A CASE STUDY OF

BENIGN FEBRILE CONVULSION

In partial fulfillment of the requirement for

NC119 A-A
Care for Mother Child and Adolescent

Presented by: BSN- 2C GROUP 5

AGPAOA, PRINCESS JOY

BAKAKEO, VALERIE GRACE
DE GUZMAN, LYKA EMERALD R.
GANAPIN, NATHANIEL
OTINGUEY, YITER
PASCUAL, JASMINE ANDREA
PASTORIN, ROBIN
SALVADOR, STAR JAZZ EXCEL
TABIO, LESTER S.
TIRADO, SHWECIN L.

PRESENTED TO
CZARINEAH BESAS, RN,
Clinical Instructor
 OBJECTIVES

GENERAL OBJECTIVES:
Aims to protect the patient from any harm, thus, ensure and maintain patient safety and well-
being before and after seizure until recovery. Also, reduce the frequency and severity of seizures through
appropriate medications or therapies.

SPECIFIC OBJECTIVES:
 Provide information about seizures and their types
 Monitor regularly the frequency of seizure and response to treatment.
 Explain the importance of healthy lifestyle including proper hygiene.
 Ensure a comfortable and safe environment to prevent injury during seizure.
 To be aware of the signs and symptoms.
 To furthermore know the complications of the disease.

 Explore the underlying pathophysiological mechanisms leading to febrile convulsions,

focusing on the relationship between fever and seizure activity in pediatric patients.
 OVERVIEW

A seizure is a burst of uncontrolled electrical activity between brain cells (also called neurons or
nerve cells) that causes temporary abnormalities in muscle tone or movements (stiffness,
twitching or limpness), behaviors, sensations or states of awareness.
Benign febrile convulsions are seizures that occur in young children, typically between the ages
of 6 months and 5 years, in response to a fever. They are considered benign because they do not
cause long-term harm or have lasting effects on the brain.
Fever, usually triggered on by a viral illness, is what causes febrile seizures. These seizures tend
to occur in families. Though the exact cause is unknown, but it is thought to involve the brain
immaturity, environmental factors, genetics, and inflammatory substances. The diagnosis
includes verifying that there is no brain infection, metabolic issues, or history of seizures without
the presence of a temperature as well. Usually, no blood tests, brain imaging, or
electroencephalograms (EEG’s) are required.

Key points about benign febrile convulsions include:

Age Group: Most commonly occur in children aged 6 months to 5 years, with the peak
incidence around 18 months.
Fever Trigger: Febrile convulsions are usually triggered by a rapid rise in body temperature,
often due to common childhood infections like respiratory or ear infections.
Type of Seizure: The seizures are typically generalized tonic-clonic seizures, involving muscle
stiffness and rhythmic jerking of the limbs.
Duration: These seizures are usually brief, lasting less than 5 minutes, and rarely continue for
more than 15 minutes.
Recurrence: They tend to be a one-time event for most children and are often the child's first
seizure. However, some children may experience recurrent febrile convulsions with subsequent
febrile illnesses.
Risk Factors: Family history of febrile seizures, especially in first-degree relatives, increases
the likelihood of occurrence.
Evaluation: Diagnosis is primarily clinical, based on the history and physical examination.
Additional investigations, such as blood tests or imaging, are typically not necessary unless there
are atypical features or concerns about underlying causes.
SEIZURE TYPES
There are two types under which seizures are classified: generalized and focal. As in the
general population, the latter are the most common type in MS ( Multiple Sclerosis) Close to
70% of seizures that occur in MS are focal
Generalized seizure
A generalized seizure involves the whole brain. There are six types of generalized seizures,
but tonic-clonic seizures are the most common type in MS.
 Absence seizure
 Atonic seizure
 Tonic seizure
 Tonic-clonic seizure
 Myoclonic seizure
 Febrile seizure

FOCAL SEIZURES
Focal seizures, which used to be called partial or localized seizures, are those that arise
from a localized region of the brain. Their appearance is less dramatic than tonic-clonic seizures
and , in some cases, may be hardly noticed by the person experiencing one.
These seizures are broadly classifies as the following:
 Focal aware seizure - Previously known as simple partial seizures, this type doesn't cause
the person to lose consciousness;
 Focal impaired awareness seizure - This type of seizure, which used to be called a
complex partial seizure, also does not cause loss of consciousness but instead results in a
sudden lack of awareness.

CAUSES
A seizure is caused by inappropriate or excessive electrical activity in the brain, usually in the
cerebral cortex. Epilepsy is defined as recurring seizures caused by this sort of abnormal brain
activity
While scientist don’t understand exactly why there’s a higher risk of epilepsy when you have MS
( Multiple Sclerosis), it may be due to a complex interplay between the role of inflammation in
both conditions and brain damage from MS lesions, which could lead to electrical disruptions.
More research needs to be done to understand this connection.
Research shows that seizures, if they occur, most often begin sometimes after the onset of MS.
Some studies have also found a link between the severity of MS and the risk of epilepsy,
meaning that the more severe the cave of MS, the more common seizures seem to be.
What is MS (Multiple Sclerosis) - It is a condition that can affect the brain and spinal cord,
causing a wide range of potential symptoms, including problems with vision, arm or leg
movement, sensation or balance. It’s a lifelong condition that can sometimes cause serious
disability, although it can occasionally be mild.

