FACULTY OF MEDICINE & HEALTH SCIENCES

DIPLOMA IN NURSING PROGRAM

CONFIRMATION OF THE VALIDITY CASE STUDY

a) REGISTERATION NUMBER : 20/21900

b) NAME : SHAHRIN BIN ABDULLAH
c) SEX / AGE : MALE / 7 YEARS OLD
d) NRIC : 130317 - 12 - XXXX
e) ADDRESS : PULAU GAYA, KOTA KINABALU, SABAH
f) WARD : 4B
g) HOSPITAL : HOSPITAL WANITA & KANAK-KANAK, SABAH
h) DATE & TIME OF ADDMISSION : 22 JULY 2020 @ 6.30 PM
i) DATE & TIME DISCHARGE : STILL IN THE WARD
j) FINAL DIAGNOSIS : FEBRILE INFECTION RELATED TO EPILEPSY
SYNDROME

HEREBY I CONFIRMED THE DETAILS / CONTENT OF CASE STUDY ARE TAKEN FROM

WARD 4B, HOSPITAL WANITA DAN KANAK – KANAK, SABAH .

____________________________________________________________________

VERIFY BY CLINICAL INSTRUCTOR (IN-CHARGE IN THE WARD),

 FACULTY OF MEDICINE & HEALTH SCIENCES
DIPLOMA IN NURSING PROGRAM

MATRIC NUMBER : DN18110048

YEAR / SEMESTER : YEAR 2 / SEMESTER 2

CASE DIAGNOSIS : FEBRILE INFECTION RELATED TO EPILEPSY

SYNDROME

CLINICAL POSTING : MN22212 ( PAEDIATRIC POSTING )

WARD / HOSPITAL : 4B / HOSPITAL WANITA DAN KANAK-KANAK,

SABAH

CLINICAL SUPERVISOR : PN. ROSE A. NAIN

 A. INTRODUCTION

My client name is Mr. S who was 7 years old boy stays together with his parent in
Pulau Gaya. His father, Mr. A was 30 years old who worked as a labourer and his mother
was 29 years old as a housewife. Mr. S has no siblings, as he is the eldest. At the beginning,
Mr. S was having fever about 4 days at home and the temperature was not documented as
their home do not have any thermometer.

At that time, while he was sleeping, his mother was trying to wake him up, but
suddenly Mr. S was having seizure with a bilateral upper limb and lower limb stiffness, up
rolling eyeball and drooling of saliva. It was lasted around 2 to 3 minutes. Then, Mr. S does
not regarded conscious. Therefore, his parent directly brought him to the Emergency
Department Hospital Wanita dan Kanak- Kanak in Likas reach about 15 minutes from Pulau
Gaya.

At the Emergency Department, suddenly, Mr. S was developed with another episode
of seizure with drooling of saliva, up rolling eyeball and having a jerky movement lasted less
than 1 minutes and aborted spontaneously. Mr. S was loaded with IV Phenytoin 20mg/kg
which to control the convulsions. As a result, Mr. S was not having any episode of seizure
and client was conscious and looks lethargic with fair hydration. No shortness of breath and
vital sign checked.
 Temperature : 38.6 °C

Pulse rate : 99 / min

SPO2 : 100 %

Blood pressure : 101 / 56 mmHg

Pain score : 0 / 10

Then, before Mr. S was admitted in the ward, they need to complete their document
about their history of COVID-19. In this era globalization, all over the world were facing with
an infectious disease called COVID -19. So, people need to be aware and always obey to
Standard Operating Procedure (SOP). Therefore, my client and his parent all are well
asymptomatic at home and also not attended any mass gathering and has no history of
travelling. No history of contact with COVID-19 positive patient. Not only that, during mass
screening at Pulau Gaya, Mr. S’s parent was taken swab test and claimed the result was
negative.

After that, Mr. S was direct admission to 4B in room 3 accompanied by mother and
PPP Lorenzo from emergency Department. On arrival, client was drowsy and pink on room
air. His vital signs had been taken by the staff nurse in-charge.

Temperature : 38.2 °C

Pulse rate : 96 / min

SPO2 : 99 %

Blood pressure : 92/52 mmHg

Pain score : 0 / 10
 From this point, during my clinical posting in ward 4B, Hospital Wanita dan Kanak-
Kanak Likas, I took this opportunity to take care of Mr. S as my case study patient and
received his consent. Due to his epilepsy syndrome, I assist him in his activity daily living
(ADLs) and sometimes I go and talk to him and his mother was there to accompanied him.

