41274643 febrile seizure
DESCRIPTION
asdTRANSCRIPT
INTRODUCTION
The immune system is responsible for knowing the difference between normal bodily substances and foreign ones, as well as protecting the body from infections and foreign substances. Different immune response can be perceived if an opportunistic microorganism is introduced in the body. One common response of the body seen in children from infection is fever. It is a physiologic response of the body that accompany childhood illnesses, especially infections.
Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Less commonly, the child becomes rigid or has twitches in only a portion of the body, such as an arm or a leg, or on the right or the left side only. Most febrile seizures last a minute or two, although some can be as brief as a few seconds while others last for more than 15 minutes. The latter is called complex febrile seizure.
Febrile seizures usually occur in children between the ages of five months and five years and are particularly common in toddlers. Children rarely develop their first febrile seizure before the age of six months or after three years of age. The older a child is when the first febrile seizure occurs, the less likely that child is to have more.
Several factors can contribute to febrile convulsion. Before 5 years of age, the child has not yet fully developed his/her hypothalamic control centre therefore temperature can easily fluctuate. Family history of this particular seizure can also contribute in developing benign febrile convulsion. Infection can be another causative factor in the occurrence of febrile seizure.
This case study features Patient N, 1 year old, lives in 348 Cristobal St., Sampaloc, Manila, was admitted last August 30, 2010, with an admitting diagnosis at Ospital ng Sampaloc of Complex Febrile Seizure without CNS infection.
The researcher has chosen this condition for it is an illness among children. She will be able to provide information from her previous studies regarding of the said illness. In this way, she will be able to demonstrate different management provided and enhance her skills and knowledge as a student nurse for future use.
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OBJECTIVES
A. General Objective
This aims to distinguish and verify the general heath problems and needs of the patient with an admitting diagnosis of Complex Febrile Seizure without CNS infection. This will help enhance the knowledge and skills of the researcher and relate to Pediatric Nursing concepts to her actual related learning experience as a student nurse. This will help the patient know importance of health and its medical understanding of the said condition through the application of nursing skills.
B. Specific Objective
1. To gather pertinent and comprehensive data through interview and medical chart.
2. To perform physical assessment in a head-to-toe approach.
3. To have a review of the anatomy and physiology of the systems affected.
4. To trace the pathophysiology of complex febrile seizure.
5. To determine and understand the different medical and nursing management employed.
6. To interpret the results of the laboratory and diagnostic procedures.
7. To study the drugs prescribed to the patient and its effects to her current condition.
8. To formulate and apply nursing care plan utilizing the nursing process.
9. To learn new clinical skills required in the management of the patient who had suffered
complex febrile seizure.
10. To render nursing care and information through the application of the nursing skills
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NURSING HISTORY
A. Initial Data
Date of Admission: August 30, 2010
Ward: Pediatric Ward
Admitting Diagnosis: Complex Febrile Seizure without CNS infection
B. Demographic Data
Patient Name: Toddler N
Address: 348 Cristobal St., Sampaloc, Manila
Date of Birth: March 18, 2009
Age: 1 year old and 4 months
Gender: Female
Weight: 10 kg
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Source of Data/Information: Patient’s mother
C. Chief Complaint
“Nilagnat siya at nagkaconvulsion” as verbalized by the client’s mother.
D. History of Present Illness
10 days prior to admission, Patient N had episodes of cough and colds. Her mother continues to
breastfeed Baby N.
7 days prior to admission, Patient N does not have a cough anymore but she still has common
colds.
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1 day prior to admission, Patient N is in a febrile state. The temperature was 37.9oC. She showed
signs of irritability and crying. Baby N’s mother gave Tempra syrup to alleviate her fever.
6 hours prior to admission, Patient N appears to still have fever, common colds, and difficulty of
breathing. Patient N’s mother applied tepid sponge bath to decrease Toddler N’s temperature of
38.5oC.
5 hours prior to admission, Patient N’s temperature didn’t lessen.
1 hour prior to admission, Patient N experienced convulsion and difficulty of breathing.
Upon admission, Patient N was irritable and experienced 2x seizure at the Emergency Room of
Ospital ng Sampaloc. She was given O2 therapy via face mask to lessen her difficulty of
breathing. Vital signs were taken with a respiratory rate of 44 breaths per minute, heart rate of
137 beats per minute, and a temperature of 39.7oC. She was later admitted of complex febrile
seizure without CNS infection.