SIGNS AND SYMPTOMS

SYMPTOMS
Television and movie depictions of seizures often paint and incomplete picture of how they can
be experienced. Seizures can vary significantly in their symptoms and severity. Some are
transient and nearly imperceptible, while others can be far more severe and unnerving
Seizures symptoms depend on the type of seizure you’re having, but in general, could include;

1. Body stiffness or jerking

2. Clenched jaw or teeth grinding
PATIENT BASE
3. Fever
BOOK BASE
4. Eyes rolling back
5. Breathing changes
6. Changes in skin color( pale or bluish color)
7. Drooling or frothing in the mouth

POST SEIZURE
8. Loss of consciousness
9. Unresponsive and disoriented/ staring
10. Vomiting or nausea after seizure
11. Weakness after seizure
12. Fatigue or sleepiness
13. Irritability

DIAGNOSIS
You'll need to see a neurologist who can tell you if your symptoms are paroxysmal symptoms or
actual seizures.
A brain wave test called an electroencephalogram (EEG) shows a difference between the two, so
your healthcare provider may order one to make this distinction. You may also have some other
lab and/or imaging tests to confirm or rule out a diagnosis of epilepsy.
Though you may have been living with your MS for some time and feel well-acquainted with its
effect on you, it's important that your healthcare provider determine what's causing how you are
feeling. Delaying a proper diagnosis if you are indeed having a seizure can lead to consequences
and keep you from being properly treated.
TREATMENT
Management focuses on addressing the underlying cause of the fever, usually an infection.
Anti-epileptic medications are generally not recommended for simple febrile seizures.
Prognosis: Benign febrile convulsions do not cause long-term neurological damage, and the
overall prognosis is excellent. Developmental outcomes are typically normal.
Prevention:
The primary prevention involves managing fever with antipyretic medications and
addressing the underlying illness. However, it's challenging to prevent febrile seizures
entirely.
 PATIENTS PROFILE

NAME: MR. C
AGE: 4 YEARS OLD, MALE
NTIONALITY: FILIPINO
CIVIL STATUS: CHILD
BIRTHDATE: AUGUST 9, 2019
ADDRESS: QUIRINO
RELIGION: IGLESIA NI CRISTO

CHIEF COMPLAINT: SEIZURE

ADMITTING DIAGNOSIS: T/C BENIGN FEBRILE CONVULSION, T/C SEIZURE
DISORDER

DATE OF ADMISSION: DECEMBER 3, 2023

TIME OF ADMISSION: 4:05 PM
WEIGHT: 16 kg
HEIGHT: 102 cm

INITIAL VITAL SIGN

BP: 90/60
PR: 132
RR: 35
O2SAT: 100%
BODY TEMP: 39.2
 MEDICAL HISTORY
PAST MEDICAL HISTORY
The patient has a history of multiple episode of seizure since he was just an infant. August 2020 was his
first hospitalization of convulsion, with (+)head trauma and fall. The second one was last August 2021
with (+)seizure and body stiffening. His EEG result says that “absence of epileptiform discharge does not
rule out the diagnosis of epilepsy”. The third was last July 2023 with +pneumonia mild risk and seizure
disorder.
The patient was taking an anticonvulsant drug which is the valproic acid, as his maintenance and has been
taking this for more than a year ( once a day everyday). But just recently the physician stopped his
maintenance

PRESENT MEDICAL HISTORY

According to the patients father, he had an episode of seizure in their house with (+)fever, body
stiffening, upward rolling of eyeballs drooling of saliva and bluish discoloration of lips and it lasted for
about less than a minute. Another was when they was on their way to the hospital in their motorcycle,
and it lasted for 45 seconds. Another was when the patient was on the ER he had an episode attack twice
the first was 1 min. and the second was less than a minute.

FAMILY HISTORY
The father has a heart disease and a survivor of mild leukemia and is allergic to crabs. While the mother
experienced Dengue fever when she was in labor with the patient. The Grandfather of the patient is a
+DM, Epileptic, and stroke.

IMMUNIZATION

The patient is an only child and delivered as Caesarean section- full term. He was breastfeed for 8 months
and it stopped there due to the baby doesn't want to drink milk anymore.The patient is allergic to
chocolates.
 GRANDFATHER
GRANDMOTHER
GRANDFATHER  DM
HYPERTENSION
GRANDMOTHER  Epilepsy
HYPERTENSION HEART DISEASE
 Stroke

FATHER
AUNT
MOTHER UNCLE
UNCLE HYPERTENSION * LEUKEMIA
DENGUE FEVER
HEART DISEASE

CHILD (MR.C)
 ALLERGY
SEIZURE
PNEUMONIA

 ALLERGY  DENGUE FEVER

 STROKE PNEUMONIA

 DM HYPERTENSION

 EPILEPSY SEIZURE

* LEUKEMIA HEART DISEASE

SOCIAL HISTORY
 GENERAL SURVEY

GENERAL
(+) FEVER (38.0 C)

INTEGUMENTARY
(+) SCARS
(+) PRESENCE OF DIRT (NAILS)

RESPIRATORY
(+) COUGH
(+) COLD

NEUROLOGIC
(+) SEIZURES

HEAD AND NECK

(+) ORAL TRUSH

THORAX AND LUNGS

(+) ABNORMAL LUNG SOUND (RHONCHI SOUND)
 PHYSICAL ASSESSMENT
DECEMBER 05, 2023 9:30 AM

AREA TECHNIQUE FINDINGS INTERPRETATION

INTEGUMENTARY:

SKIN INSPECTION  Brown Skin Color

 Birthmark NORMAL
GENERAL COLOR  No Presence Of
Lesions

 (+) Scars ABNORMAL

(DUE TO INSECT BITES)
TEXTURE
 Soft NORMAL

MOISTURE
 No Signs Of NORMAL
Dryness
PALPATION
 Warm To Touch ABNORMAL
(DUE TO HIGH FEVER)
 No Swelling Or
Edema
 Pinched Up Skin
NORMAL
Returns
Immediately To
Original Position
EXTREMITIES
(UPPER EXTREMITIES)

NAIL INSPECTION  Presence Of Dirt ABNORMAL

(DUE TO POOR HYGIENE)

 Pinkish In Color
NORMAL
 No Cyanosis

 2 Seconds Capillary
NORMAL
Refill
PALPATION
NORMAL
 Pinkish In Color
NORMAL
 No Lesions
NORMAL
PALMS INSPECTION  Feels Warm,
Smooth

PALPATION

ARMS INSPECTION  (+) SCARS ABNORMAL

(DUE TO INSECT BITES)
PALPATION
 SYMMETRICAL
IN SIZE NORMAL

 (-) SKIN
TURGOR BOTH
ARM
LOWER
EXTREMITIES INSPECTION  PRESENCE OF ABNORMAL
DIRT (DUE TO POOR HYGIENE)
NAILS
  PINKISH IN
PALPATION COLOR
 NO CYANOSIS NORMAL

 2 SECONDS
CAPILLARY
REFILL NORMAL
INSPECTION
 PINKISH IN
FEET COLOR ON THE
PALM OF THE NORMAL
FEET
INSPECTION
 NO LESIONS
LEG
 SYMMETRICAL
IN SIZE NORMAL

 (-) EDEMA NORMAL

BOTH LEGS

 NO LESIONS

HEAD AND NECK

AREA TECHNIQUES FINDINGS INTERPRETATION

HEAD INSPECTION  OVAL HEAD NORMAL
SHAPE
 49 CM
HAIR INSPECTION  BLACK COLOR
 STRAIGHT NORMAL
 NO PRESENCE OF
LICE
PALPATION  ROUGH
SCALP INSPECTION  NO PRESENCE OF
LESIONS
 NO DANDRUFF NORMAL
 NO PRESENCE OF
WOUND

EYES
PUPIL INSPECTION  PUPIL IS
EQUALLY ROUND NORMAL
AND
REACTIVATED TO
LIGHT
EYELIDS ACCOMMODATIO
N
 LASHES SHORT, NORMAL
EVENLY SPACED,
CONJUNCTIVA AND CURLED
OUTWARD

SCLERA  MARKED ABNORMAL

CORNEA REDNESS OF THE (TEARY EYES)
CONJUNCTIVA
 SCLERA IS WHITE NORMAL
 TRANSPARENT
CORNEA
 PALPATION
 NO PAIN OR NORMAL
DISCOMFORT
WHEN PALPATED
EARS
OUTER EAR INSPECTION  SYMMETRICALLY
APPEARANCE NORMAL
AND EQUALLY IN
SIZE
INNER EAR
 PRESENCE OF NORMAL
EARWAX
 MOIST
NOSE
COLOR INSPECTION  SAME COLOR OF NORMAL
THE FACE

APPEARANCE  SYMMETRICALLY NORMAL

APPEARANCE

INTERNAL NOSE  NO REDNESS IN NORMAL

NASAL MUCOSA
ABNORMAL
 PRESENCE OF (DUE TO COLD- LEFT
MUCOSA NOSTRILL)

PALPATION
NORMAL
 NO TENDERNESS
OR PAIN WHEN
PALPATED

AREA TECHNIQUE FINDINGS INTEEPRETATION

MOUTH INSPECTION  NO PRESENCE OF
CLUFF
 SYMMETRICALLY NORMAL
APPERANCE

PALPATION  NO TENDERNESS
AND SWELLING NORMAL
UPON PALPATION
LIPS INSPECTION  PINK IN COLOR
 NO CRACKS
 MOIST, SMOOTH NORMAL
WITH NO LESION
BUCAL MUCOSA INSPECTION  PINK IN COLOR
 SMOOTH, MOIST,
WITHOUT NORMAL
LESIONS
GUMS INSPECTION  PINK AND MOIST NORMAL
TEETH INSPECTION  20 TEETHS NORMAL
 NO CAVITY
 PRESENCE OF ABNORMAL
TARTAR INFRONT (DUE TO POOR HYGIENE)
OF HIS TEETH
INSPECTION  PINKISH IN NORMAL
COLOR
TOUNGE  PRESENCE OF NORMAL
TASTE BUDS
 ABLE TO MOVE
 TOUNGE FREELY NORMAL
AND WITH
STRENGTH
 NO LESIONS NORMAL

 PRESENCE OF ABNORMAL
ORAL THRUSH (DUE TO POOR
HYGIENE)
NECK
ACTIVE RANGE INSPECTION  CAN MOVE
OF MOTION FLEXION, NORMAL
EXTENSION, TILT
AND LATERAL
COLOR INSPECTION ROTATION