During interviewing, Mr. S was unable to answer my question. He just gave me his
smile and staring at me. So, I asked Mr. S’s mother permission to take Mr. S case for my
case study, thankfully his mother was agreed. Then, I started interview his mother and read
his case note to find out more about his condition. When I asked question to Mr. S, he just
can smile and sometime he just nodded his head.

FEBRIILE INFECTION RELATED TO EPILEPSY SYNDROME (FIRES)

Febrile infection related epilepsy syndrome (FIRES) has previously also been known
as fever induced refractory epilepsy in school-aged children. It is a severe post-infectious
neurological disorder that presents with intractable status epilepticus in a previously normal
child or less commonly adult after a febrile illness. If the patient survives, they have
intellectual and motor impairment and ongoing intractable seizures.
 This syndrome presents with onset of seizures between 2-17 years of age. There is a
slight male predominance. A febrile upper respiratory or gastrointestinal illness precedes the
onset of seizures by 1-14 days median 4 days. Seizures rapidly progress to refractory status
epilepticus. The condition has a high mortality, surviving patients require prolonged
ventilator support and have cognitive and neurological impairment and ongoing seizures.
There are limited responses to specific therapies such as the early use of the ketogenic diet.

Risk Factors for Recurrence of Febrile Seizures

Major Minor

 Age less than 1year  Family history of febrile seizure

 Duration of fever less than 24hr  Family history of epilepsy
 Fever38-39 (100.4-102.2°F)  Complex febrile seizure
 Day care
 Male gender
 Low serum sodium at time of
presentation
Symptoms

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process
your brain coordinates. Seizure signs and symptoms may include:

 Temporary confusion
 A staring spell
 Uncontrollable jerking movements of the arms and legs
 Loss of consciousness or awareness
 Psychic symptoms such as fear, anxiety or déjà vu

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will
tend to have the same type of seizure each time, so the symptoms will be similar from
episode to episode.

Triggering factor of seizure

• Flashing of dark or light pattern

• Starting movement

• Over hydration

• Photosensitivity
i. Demography data:

Date and Time of Admission : 22 July 2020 at 6.30 PM

Name : Shahrin Bin Abdullah
Date of Birth : 17 March 2013 Birth Weight : 2.95 KG
Sex : Male Birth Place : Hospital Wanita dan
Kanak-Kanak, Likas
Race : Bajau Religion : Islam

ii. Health History

1. Chief complaint:
 Fever for 4 days
 Nausea and vomiting 3 times in a week and vomit contain food particle and no
blood
 Child less active since 2 days before admit to 4B
 Muscle weakness

2. Current health or illness:

 Having more than 1 episode of seizure in a day
 Unable to tolerate orally
 Vomiting after meals
 Stable and comfortable under room air and having a good breathing
 Having body weakness
 No diarrhoea or abdominal pain

3. Past health history:

i. Birth history
 My client was born on 17th March 2013 at 10.46 AM in Hospital Wanita dan
Kanak-Kanak, Likas.
 Born via Spontaneous Vaginal Delivery (SVD) at 41 weeks of gestational age of
delivery
  No bleeding, trauma, infectious illness and rupture of membrane during delivery
 Apgar scores was 9/10, having no breathing problems and no abnormalities find
out during assessment
 Birth weight about 2.95 Kg.

ii. Major medical illnesses

 Skin infection over scalp
 Febrile Seizure

Major surgical illnesses-list operations and dates

 Do not have any surgical illness

Trauma-fractures, lacerations
 Left distal radial fracture in January 2020 related to fall treated with POP at
Emergency Department. Repeated X-Ray in February 2020 during Ortho Clinic
follow up and was resolved.

Previous hospital admissions with dates and diagnoses

a) 1st Hospitalization
 1 Years 8 months old
 On 17th November 2013
 Skin infection over scalp

b) 2nd Hospitalization
 2 Years old
 On 17th March 2014
 Febrile Seizure

c) 3rd Hospitalization
 2 Years old 6 months
 On 17th September 2014
 Viral Febrile Illness
iii. Immunisation:
 Client’s was immunised and having his immunisation by age:
 BCG and Hepatitis B Dos 1
 Hepatitis B Dos 2 at 1 month
 DTaP Dos 1, Hib Dos 1 and Polio Dos 1 at 2 month
 DTaP Dos 2, Hib Dos 2 and Polio Dos 2 at 3 month
 DTaP Dos 3, Hib Dos 3 and Polio Dos 3 at 5 month
 Hepatitis B Dos 3 and Measles Dos 1 at 6 month
 MMR Dos 1 at 9 month
 MMR Dos 2 at 12 month
 DTaP Booster, Hib Booster and Polio (IVP) Booster at 18 month

iv. Allergies:
 Patient claimed that he does not have any allergies towards medication.
 Patient claimed that he does not have any allergies towards seafood or
others food.
 Patient claimed that he does not have any allergies towards dust.