E. Past Health and Medical History
1. Immunization
The client had complete immunizations of BCG, DPT, Hepatitis B, Oral Polio and Anti-Measles Vaccine.
2. Allergies
The patient has no allergies to food or non-food protein allergens.
3. Illnesses
The patient had a history of neonatal sepsis and pneumonia when she was 2 weeks old.
4. Injuries/Accidents
On July 2010, the patient’s mother stated that Patient N has fallen from a 2 ½ feet height table.
5. Hospitalizations
As stated by the patient’s mother, Toddler N had a history of hospitalization at Jose R. Reyes Memorial Medical Center last March 2009 with an admitting diagnosis of Neonatal Sepsis
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LEGEND:
Hypertension
Neonatal Sepsis
Neonatal Pneumonia
Asthma Identified Patient
Female Male
and Pneumonia when she was 2 weeks old. The patient stayed 1 week long for treatment at the hospital.
F. Family Medical History
Patient’s mother has a family history of hypertension, and asthma while patient’s father has a family history of hypertension.
Family Genogram
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G. Psychosocial History
Patient N’s father is both a smoker and an alcohol drinker. According to the patient’s mother, they live cohabitually with her mother-in-law in Sampaloc, Manila. The type of housing they lived in is made of mixed materials: cement and wood. The environment they live in is clean, and peaceful. They have a harmonious relationship with their neighbours. They have a good and clean housing condition with an adequate electricity and water supply.
H. Health Maintenance Activities
1. Sleep – According to the patient’s mother, Toddler N sleeps at least 14-16 hours a day.
2. Diet – The patient’s mother continues to breastfeed Toddler N at least 4-6 times a day.
The patient’s food intake is approximately 5-6 tablespoon per meal. Usually, Toddler N
eats rice porridge. They normally eat three times a day.
3. Elimination – Toddler N usually consumes 3 fully used diapers per day. The diaper
weighs approximately 20-30 grams. She defecates at least twice a day. The stool is
watery and yellowish brown in color.
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REVIEW OF SYSTEMS
General: According to the mother, Toddler N is irritable, restless, and cries often upon staying at the
hospital for 1 day.
Integumentary: Toddler N’s skin color is light brown. According to the patient’s mother, Toddler N has
rashes along her extremities and body, both posterior and anterior, upon staying in the hospital for 1
day.
Eyes/Ears/Nose/Mouth/Throat: According to the mother, the patient has no pus or redness seen in the
eyes. There is no problem in getting the child’s attention upon calling her name. Toddler N has clear,
watery secretions seen in her nose.
Cardiovascular: Toddler N, according to the mother, has no previous heart problem.
Respiratory: Toddler N, according to the mother, appears to have difficulty in breathing during
convulsion but without the active seizure, the client has no problem breathing.
Gastrointestinal: The patient’s mother feeds Toddler N through breastfeeding 4-6 times per day and
intake of solid foods, usually rice porridge. The patient doesn’t experience vomiting. Toddler N has an
increased bowel movement at least four times upon staying in the hospital for 1 day. According to the
mother, Toddler N normally defecates twice a day. The patient’s mother has observed that the stool of
Toddler N is watery and yellowish brown in color.
Genitourinary: According to Toddler N’s mother, the patient consumes at least 3 fully used diapers per
day. The diaper normally weighs 20-30 grams per day. The urine is clear and light yellow in color.
Musculoskeletal: Toddler N has no weakness and limitation in movement in her extremities. There was
no swelling, wounds, or injuries observed by her mother on the patient’s joints and muscles.
Neurologic: The patient is awake and appears alert upon getting her attention according to the mother.
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PHYSICAL ASSESSMENT
General Appearance
Toddler N has a weight of 10 kg. The patient is clean and does not have any offensive odor.
Toddler N is irritable, restless, and cries frequently during her stay in the hospital for 1 day.
Vital Signs
Vital signs were taken with a respiratory rate of 39 breaths per minute, heart rate of 137 beats
per minute, and a temperature of 37.1oC upon assessment.