 BROWNISH
THYROID PALPATION COLOR, NO NORMAL
LESIONS

 NON PALPABLE,
NO PALPABLE NORMAL
WHEN PALPATE
THORAX AND LUNGS

AREA TECHNIQUES FINDINGS INTERPRETATION

POSTERIOR INSPECTION  THORAX IS NORMAL
THORAX OVAL

HEART AUSCULTATION  HEART RATE

IS 135 BPM
 USE OF NORMAL
ACCESSORY
LUNGS INSPECTION MUSCLE IS
NOT NOTED

AUSCULATATION  RONCHI ABNORMAL

SOUND (DUE TO COUGH AND
COLD)

ABDOMEN

AREA TECHNIQUES FINDINGS INTERPRETATION

INSPECTION  BROWN IN
COLOR WITH NORMAL
NO LESIONS
ABDOMEN  (+) SCARS ABNORMAL
(DUE TO INSECT
 ROUND BITES)
SHAPE
AUSCULTATION
 HIGH PITCH,
IRREGULAR
GURGLES NORMAL
 5-35 TIMES
PER MIN;
PRESENT
EQUALLY IN
ALL FOUR
QUADRANT
PALPATION
  NON
TENDER, NORMAL
SOFT AND
NO MASSES

CRANIAL NERVE

AREA TECHNIQUES FINDINGS INTERPRETATION

ASK THE CLIENT TO  CLIENT WAS
SMELL AND ABLE TO NORMAL
IDENTIFY THE DESCRIBE THE
SMELL OF ODOR OF
CN1- OLFACTORY ALCOHOL WITH MATERIALS
EACH NOSTRIL USED
SEPERATELY AND
WITH THE EYES
CLOSED

CN3: REACTION TO NORMAL

ACCOMMODATION  BOTH EYES ARE
CN3,4,6 AND REACTION TO ABLE TO MOVE
OCULOMOTOR LIGHT AS NECESSARY
TROCHLEAR AND
ABDOCENS CN5: ASK THE
CLIENT TO FOLLOW  PERRLA (PUPIL NORMAL
THE MOVEMENT OF EQUALLY
THE PENLIGHT ROUND AND
WITH THE EYES REACTION TO
ONLY LIGHT AND
ACCOMMODATI NORMAL
CN6: SIX CARDINAL ON)
RESPONSE
 BOTH EYES
MOVE IN
COORDINATION
 GORDONS

BEFORE DURING INTERPRETATION

Health The patient’s father stated that the The father stated the the The health perception
perception or patient is open to his parents whenever patient often cries when of the patient is good
Health he feels sick, or when he feel pain in something is wrong. but the patient has a
management his body. And that his child That’s the time his father poor health.
completed immunization. will ask him what’s
wrong.
They buy medicines like Paracetamol,
Biogesic, Cetirizine that is available They still follow the
OTC. The father stated that they routine prescribed.
followed the routine prescribed. The
patient has history of fall to the bed.

Nutritional/ The father stated that his son gain The patient’s father Patients Nutritional
Metabolic weight within the last 6 months. The shared that patient is able health status changed
father stated that the appetite of his to eat small amount of because of his
son is good. But Patient C is allergic meals a day due to hospitalization.
to chocolates. He take Cetirizine every decrease in appetite
time his allergy attacks. because of his illness.
The average day’s fluid intake is 4-5 The patient drink 750 ml
glass. The father also shared that the of water a day and has
patient likes to eat fruits, vegetables, also IV fluid.
and fried chicken.

The patient’s father stated that the The father stated the the The amount of void
child doesn’t experience any problem child’s voiding and and feces changed but
Elimination in voiding and defecating. Patient C defecating patterns there’s no changes in
don’t use any diapers. He defecates 2 change. The patient only the color and
times a day. The consistency of stool defecates once a day and consistency.
is sometimes hard sometimes liquid. voids 3-4 times a day.
The color of stool is sometimes The color of stool is
yellowish to greenish and there is no sometimes yellowish to
bleeding. No history of constipation greenish and still there is
and diarrhea. The father stated that his no bleeding. No history
son void 2-3 times a day. Color is of constipation and
yellow. The amount of voiding and diarrhea.
defecating vary.
The father stated that when it comes to The patient’s father
taking a bath, dressing, toileting, and stated that patient doesn’t
Activity feeding, his son can do it on his own have energy to play since There are big changes
Exercise and he doesn’t need assistance. When he feels weak and tired. on the patients Activity
it comes in shopping, laundry, When it comes in taking Exercise pattern due to
transportation of course he need a bath, dressing, his current condition.
someone to guide him. shopping, feeding, his
father is always on his
He can climb 2 stairs without side to guide him.
experiencing any difficulty. He walks
inside and outside of their house
without experiencing any difficulty.
The patient’s father stated the patient
 always play with his aunt because he
is always inside of their house.

Cognitive The patient is completely unaware of Patient is still unaware Nothing has change as
Perceptual what is happening on his about what is happening the patient is still
Pattern surroundings. and about his condition. unaware about his
condition.
The patient has no sensory problems. There’s an obstruction on
his left nose.
The father mentioned that his son feels
back pain because of history of fall in During the interview the
bed. The pain eventually goes away patient is cooperative
and you’ll be surprised to see him and responsive but
playing again. didn’t talk that much, just
nodding his head when
he’s responding to
questions that’s why his
dad answers all the
questions asked

Sleep and Patient C usually sleeps at 6 pm and At the hospital, patient Changes occur because
Rest wakes up at 5am but he wakes up doesn’t have a normal of frequent round of
every time he need to void. It depends sleeping pattern the nurses and due to
based on his dad if he take a nap in the especially at night the discomfort he felt
afternoon around 1-3 pm, he gets sleep because of the frequents with the unfamiliar
at 9pm and wakes up 7am. The father round of nurses for V/S environment.
mentioned that there’s a problem monitoring. The father
because when it’s 1 or 2am his son also stated that the
wakes up and can’t go back to sleep patient is asleep most of
easily. the time.
Self
Perception
and Self- The patients father stated that patient The father stated that the The patient has a
Concept views himself as a future protector of patient is lonely because strong self perception
Pattern the family. She also stated that he he has to skip school and and self concept.
always talks about doing his best in needs to be hospitalized.
school for his parents to be proud
someday.

