-Convulsion means abnormal muscular contractions of either epileptic or non-epileptic origin.
Causes of convulsions
I. Acute convulsions:
► Febrileconvulsions, due to causes outside CNS e.g., tonsillitis, otitis media, ….etc.
► Intracranial infections: e.g., brain abscess, meningitis, encephalitis.
► 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).
► Post infectious, e.g., after meningitis.
► Post toxic, e.g., kernicterus.
► Post-traumatic, e.g., intracranial heamorrhage.
► Degenerative brain diseases.
► 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.