrile seizures, namely:· Age child when seizures between 6 months and 4 years· Seizures lasted no more than 15 minutes· Seizures are common· Seizures arising in the first of 16 hours after the onset of fever· Neurological examination before and after seizures normal· EEG examination made at least one week after the normal temperature showed no abnormalities· Frequency of seizure generation in one year does not exceed four times
E. Medical TreatmentIn the handling of febrile seizures there are 4 factors that need to be done, namely:· Elimination of seizures as soon as possibleEradication seizure in subsection Child Neurology, Section of Child Health, Faculty of Medicine as follows:If a child comes in a state of spasm, then:1. Immediately given IV diazepam ® average dose 0.3 mg / kgOrdiazepam rectal dose £ 10 kg: 5 mgif seizures are not stopped ≥ 10 kg: 10 mgwait 15 minutescan be repeated in a way / same dose samapai seizures stoppedgiven an initial dose of phenobarbital at a dose:neonates: 30 mg IM1 month - 1 year: 50 mg IM> 1 year: 75 mg IM2. When diazepam is not available, directly using a starting dose of phenobarbital and subsequently forwarded to the rumat dose.· First aid at the time of seizure1. All tight clothing is opened2. The position of the head should be tilted to prevent aspiration of gastric contents3. Try to keep the airway bebasuntuk ensure oxygen demand4. Suctioning should be done regularly and given oxygen· Treatment rumatPhenobarbital maintenance dose: 8-10 mg / kg divided into 2 doses on the first day, the second passed 4-5 mg / kg divided into 2 doses the next day.· Finding and treating the causeCause of febrile seizures are upper respiratory infections and acute astitis media. Adequate antibiotics to treat the disease. In patients with known seizure as long intensive inspection lumbar function, potassium, magnesium, calcium, sodium and liver physiology. If necessary X-ray photograph skull, EEG, ensefalografi, etc..
F. The concept of Nursing Care In Patients With Febrile seizuresThe steps in the nursing process include:1. AssessmentObjective Data1. General Examination (Corry S, 2000 case: 36)First note the general state vital: the level of consciousness, blood pressure, pulse, respiration and temperature. At a simple febrile seizure will get a high temperature while consciousness after a seizure will return to normal as before seizures without neurological abnormalities.2. Physical examinationHeadAre there any signs or makrosepali micro? Are there any head shape dispersion? What are the signs intrakarnial pressure increase, which is the crown of a large convex, how are the crown of a massive cover or not?.HairStarted colors, cover, distribution and other characteristics of hair. Patients with protein-energy malnutrition have a rare hair, red hair like corn and easily removed without causing pain to the patient.Face / face.Facial paralysis caused facial asymmetry; paresis left side when the child cries or laughs, so that their faces to the healthy side. Are there signs rhisus sardonicus, opisthotonos, trimus? Is there a cranial nerve disorder?EyeWhen a seizure occurs dilated pupils, for the pupils, and visual acuity check. Is the state of the sclera, conjunctiva?EarCheck the function of the ear, ear cleaning as well as the signs of infection such as swelling and pain in the area behind the ears, discharge from the ears, decreased hearing.NoseAre there nostril breathing? Polyps are blocking the airway? Is out secretions, how consistency, the numbers?MouthSardonicus there signs? Is there cynosis? How does the state of the tongue? Is there stomatitis? How many teeth are growing? Are there any dental caries?ThroatAre there signs of inflammation of tonsils? Are there signs of pharyngeal infection, fluid exudates?NeckAre there signs of a stiff neck, enlargement of the thyroid gland? Is there a vein enlargement jugulans?ThoraxOn infection, observe chest shape clients, how to respiratory motion, frequency, rhythm, depth, is there a retractionIntercostale? On auscultation, breath sounds are there additional?HeartHow state and cardiac frequency and rhythm? Are there additional sound? Is there bradicardi or tachycardia?AbdomenIs there distensia abdomen and the abdominal muscle stiffness? How skin turgor and intestinal peristalsis? Are there signs meteorismus? Is there an enlarged spleen and liver?SkinWhat is the state of cleanliness and good skin color? Is there edema, hemangioma? What is the state of skin turgor?ExtremityIs there edema, or paralise especially after having a seizure? How does the temperature on acral areas?