Role- The patient is an only child. Patient C can speak in There is no change
Relationship Ilocano and Tagalog. The when it comes in role-
Pattern Patient C can speak in Ilocano and patient live with his Dad. relationship pattern.
Tagalog in their house. The patient
live with his Mom, Dad, Grandmother The father stated that his
and Aunt. The father stated that his son is uncomfortable
son is uncomfortable when he when he socialize with
socialize with other people. He is other people. He is
comfortable only in his family. comfortable only in his
family.
Sexuality The patient is male. The patient is male, 4 Nothing has changed.
Reproductive years old.
The patient is 4 years old.
No experience for sexual
No experience for sexual activities. activities.

Coping Stress The patient’s father stated whenever The patients stress There is a change due
Tolerance his son is unwell as his coping reliever is watching to his hospitalization.
mechanism he’s playing until he feels YouTube.
okay.
The father shared that he
The father shared that he talk with his talk with his son if
son if there’s a problem. there’s a problem.

Value Belief The religion of the patient is Iglesia Ni Together with his family, The patient has a
Cristo. The patient goes to church they continue to pray for strong faith with God.
every Tuesday and Sunday with his his fast recovery and for
parents to attend mass. Mr. C is not Gods provision to their
eating dinuguan. The father stated needs in the hospital.
that some of their church members
visit them when they can’t attend
church. And also the patient’s father
mentioned that their religious beliefs
helped them in dealing with
problems.
 COURSE IN THE WARD
Date/Time Progress Doctor’s order Interpretation
notes
12/03/23 Admit patient to -To receive treatment and/or care.
4:05 PM pedia ward

Secure consent for -To have ethical considerations and to

admission protect patients’ freedom to make a
health care decision and to also
protect the nurse.

NPO if w/ DOB -To decrease vomiting and prevent

and Seizure and prevent aspiration

Diagnostic -Diagnosis and laboratory tests can

Wt. 16 KG - CBC, Na, k, RBS find the cause if there’s any
HT. 102 cm abnormalities on the patient’s body

Therapeutics:

Paracetamol - To lower high body temperature,

alleviate pain, and lessen discomfort.

Diazepam -To suppress or stop seizures

Ceftriaxone q12 -To reduce the swelling and

CI ANST inflammation in the blood vessels

12-4-2023 (+) O2 support @ 2- -To detect and monitor medical

4:30 AM Seizure 4Lpm via face problems.
episode mask .

Monitor Vital signs -To monitor deviation from normal

q1hr until stable

Monitor Vital signs - To check if there is any nutritional

q1 problems, kidney disease or liver
TP disease.

Start phenytoin -To control seizures (Convulsion)

160mg IV then
27mg q8°
 Watch out for -Timely recognition of these signs
decrease O2 SAT can be critical in preventing
complications and improving
outcome

Hook to cardiac - To check if there is any changes it

monitor and pulse may help to identify patients with low
oximeters arterial oxygen tension who need
immediate intervention.

Refer -For further assessment and treatment

12/4/23 (+) To follow the same -To prevent dehydration

8:00 AM Febrile IV fluid
Temp:
39.3 Continue -For continuous action and effect
medications

Refer -For further assessment and treatment

Date/Time: December 3, 2023/ 8:52pm
URINALYSIS
Color: Yellow Transparency:
Clear

CHEMICAL EXAMINATION INTERPRETATION

LEUKOCYTES NEGATIVE NORMAL
NITRITE NEGATIVE NORMAL
UROBILINOGEN NEGATIVE NORMAL
PROTEIN NEGATIVE NORMAL
pH 5.5 Normal Range- 7.35 ABNORMAL
It indicates acidic
BLOOD NEGATIVE NORMAL
SP.GRAVITY 1.010 NORMAL
-Mild dehydration
KETONE NEGATIVE NORMAL
BILIRUBIN NEGATIVE NORMAL
GLUCOSE NEGATIVE NORMAL

MICROSCOPIC INTERPRETATION
EXAMINATION
PUS CELLS 0-1 /HPF NORMAL
RED BLOOD 0-2 /HPF ABNORMAL
CELLS
It indicates malnutrition
TYPE:
EPHITHELIAL RARE /LPF NORMAL
CELLS
TYPE:
MUCUS /LPF NORMAL
THREADS
BACTERIA /HPF NORMAL
YEAST CELLS /HPF NORMAL
CRYSTALS:
A. URATES /HPF NORMAL
(ACIDIC)
A. PHOSPHATE /HPF
(ALKALINE)
 CBC - 5 PARTS