Skin, Hair, and Nails
Toddler N has a uniform light brown skin. She does not have edema, lesions, or nodules present
on her skin. There are rashes present in her upper extremities and body, both posterior and anterior.
When the skin is pinched, it goes back less than one second. Hair is evenly distributed and does not have
any scalp problem or parasites seen. Her nail convex curvature is in approximate angle of 160 o. The
blanch test has more than 3 seconds return of pink color on her nails.
Skull and Face
Toddler N is normocephalic and has a smooth contour upon palpation. She has symmetric facial
appearance. There were no masses, lesions, nodules, and tenderness present.
Eyes
Toddler N has evenly distributed eyebrows. She can easily close her eyelids. Eyeballs are
symmetrical and the sclera is white. The pupils are equally round, reactive to light and accommodation.
Both palpebral and bulbar conjunctiva is pink in color. No pus, inflammation, or infection seen.
Ears
Both ears are symmetrical. No tenderness or infection present in Toddler N’s ears.
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Nose and Sinuses
Toddler N has a clear, watery discharge seen in her nose. No lesions and tenderness is seen in
the nose. No obstruction is seen in her nose upon inspection. Nasal septum is in the midline. No
tenderness in the sinuses is palpated on her nose.
Mouth and Oropharynx
Toddler N’s oral mucosa is uniformly pink. No inflammation, tenderness, lesions seen.
Neck
No palpable lymph nodes felt. Toddler N’s neck muscles are symmetrical in movement. She
demonstrates a complete head control.
Chest and Lungs
The chest expansion is symmetrical. Toddler N’s spine is vertically aligned. Respiratory rate,
upon assessment, is 39 breaths per minute. No adventitious breath sounds are heard. There is absence
of intercostal retraction.
Cardiovascular and Peripheral Vascular System
Heart rate is 137 beats per minute. S1 and S2 sound are present and no murmurs are heard.
Capillary refill test reveals a slow return of blood when pinched.
Abdomen
Toddler N shows a smooth contour and uniformity in color in the abdomen. The bowel sounds
are heard. When palpated, she doesn’t have any tenderness.
Breast and Axillae
Toddler N has a symmetrical and smooth contour of her breast. There were no masses, nodules,
and lesions seen.
Musculoskeletal System
Both extremities of Toddler N are in equal size. There were no lesions, contractures, and
tenderness seen upon inspection.
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Neurologic System
Toddler N is responsive to touch, sound, and light. She exhibits blink and pupillary reflex.
Genitals and Inguinal Area
Toddler N’s genital has an intact skin. It appears to have no swelling, infection, or discharges. No
nodules and masses are palpated in the inguinal area.
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REVIEW OF ANATOMY AND PHYSIOLOGY
Temperature control in children is not completed until approximately five years of age. This may
be due to the immaturity of the nervous system. The maintenance of body temperature is mainly
coordinated by the hypothalamus, a central control center 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 ºC. 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.
The ‘normal set point’ in childhood reflects a decreasing basic metabolic rate (BMR) as the child
grows. The body temperature of the three-month-old child is 37.5 ºC, whereas at thirteen years it is 36.6
ºC. Even as the temperature regulatory mechanisms mature through childhood, babies and small
children are highly susceptible to temperature fluctuations, as they produce more heat per kilogram of
body weight than older children. Changes in environmental temperature, increased activity, crying,
emotional upset and infections all cause a higher and more rapid increase in the younger child. The
younger the child the less able he or she is to vocalize the feeling of hot or cold or to do something
about it. All children may also become too cold. Small individuals who do not have warm clothes and
warm homes will not grow if the temperature of their environment is consistently low. They will use
much of the energy from their food intake to generate heat (metabolic rate) and leave no spare calories
for tissue growth. 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
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head in a cold environment conserves heat for growth. Schoolchildren may experience a sequence of
small growth spurts and at times be relatively thin with minimal body fat. At the swimming pool, for
example, where children enjoy jumping in and out of the water as they play, thin children may become
cold more quickly than their fatter friends who have an insulation layer beneath their skin.
Heat can generated through the metabolism of the liver, muscles, and other chemical activities.
