Nursing care plan of Convulsive Disorders

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Definition

-Convulsion means abnormal muscular contractions of either epileptic or non-epileptic origin.

 

Causes of convulsions

I. Acute convulsions:

 

With fever:

► Febrileconvulsions, due to causes outside CNS e.g., tonsillitis, otitis media, ….etc.

► Intracranial infections: e.g., brain abscess, meningitis, encephalitis.

Without fever:

► Trauma : e.g., intracranial heamorrhage.

► Toxins / poisons : e.g., lead poisoning.

► Anoxia / ischemia : e.g., respiratory failure, hypotension.

► Metabolic : e.g., hypoglycemia, hypocalcemia.

 

II. Chronic convulsions (recurrent) i.e., epilepsy

► Primary (idiopathic).

► Secondary:

► Post infectious, e.g., after meningitis.

► Post toxic, e.g., kernicterus.

► Post-traumatic, e.g., intracranial heamorrhage.

► Degenerative brain diseases.

► Post-anoxic.

 

Febrile convulsions:

► Febrile convulsions (FC) occurs as a result of infection outside the CNS or to high environmental temperature in a child who is neurologically normal.

► Febrile convulsion occurs at age from 6 months to 6 yrs.

► Males are affected more than females.

► If febrile convulsion is not treated, there is high rate of recurrence, especially in the 1st yr or two after onset.

 

Causes of Febrile convulsions:

► The exact cause is unknown, but 1/3 of cases have positive family history of febrile convulsion.

► Febrile convulsion occurs at the peak of fever or with sudden rise in temperature.

► It always occurs in the 1st 24 hrs of febrile illness.

► Each seizure is generalised and only one seizure in 24 hrs period.

► The EEG (electroencephalogram) is normal.

 

Therapeutic management of Febrile convulsions:

► Control convulsions by anticonvulsive drugs.

► Lower body temperature by tepid sponge or tub bath and antipyretics.

► Treat the cause of infection, e.g., antibiotics for otitis media.

 

Nursing care of Febrile convulsions:

Nursing diagnosis of Febrile convulsions

1- hyperthermia / alteration in body temperature.

2- high risk for injury related to convulsions.

3- high risk for fluid volume deficit related to hyperthermia.

4- knowledge deficit related to febrile convulsion management.

 

Nursing interventions of Febrile convulsions

The nurse should:

► Provide safety measures.

► Reduce fever using tepid bath (no alcohol or ice is added) either in bed or in tub. If tub is used the nurse must :

– use warm water first, then cold water gradually to prevent chilling.

– give the bath for 20-30 min.

– use floating toy to divert the young child’s attention.

– older child can help in bathing.

– dry child’s skin after bathing.

► Monitor temperature every half an hour.

► Offer fluids every hour if child is awake.

► Observe signs and symptoms of dehydration.

► Teach parents about :

– signs and symptoms of fever.

– measures to reduce fever.

– how to administer anti-convulsive drugs.

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