Date/Time: December 3, 2023/ 9:05 pm

PARAMETER RESULT UNIT REFERENCE INTERPRETATION
RANGE
WBC 8.09 10^9/L 4.00-12.00 NORMAL
Neu# 6.22 10^9/L 2.00-8.00 NORMAL
Lym# 1.35 10^9/L 0.80-7.00 NORMAL
Mon# 0.50 10^9/L 0.12-1.20 NORMAL
Eos# L 0.01 10^9/L 0.02-0.80 ABNORMAL
Indicates a condition that
suppresses the immune system
Bas# 0.01 10^9/L 0.00-0.10 NORMAL
Neu% H 76.8% 50.0-70.0 ABNORMAL
Bacterial infections, stress
Lym% L 16.7% 20.0-60.0 ABNORMAL
These are vital for producing
antibodies that help the body to
defend it self against bacteria,
viruses, and other infections
Mon% 6.2% 3.0-12.0 NORMAL
Eos% L 0.2% 0.5-5.0 ABNORMAL
Indicates a condition that
suppresses the immune system
Bas% 0.1% 0.0-1.0 NORMAL
RBC 4.73 10^12/L 3.50-5.20 NORMAL
HGB 121 g/L 120-160 NORMAL
HCT 37.5% 35.0-49.0 NORMAL
MCV 79.1 fL 80.0-100.0 NORMAL
MCH 25.6 g/L 27.0-34.0 NORMAL
MCHC 323g/L 270-340 NORMAL
RDW-CV 12.7% 11.0-16.0 NORMAL
PLT 241 10^9/L 100-300 NORMAL

Date/Time: December 3, 2023/4:57 pm

 ELECTROLYTES
TEST RESULT REFERENCE INTERPRETATION
VALUE
SODIUM 128 135.0-145mmol/L ABNORMAL
Excessive intake of
fluid
POTASSIUM 4.1 3.5-5.1mmol/L NORMAL
CHLORIDE ---- 98-107mmol/L NOT APPLICABLE
CALCIUM ---- 2.10-2.55mmol/L NOT APPLICABLE
(TOTAL)
CALCIUM ---- 1.05-1.25mmol/L NOT APPLICABLE
(OINIZED)

BRAIN ANATOMY
INTRODUCTION

The brain is a complex organ that controls thought, memory, emotion, touch, motor
skills, vision, breathing, temperature, hunger and every process that regulates our body.
Together, the brain and spinal cord that extends from it make up the central nervous system, or
CNS.

 FRONTAL LOBE - manage thinking, emotions, personality, judgment, self-control,

muscle control and movements, memory storage and more
 PRIMARY MOTOR CORTEX - generate signals to direct the movement of the body
 PRIMARY SOMATOSENSORY CORTEX - This area of the cerebral cortex receives
sensory information from the somatic senses, plus proprioceptive senses and some visceral
senses
 PARIETAL LOBE - are primarily responsible for receiving and processing sensory input
such as touch, pressure, heat, cold, and pain. The parietal lobes are also involved in the
perception of body awareness and the construction of a spatial coordinate system (mental
map) to represent the world around us.
 TEMPORAL LOBE - managing your emotions, processing information from your senses,
storing and retrieving memories, and understanding language
 OCCIPITAL LOBE - responsible for visual perception, including colour, form and motion.
 NEURON ANATOMY

 DENDRITE - to receive information from other neurons, called pre-synaptic neurons, or

from the environment
 AXON TERMINAL - the site of neurotransmitter release. Neurotransmitters are chemical
messengers that are released from the axon and received by effector cells. This process is
critical for delivery of the message to the cells and tissues that are being controlled.
 AXON - to carry electrical impulses that are the means of communication within the brain
and between the brain and the rest of the body.
 NEURON NUCLEUS - is the central area where all the neuronal protein synthesis takes
place. The nucleus contains the genetic material that helps in the ribosomal RNA synthesis
process. Another function of the neuron's nucleus is to guide the axon hillock that generates
the impulses throughout the axon.
 SOMA - contains genetic information, maintains the neuron's structure, and provides energy
to drive activities
 SCHWANN CELLS - plays a vital role in maintaining the peripheral nervous system
(PNS).
 MYELIN SHEET - Myelin is an insulating layer, or sheath that forms around nerves,
including those in the brain and spinal cord. It is made up of protein and fatty substances.
This myelin sheath allows electrical impulses to transmit quickly and efficiently along the
nerve cells. If myelin is damaged, these impulses slow down.
 NODE OF RANVIER - allow for ions to diffuse in and out of the neuron, propagating the
electrical signal down the axon.
WHAT HAPPENS TO NEURONS DURING FEBRILE SEIZURE
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