When children are exposed in a cold environment, it can result to hypoglycemia, elevated serum
bilirubin, metabolic acidosis, and increased metabolic rate. When heat loss occurred, non-shivering
thermogenesis (NST) heat production takes place in the subcutaneous tissue, hypothalamus, and spinal
cord to compensate for the sudden change in temperature.
Heat loss transpires through the contact in a cold environment, vasodilation, sweating where
the preoptic area of the brain stimulates secretion of water to the skin for evaporation. There are
different areas in the body where we can measure the temperature such as axillae, tympanic
membrane, and mouth.
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PATHOPHYSIOLOGY
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Non-Modifiable Factors: Underdeveloped hypothalamic
control centre Family history of febrile
convulsion Infection
Modifiable Factors:
Hygiene Diet Environment
Immune response
Endogenous pyrogens
Production of pro-inflammatory cytokines, such as interleukins 1β (IL-1β) and 6 (IL-6), interferon (INF)-α, and
WBC
Hypothalamic circulation
Mucus production
Release of prostaglandin E2
Anterior hypothalamus
Elevated thermoregulatory set-
point
Heat production
Heat conservation
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Fluid conservation
Urine output
Vasoconstriction
Cerebral perfusion
Irritable and restless
Metabolism of the liver
Glucose breakdown
Muscle contraction
Fever
Energy demand
Immature hypothalamic control
Temperature fluctuates to >39 ºC
Neuronal excitability Bronchospasm
Difficulty of breathing
RR
Febrile seizure
LABORATORY AND DIAGNOSTIC PROCEDURES
Hematology Report: August 30, 2010
NORMAL VALUES ACTUAL RESULT
Hemoglobin Male: 14-16 g/dlFemale: 12-14 g/dl
10.2 g/dl
Hematocrit Male: 0.40-0.57Female: 0.37-0.47
0.38
WBC count 4.80-10.80 18
Segmenters 60-70% 60%
Lymphocyte 30-40% 39%
Eosinophil 1-3% 1%
Platelet 130-400 256
Interpretation:
There is a decrease in haemoglobin and an elevated white blood cell count. Other blood
components are within the normal level.
Analysis:
A decrease in hemoglobin is physiologically low normal because of the increasing demands of
the body for iron. An evident increased in white blood cell count indicates that a bacterial infection is
present.
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MEDICAL-SURGICAL MANAGEMENT
Medical Management:
1. Administration of due medications as ordered by the physician.
The following medications are:
Cefuroxime, an anti-infective, cephalosporin – 0.33 g, IV, q8h
Salbutamol, a bronchodilator, sympathomimetics – 1 nebule (1cc + 1cc NSS),
inhalation, q6h
Paracetamol, an antipyretic, nonsteroidal anti-inflammatory drug – 1.2 ml in a
100g/1ml, PO, PRN
Diazepam, an anticonvulsant, benzodiazepine – 2 g, IV, for active seizure
Chloramphenicol, anti-infective – 125 mg, IV, q6h
2. Intravenous Replacement Therapy
IV replacement therapy is the fastest way of replacing fluid loss and electrolyte
imbalances. It can also be used to keep the vein open for the administration of medications.
The following IV solutions administered:
D5 0.3 NaCl, a hypotonic solution, 500 cc x 8° - causes cell shrinkage therefore
reducing body heat.
D5 IMB, a hypertonic solution, 1 L at 41 cc/hr – for cell rehydration.
3. Oxygen Therapy
Oxygen therapy is used during emergency medical services. It is for the difficulty of
breathing during active convulsion. Oxygen inhalation at 2-3 L was given via face mask.
4. Laboratory and Diagnostic Procedures
August 30, 2010
Complete Blood Count – It is used as a broad screening test to check for such disorders
as anemia, infection, and many other diseases. This evaluates the three types of cells in
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the blood which are red blood cells, white blood cell, and platelets. This provides an
overview of the general health of the patient.
Nursing Management:
Vital signs monitoring every 1 hour
Input and Output of Fluid Measurement
Administer medication due as ordered by the physician
Patient, a toddler, has developed a stranger anxiety as manifested by “white coat
syndrome.” A nursing intervention would be is to establish rapport by playing with the
patient.
Encourage the mother to increase and continue breastfeeding for faster recovery of the
patient.
Provide opportunity for the patient to rest from time to time.