GenetaliaIs there any deformity edema, secretions coming out of the vagina, signs of infection?2. Examination SupportDepending on available facilities where patients are treated, the examination includes:1. BloodComplete blood count, TT, WidalBlood Glucose: Hypoglycemia is a predisposition to seizures (N <200 mq / dl)BUN: BUN Increased seizures and is potentially toxic due Nepro indication of drug administration.Electrolytes: K, Na: Electrolyte imbalance predisposes to seizures.Potassium (N from 3.80 to 5.00 meq / dl)Sodium (N 135-144 mEq / dl)2. Cerebral Spinal Fluid: Detecting abnormal pressure of CCS signs of infection, bleeding cause seizures.3. Skull Ray: To identify the process chamber and the lesions persisted4. Tansiluminasi: A way done in infants with Uub is still open (under 2 years) in a dark room with a special lamp for transillumination head.5. EEG: Techniques to suppress the electrical activity of the brain through the intact skull to determine the focus of seizure activity, the results are usually normal.6. CT Scan: To identify lesions infaik cerebral hematoma, cerebral edema, trauma, abscesses, tumors with or without contrast.3. Nursing diagnoses that appear are:1. Ineffective breathing pattern related to neuromuscular damage.2. The risk of recurrent seizures related to hiperthermi.- Respiration 40-60 x / mnt- Not of aspirationIntervention:1. patient's mouth clear of objects such terentu dentures and food during the seizure phase2. tilt the patient's head during the seizure phase3. Put your clothes on the neck or chest and abdomen4. Put spatel tongue or artificial airway or soft object rolls5. Suction as indicatedCollaboration:Give supplemental oxygen
DX 2: Risk of seizures associated with hyperthermia reObjective: The client does not have seizures during intercourse with hiperthermiOutcomes:1. Seizure does not occur again.2. Temperature from 36.5 to 37.5 º C (baby), 36 to 37.5 º C (children)
24-28 x / min (child)5. Awareness composmentisPlan of Action:1. Loosen clothing, give light clothing that easily absorbs sweat.2. Give cold compress3. Give extra fluids (milk, juice, etc.).4. Observation seizures and vital signs every 4 hours5. Limit activity bsp;: No physical trauma during treatment.Criteria results:1. Physical trauma does not occur during treatment.2. Maintaining control measures seizure activity.3. Identify actions that must be given when having a seizure.Plan of Action:1. Give safety on the side of the bed and use a low bed.2. Tinggalah with clients during the seizure phase ..3. Give spatel tongue between the upper and lower teeth ..4. Place the client in a soft spot.5. Record seizure types (location, time) and the frequency of seizures ..6. Record vital signs after seizure phase
DX 4: Nursing Diagnosis / Concern: Impaired sense of comfort associated with hiperthermi.Objective: Feeling comfortable fulfilledExpected outcomes: body temperature 36 to 37.5 º C, N; 100-110 x / min,
RR: 24-28 x / min, Awareness composmentis, not fussy child.Plan of Action:1. Assess factors - factors hiperthermi occurrence.
Observation of signs - vital signs every 4 hours
Maintain normal body temperature2. Teach the family gave a cold compress on the head / armpit.
Suggest to use a thin shirt and made of cotton fabric3. Leave the room window open4. Give extra fluids to drink a lot of patient advocate
Limit physical activity.
Dx 5: Lack of knowledge of the family in relation to lack of informationObjective: increase family knowledge about her illness.Outcomes:1. Families do not often ask about his illness.2. Families are able to participate in the nursing process.3. family obeying all the nursing process.Plan of Action:1. Assess the level of knowledge of family2. Give an explanation to the family of the causes and consequences of febrile seizures3. Describe any maintenance action to be performed.4. Provide Health Education on how to help children prevent seizures and febrile seizures, among others:1. Do not panic when seizures2. Lay the child flat and gentle place.3. Head tilted.4. Put the spoon handles have wrapped a wet cloth, and then put into the mouth.5. After the seizures stopped and the patient unconscious drug soon Drinks wait until things calm.6. If the high temperature during seizures do cold compresses and give a lot of drinking7. Immediately brought to the hospital when a long seizures.5. Provide Health Education in order to be on hand febrifuge, when children heat.6. If the child recovers, keep children not exposed to infectious diseases by avoiding people or friends who suffer from infectious diseases that do not trigger an increase in temperature.7. Tell the family if the children will be immunized in order to inform the officer that her son had suffered immunization febrile seizures.
REFERENCES
MOH. , 1989. Baby And Child Care. Ed 1. Jakarta: Center for Health Manpower Education.
Lumbantobing, SM.1989.Penatalaksanaan Muthakhir Seizures In Anak.Jakarta: FKUI
Sachann, M Rossa. , 1996. Pediatric Nursing principle. Jakarta: EGC.
Suriadi, dkk2001. Askep In Children. Jakarta. Interpratama Dawn Pt.
Sataf Instructor of Pediatrics School of Medicine. 2000. Lecture Two books of Pediatrics. Jakarta: Jakarta Medika Printing Info
Ngastiyah. , 2005. Sick Child Care, ed 2. Jakarta: EGC.
Hidayat, aziz alimun. 2006. Introduction to Nursing Children. Jakarta: Salemba.