After 30 minutes of Independent: After 30 minutes of

SUBJECTIVE: Risk for Injury related nursing interventions, Regular monitoring of nursing interventions,
to Seizure as evidenced the patient is expected Regularly monitored VS helps identify the goal was MET.
by history of seizures to: Vital signs changes in the child’s the patient and the
and potential harm condition, enabling parent was able to:
during episodes. Minimize the risk of Elevated the side rails prompt intervention.
ASSESSMENT
OBJECTIVE: DIAGNOSIS PLANNING
injury during a febrile INTERVENTIONS
and Padded the sides of RATIONALE EVALUATION
Minimized the risk of
episode by providing a the bed. Minimizing injury during a febrile
Parent stated child’s safeAfter 30 minutes of
environment. Independent: environmental risk and after 30 minutes
episode by of
providing
SUBJECTIVE:
history of seizure High body nursing interventions Instructed the parents to To avoiding
obtain anunnecessary
accurate nursing intervention,
a safe environment.
during fever temperature related the patient’s elevated Regularly
avoid monitored
restraining the core temperature
restraints andinjury
prevent the goal was MET,
episodes. to infection as temperature of the child’s
child duringvital signs, detect
a seizure. for afurther
during seizure the patient was able
evidenced by Flushed 38.1 C is lessen specially body development to:
OBJECTIVE: skin and skin is within normal range temperature.
Warm to touch Tepid sponge bath Reduced body
Flushed skin Performed Tepid helps in lowering temperature within
Skin is Warm to sponge bath to body temperature. the range of 37.3 C
touch patient.
Temp: 38.1 C
Instructed the parent Maintaining oral fluid
to maintain oral fluid intake prevents
intake. dehydration.

Instructed the parent Loosening clothes

to loosen the patient’s allows body to
cloths release heat, which
can help in managing
the fever and
Dependent: improving comfort.

Administered Administering
paracetamol as paracetamol aid to
prescribed reduce fever
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Ineffective Airway After 1 hour of Independent: After 1 hour of

SUBJECTIVE: Clearance related to nursing interventions, Assessed respiratory Continues monitoring nursing intervention,
excessive mucus the patient is rate regularly. And helps to detect the goal was MET,
production as expected to: auscultate lung sound improvements, the patient was able
OBJECTIVE: evidenced by to identify changes. guiding interventions to:
persistent cough with Improve airway adjustments.
Persistent cough phlegm clearance and reduce improved airway
with phlegm cough frequently. Encouraged the clearance and reduced
parents to maintain Hydration helps in cough frequently
Rattling sound is their child’s oral fluid liquefying respiratory
heard during the intake. secretions, making
auscultation of them easier to expel.
lungs.
Instructed the parents Elevating the head
to Elevate the patient‘s facilitates drainage of
head during sleep. respiratory secretions.
And promote upright
positioning during
waking hours.
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Impaired Hygiene After 30 minutes of Independent: After 30 minutes of

SUBJECTIVE: related to inadequate nursing interventions, Parental education nursing interventions,
parental care as the patient will be Educated parents on promotes awareness the goal was MET,
evidenced by Dirty expected to: the significance of and enables them to the patient was able
and unkempt nails maintaining clean take appropriate to:
OBJECTIVE: observed on the Improve the child’s nails for overall action
pediatric patient. hygiene by ensuring health and hygiene. Improved hygiene by
Dirty and unkempt clean and trimmed Trimming the nails, trimmed the dirty
nails observed on nails. Encouraged the preventing the risk of nails.
the pediatric patient. parent to trim the injury cause by
child’s nail. accidental scratches,
and reduce the risk of
infection
 DRUG NAME CLASSIFICATION MECHANISM OF INDICATION CONTRA ADVERSE EFFECT NURSING
ACTION INDICATION RESPOSIBILITY

GENERIC Therapeutic class: Binds to bacterial Treatment of skin Contraindicated in CNS: headache BEFORE:
NAME: antibiotic cell membranes, and skin structure patients with - dizziness - Check doctors order
CEFTRIAXONE inhibits cell wall infections, bone hypersensitivity to - lethargy - Tell patient to report
synthesis. and joint drug or other history of allergic reactions
infections, cephalosphorin. GI: nausea to the drug
Therapeutic complicated and - vomiting -Inform patient and SO
Effect: uncomplicated - diarrhea need and importance of the
BRAND NAME: Bactericidal. urinary tract drug to him/her.
ROCEPHIN infections HEMATOLOGIC: - identify the 10 Rights of
Lower respiratory - Bone marrow medication administration
tract infections, depression
intra- abdominal DURING:
ROUTE: infections, HYPERSENSITIVITY: -Administer ceftriaxone
IV Meningitis, Otitis - Ranging from rash to according to the prescribed
Media fever to anaphylaxis route (usually intravenous
or intramuscular).
FREQUENCY: -Monitor the patient for any
Q12 signs of adverse reactions
during administration.
DOSAGE:
- AFTER:
-educate patient and SO
about the possible adverse
reactions of the drug.
- document drugs name,
time and date of
administration on the
patient’s chart.
 DRUG NAME CLASSIFICATION MECHANISM OF INDICATIONS CONTRA ADVERSE NURSING RESPOSIBILITY
ACTION INDICATION EFFECT

GENERIC NAME: Therapeutic class: Inhibiting - mild pain or hypersensitivity CNS BEFORE:
PARACETAMOL Analgesic and prostaglandin and fever - use cautiously - agitation, - Conduct a thorough patient assessment,
antipyretic other substances that - mild to moderate in patients with - anxiety, including medical history, allergies, and
BRAND NAME: sensitize pain pain; mild to long term - fatique current medications.
ACETAMINOPHE receptors. Drug may moderate pain alcohol use - headache - 10 rights of medication administration
N relieve fever through with adjunctive because - insomnia - check for contraindications and
central action in the opioid analgesics; therapeutic - pyrexia potential drug interaction.
ROUTE: hypothalamic heat- fever. doses cause - monitor Vital signs.
IV regulating center. hepatotoxicity in CV
these patients. - hypotension DURING:
-peripheral - identify the patient
FREQUENCY: edema - Follow the appropriate route of
Q4 -periorbital administration
edema
DOSAGE: - tachycardia
160 mg AFTER:
GI - Monitor the patient for the therapeutic
- nausea effects of the medication.
- vomiting - Document the administration of
-abdominal pain medication.
- diarrhea - Record the patient's response to the
- constipation medication.
 DRUG NAME CLASSIFICATION MECHANISM OF INDICATIONS CONTRA ADVERSE NURSING RESPOSIBILITY
ACTION INDICATION EFFECT