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DRUG STUDY
CLASSIFICATION DOSAGE AND ADMINISTRATION
PHARMACOLOGIC ACTION
INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS
Cephalosporins Parenteral (IV)
Dosage: 0.33 g
*q8h – 12am, 8am, 4pm
Cephalosporin inhibits bacterialwall synthesis,rendering cell wallosmoticallyunstable, leadingto cell death bybinding to cell wallmembrane.
Treatment of infection
Nausea and vomiting, diarrhea, nephrotoxicity,bone marrow depression, rashes, fever, urticuria
Check for signs and symptoms of superinfection
Assess for anaphylaxis:rashes, urticaria,chills, fever,dyspnea
Monitor the urine output, bowel movement, and for bleeding.
Generic Name: Cefuroxime
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Generic Name: Salbutamol
CLASSIFICATION DOSAGE AND ADMINISTRATION
PHARMACOLOGIC ACTION
INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS
Sympathomimetics, Bronchodilator
Inhalation
Dosage: 1 nebule (1cc + 1cc NSS)
*q6h – 12am, 6am, 12pm, 6pm
Salbutamol is a direct-acting sympathomimetic with selective action on β2 receptors, producing bronchodilating effects.
To relieve bronchospasm associated with active convulsion
Tachycardia, tremors, palpitation, paradoxical bronchospasm, hypotension
Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 60–90 min after drug administration.
Monitor signs and symptoms of fine tremor in fingers; CNS stimulation, particularly in children 2–6 y, (hyperactivity, excitement, nervousness, insomnia), tachycardia, GI symptoms. Report promptly to physician.
Lab tests: Periodic ABGs, pulmonary functions, and pulse oximetry.
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Generic Name: Diazepam
CLASSIFICATION DOSAGE AND ADMINISTRATION
PHARMACOLOGIC ACTION
INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS
Benzodiazepines, Anticonvulsant
Parenteral (IV)
Dosage: 2 g
*For active seizure
Diazepam is a long-acting benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.
Adjunct management of seizure
Hypotension, muscle weakness, respiratory depression, tachycardia, incontinence, constipation
Monitor for adverse reactions. Most are dose related. Physician will rely on accurate observation and reports of patient response to the drug to determine lowest effective maintenance dose.
Monitor I&O ratio, including urinary and bowel elimination.
Observe patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression may occur.
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Generic Name: Paracetamol
CLASSIFICATION DOSAGE AND ADMINISTRATION
PHARMACOLOGIC ACTION
INDICATIONS SIDE EFFECTS
NURSING CONSIDERATIONS
Nonsteroidal anti-inflammatory drugs,
Anti-pyretic
PO
Dosage: 1.2 ml in a 100g/1ml
*PRN, for temperature more than 37.8oC
Paracetamol produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.
To alleviate fever
Nausea, allergic reactions, skin rashes, liver damage
Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days.
Advise patient or caregiver that many over the counter products contain acetaminophen; be aware of this when calculating total daily dose.
Warn patient’s mother that high doses or unsupervised long term use can cause liver damage.
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Generic Name: Chloramphenicol
CLASSIFICATION DOSAGE AND ADMINISTRATION
PHARMACOLOGIC ACTION
INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS
Anti-infective drugs Parenteral (IV)
Dosage: 125 mg
*q6h – 12am, 6am, 12pm, 6pm
Chloramphenicol inhibits bacterial protein synthesis by binding to 50s subunit of the bacterial ribosome, thus preventing peptide bond formation by peptidyl transferase. It has both bacteriostatic and bactericidal action against H. influenzae, N. meningitidis and S. pneumonia.
Treatment of infection
Bleeding, visual impairment, confusion, rashes, fever, bone marrow suppression
Monitorhematologicdata carefully, especially withlong-termtherapy by anyroute ofadministration.
Do not givethis drug IMbecause it isineffective.
Check for signs and symptoms of superinfection.
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NURSING CARE PLAN
CUES NURSING DIAGNOSIS
INFERENCE GOALS NURSINGINTERVENTIONS
RATIONALE EVALUATION
Objective: Recurrent seizure of more than 15 mins.