-Adjunct therapy to Contraindicated BEFORE:

GENERIC NAME: Therapeutic class: Specifically, the skeletal muscle in patients with a CNS -Assess baseline vital sign.
DIAZEPAM Anticonvulsant, allosteric binding spasm known allergy to -lethargy -10 rights of medication
Skeletal muscle within the limbic -Adjunt therapy to diazepam. Also -amnesia administration
BRAND NAME: relaxant system leads to the convulsive disorder contraindicated in -psychosis -check for contraindications and
VALIUM anxiolytic effects -Sekeletal muscle patients with potential drug interaction.
seen with diazepam. relaxant myasthenia CV
Allosteric binding gravis, severe -transient DURING:
ROUTE: within the spinal respiratory hypotension -identify the patient
- IV cord and motor insufficiency and -Do not use for more than four
neurons is the sleep apnea EYE, EAR, months unless directed by clinician.
primary mediator of syndrome. NOSE, THROAT -Avoid non-prescribe medications
FREQUENCY: the myorelaxant (EENT) unless approved by clinician.
- effects seen in -nystagmus -Monitor the patient for Any signs of
diazepam. -blurred vision adverse reactions during
Mediation of the administration.
sedative, amnestic, Genitourinary(GU)
and anticonvulsant -incontinenece AFTER:
effects of diazepam -urine retention - Monitor the patient for the
is through receptor therapeutic effects of the medication.
binding within the Respiratory - Document the administration of
cortex, thalamus, -depression medication.
and cerebellum. - Record the patient's response to the
Skin medication.
-disquamation - Seek pyschiatric help if depressed.
 DRUG NAME CLASSIFICATION MECHANISM OF INDICATIONS CONTRA ADVERSE NURSING RESPOSIBILITY
ACTION INDICATION EFFECT

-Nausea
GENERIC NAME: Therapeutic class: Blockade of sodium -used to control -Known -Drowsiness BEFORE:
PHENYTOIN Anticonvulsant and calcium influx seizure hypersensitivity -Confusion - Conduct a thorough patient
BRAND NAME: into neuronal axon. -neuropathic pain to hydantoin -Stomach pain assessment, including medical history,
-choreoatethosis
EPTOIN Inhibit the release of product. -Poor allergies, and current medications.
-myotonia
excitatory -
-Heart problems. coordination - 10 rights of medication
transmitter. And -Liver disease. -Loss of appetite administration
ROUTE: potentiate the action -Diabetes. -Enlargement of - check for contraindications and
- IV of GABA. -Depression. the gums potential drug interaction.
-Suicidal thoughts -Abnormal eye - monitor Vital signs.
FREQUENCY: or actions. movement
- q8 DURING:
- identify the patient
- Follow the appropriate route of
administration
- 160mg then
27mg
AFTER:
- Monitor the patient for the
therapeutic effects of the medication.
- Document the administration of
medication.
- Record the patient's response to the
medication.
 PATHOPHYSIOLOGY

PREDISPOSING FACTORS: PRESIPITATING FACTORS:

VV
>AGE: 4 Y/O >ENVIRONMENT

>MALE >POOR HYGIENE

BACTERIA AND VIRUS

ENTER THE SYSTEM

>DROPLETS TRANSMISSION ENTERS TO THE NOSE BY

>HAND CONTACT INHALING

HAIR LINING FILTERS AND

IMMUNE DEFENSE
TRAP SOME PATHOGENS

JUNCTION TO THE
POSTERIOR NOSE TO THE
POTENTIAL INVADERS
PHARYNX

IMPINGE ON THE BACK OF

THE THROAT
SEIZURE

TRANSPORT PATHOGENS
UP TO THE PHARYNX HIGH GRADE
FEVER (38C<)

ERYTHEMA INFLAMMATORY
SEND SIGNAL TO THE
RESPONSE OF THE
HYPOTHALAMUS
IMMUNE SYSTEM
SWELLING

COUGH FEVER
COLDS
LEGEND

PATIENT BASE

BOOK BASE
 DISCHARGE PLAN

✓ give fever-reducing medications during

febrile illnesses
M ✓ Follow proper order dose of drug to achieve
drug reaction
MEDICATION

✓ Emphasize the importance of rest and

E avoiding strenuous activities during recovery
EXERCISE
✓ Follow any additional treatments of therapies
T recommended by doctor.
TREATMENT
✓ Educate the family on febrile seizure
H symptoms and signs of complications
✓ Advice the family to stay calm and follow the
HEALTH TEACHING necessary steps to make sure your child is safe
while they have a seizure.

✓ Provide contact information for reaching out

O in case of emergency or severe symptoms.
✓ Schedule a follow-up appointment for
OUTPATIENT monitoring and assessing recovery progress

✓ Recommend a balanced diet such as

D ketogenic diet.
✓ Drink a small and frequent amount of water.
DIET
✓ Address any spiritual or emotional needs of
S the patient and family.
✓ Encourage the patient and SO to engage in
SPIRITUAL activities that promote mental and emotional
well-being