Risk for injury related to neuromuscular dysfunction
Endogenouspyrogens
Immune response
Release of chemical
mediators
Fever greater than 39 oC
Neuronal excitability
Febrile seizures
Impaired coordination of
movement
Risk for injury
Within 8 hours of nursing intervention, the client will be free of injury as manifested by:
Intact skin
No pain, bruises, or fractures present
No limitation in movement
Independent: Raise the side rails always
Maintain bed in lowest position with wheels locked
Monitor environment for potentially unsafe conditions and modify as needed
Encourage bed rest.
Ensure that the floor is unobstructed and properly lighted
To avoid injuries.
To promote client safety
To promote safe and physical environment and individual safety
To prevent fatigue and promote healing.
To prevent errors resulting in client injury
Goal was met after 8 hours of nursing intervention as manifested by:
Intact skin
No pain, bruises, or fractures present
Able to move freely
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CUES NURSING DIAGNOSIS
INFERENCE GOALS NURSINGINTERVENTIONS
RATIONALE EVALUATION
Objective: Recurrent seizure of more than 15 mins.
Risk for aspiration related to bronchospasm
Endogenouspyrogens
Immune response
Release of chemical
mediators
Fever greater than 39 oC
Neuronal excitability
Febrile seizures
Bronchospasm
Risk for aspiration
Within 8 hours of nursing intervention, the client will experience no aspiration as manifested by:
Noiseless respirations
Clear breath sounds
Clear, odourless secretions
Independent: Elevate client to highest or best possible position for eating and drinking
Provide soft foods
Offer very warm or very cold liquids
Determine best resting position with the head of bed elevated at 30o angle
To reduce risk for aspiration
To aid in swallowing effort
Activates temperature receptors in the mouth that help stimulate swallowing
Upper airway patency is facilitated by upright position
Goal was met after 8 hours of nursing intervention as manifested by:
Noiseless respirations
Clear breath sounds
Clear, odourless secretions
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CUES NURSING DIAGNOSIS
INFERENCE GOALS NURSINGINTERVENTIONS
RATIONALE EVALUATION
Objective: Difficulty of breathing during active convulsion
RR=39 cpm
Ineffective airway clearance related to neuromuscular dysfunction
Endogenouspyrogens
Immune response
Release of chemical
mediators
Fever greater than 39 oC
Neuronal excitability
Febrile seizures
Bronchospasm
Ineffective airway clearance
Within 8 hours of nursing intervention, the client will be able to maintain airway patency as manifested by:
Decrease RR=39 cpm to 36cpm
Improve clear airway
Absence of strenuous breathing during active convulsion
Independent: Monitor child for feeding intolerance, abdominal distention, and emotional stressors
Position patient on high back rest
Prepare emergency kit especially for oxygen therapy
Keep environment allergen free
To determine if airway is compromised
Upper airway patency is facilitated by upright position
To maintain adequate airway during active convulsion
To clear open airway
Goal was met after 8 hours of nursing intervention as manifested by:
Decrease RR=39 cpm to 36cpm
Improve clear airway
Absence of strenuous breathing during active convulsion
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DISCHARGE PLAN
Medications
Instruct and explain to the mother that the medication, especially the antibiotics, is important to
continue depending on the duration that the doctor ordered for the total recovery of the
patient.
Inform the mother of the side and adverse effects of the drugs she is giving to her daughter.
Instruct to report immediately any side or adverse effects when taking the prescribed drug such
as nausea, vomiting, diarrhea, rashes.
Take the entire course of any prescribed medications. After a patient’s temperature returns to
normal, paracetamol is administered if fever occurs. Avoid using paracetamol more than 5 days.
Instruct the mother to avoid over-the-counter drugs without the consultation of the physician to
avoid any drug-drug interaction.
Exercise
Encourage the mother to have her daughter rest from time to time for faster recovery.
Treatment
Comply with the established treatment regimen given by the doctors including prescribed
medications.
Encourage the mother to expose the patient to early morning sunlight
Advise the mother to provide tepid sponge bath when fever occurs
Provide oxygen therapy during active convulsion to alleviate the difficulty of breathing.
Hygiene
Encourage and explain to the mother that it is vital to maintain proper hygiene by frequently
washing her hands.
Out-patient
It’s important for the toddler to have her follow-up check up to ensure and have the patient’s
progress monitored.
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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.
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