v. Current Medication:

1. Drug name Penicillin

Dosage 250 mg
Route Intravenous (IV)
Indications An antibiotic to treat many different types of bacteria such as an
ear infections
Side effect  Skin rash
 Chills
  Muscle or joint pain
 Numbness
 Muscle weakness

2.
Drug name Azithromycin
Dosage 500 mg
Route Tablet (T)
Indications Used to treat a wide variety of bacterial infections. It is a
macrolide-type antibiotic. It works by stopping the growth of
bacteria
Side effect  Stomach upset
 Nausea and vomiting
 Abdominal pain
 Diarrhoea

3. Drug name Phenytoin

Dosage 20 mg
Route Intravenous (IV)
Indications An anti-epileptic drug also called an anticonvulsant. Phenytoin
works by slowing down impulses in the brain that cause seizures
and used to control the seizures.
Side effect  Shortness of breath
 Skin pain
 Burning in your eyes
 Skin rash

Drug name Diazepam

4.
Dosage 5 mg
Route Intravenous (IV)
Indications Used to treat anxiety, alcohol withdrawal, and seizures. It is also
used to relieve muscle spasms and to provide sedation before
medical procedures. This medication works by calming the brain
and nerves.
 Side effect  Drowsiness
 Tiredness
 Dizziness
 Blurred vison

5. Drug name Paracetamol

Dosage 300 mg
Route Tablet (T)
Indications Used to treat many conditions such as headache, muscle aches,
arthritis, backache, toothaches, colds, and fevers. It relieves pain
in mild arthritis but has no effect on the underlying inflammation
and swelling of the joint.
Side effect  Nausea
 Vomiting
 Stomach pain
 Loss of appetite

Nursing responsibility regarding medication given

Applying 7 Rights Medication:

 Right patient
 Right medication
 Right dose
 Right time
 Right route
 Right documentation
 Right to refuse

4. Family medical history :

 Mr. S ’s father does not have any medical illness and do not have any problem
regarding mental illness, growth problems or ethnic background.
 Mr. S ’s mother had hypertension, does not have any problems towards mental
illness.
 Both are free from thalassemia
 Does not have any history of epilepsy malignancy
iii. Nursing Assessment

1. Vital Signs:

Temperature
 Tympanic : 36.9 ° C

Heart rate
 Apical pulse : 99 beats/min

Respiratory rate
 21 beats/min

Blood pressure
 At right arm : 106/60 mmHg

Growth parameters - must plot on appropriate growth curve

 Weight
 Height/length

Occipital Frontal Circumference (OFC):

Across frontal-occipital prominence so greatest diameter

2. General appearance:

 Patient look was a bit lethargic, alert and conscious

 Patient can give a good respond with the treatment given
 Patient’s hydration was fair and don’t have tachypnoea
 Patient can communicate but at a slow range and only can answer a few
question
 Have a good nutritional
3. Feeding history:

 Breast feeding since birth

 Started eating solids food at 6 months with baby puree, rice porridge and
baby cereal
 During admission in the ward, patient was feeding with formula ordered
by the physicians:
17 MLS of MCT oil + 2g Carborie + 1g Ceprolac mix with 245 MLS
of water + RCF 55 millilitre = 300 MLS
RCF is intended for persons who are unable to tolerate the type or amount
of carbohydrate in milk or infant formulas. This product has no added
carbohydrate which was infant formula available for the dietary
management of seizures in infants.

4. Developmental milestone assessment

5. Family Functional (family tree):

 Living at their own home at Pulau Gaya complete with electricity and
water
 Having almost complete facilities at home
 Having own vehicle

Father Mother

- 30 years old - 29 Years old

- Laboured - Housewife

Mr. S
 6. Coping Strategies for Hospitalization

iv. Physical Examination:

8. Head to toe physical assessment:

i. Skin and Lymphatics:
 Light brown and uniform in colour
 No foul odor found
 No masses and lesions free
 No wound and laceration
 Skin looks moist and no rashes
 Have mole at the right cheeks
 No enlarge lymph node and not tender

ii. Head:
 Asymmetrical with frontal, parietal and flatted occipital prominences
 Head was not tenderness
 Symmetrical facial expression such as smiling and frowning
 Posterior fontanel is closed and anterior fontanel is still open.
iii. Eye:
 Eyes is symmetrical
 Equal eye lashes distribution
 Eyebrows are symmetrically aligned and evenly distributed
 Have equal movement
 No discharge and no discoloration of eyelids
 When lids are close, sclera is not visible
 Sclera white
 Pink conjunctiva
 No oedema or tenderness over the lacrimal gland

iv. Ear:

 Ear was symmetrical

 Colour same as facial skin
 Auricle aligned with other canthus of the eye
 Absence of lesions
 Ear was firm and not tender

v. Nose:

 Nose are symmetrical

 No discharges
 No nasal flaring
 Uniform in colour
 Not tender
 No lesions
 Pink mucosa
 Nasal septum intact and in the midline
 Sinuses are not tender
 vi. Mouth:
 Tooth are still aligned and undamaged
 Have moist and smooth texture of lips
 Uniform pink colour of gums, tongue and tonsil
 Moist and slightly rough tongue
 Light pink and smooth soft palate
 Light pink hard palate
 Uvula is positioned in the midline of soft palate

vii. Neck:
 Generally uniform in colour
 No palpable lymph nodes in the
 Neck can move freely

viii. Chest and Lungs:

 Inspection
o Pattern of breathing
 Abdominal breathing is normal in infants
 Period breathing is normal in infants (pause < 15 seconds)
o Respiratory rate
o Use of accessory muscles: retraction location, degree/flaring
o Chest wall configuration
 Auscultation
o Equality of breath sounds
o Rales, wheezes, rhochi
o Upper airway noise
ix. Cardiovascular
 Auscultation
o Rhythm
o Murmurs
o Quality of heart sounds
 Pulses
o Quality in upper and lower extremities
x. Abdomen:
 Uniform in colour
 Symmetric contour
 Rounded or protuberant abdomen
 Absence of lesions and tenderness
xi. Musculoskeletal:
  Back
o Sacral dimple
o Kyphosis, lordosis or scoliosis
 Joints (motion, stability, swelling, tenderness)
 Muscles
 Extremities
o Deformity
o Symmetry
o Edema
o Clubbing
 Gait
 1. In-toeing, out-toeing 2. Bow legs, knock knee
 “Physiologic” bowing is frequently seen under 2 years of
age and will spontaneously resolve
o Limp
 Hips
o Ortolani’s and Barlow’s signs
xii. Neurologic -most accomplished through observation alone
 Cranial nerves
 Sensation
 Cerebellum
 Muscle tone and strength
 Reflexes
o DTR
o Superficial (abdominal and cremasteric)
o Neonatal primitive
xiii. Genitourinary:
 External genitalia
 Hernias and Hydrocoeles
o Almost all hernias are indirect
o Can gently palpate; do not poke finger into the inguinal canal
 Cryptorchidism
o Distinguish from hyper-retractile testis
o Most will spontaneously descend by several months of life
 Tanner staging in adolescents - See Tanner Staging handouts
 Rectal and pelvic exam not done routinely - special indications may exist
Laboratory investigation and results:

Diagnostic / Result Indication Interpretation

Laboratory
Procedure
Lumbar CSF 4.04 A CSF analysis may Your CSF analysis results
puncture: Glucose include tests to may indicate that you
(Normal)
diagnose infectious have an infection, an
Cerebrospinal
diseases of the autoimmune disorder,
Fluid (CSF)
brain and spinal such as multiple
CSF Serum cord, including sclerosis, or another
0.74 meningitis and disease of the brain or
Glucose encephalitis. CSF
(Normal) spinal cord. Your
tests for infections provider will likely order
look at white blood more tests to confirm
cells, bacteria, and your diagnosis.
CSF other substances
0.28
Protein in the
(Normal) cerebrospinal fluid

Magnetic MRI scanner would A special type of MRI is

Resonance be used to detect: the functional MRI of the
Normal
Imaging brain. It produces
 anomalies of
(MRI) images of blood flow to
the brain and
certain areas of the
spinal cord
brain. It can be used to
examine the brain's
 Tumor, cysts,
anatomy and determine
and other
which parts of the brain
anomalies in
are handling critical
various parts of
functions.
the body

 injuries or
This helps identify
abnormalities
 of the joints, important language and
such as the movement control areas
back and knee in the brains of people
being considered for
brain surgery.
Full Blood Hematocrit 32.9 The FBC is used as Most FBCs come back
Count a broad screening with cell numbers in the
(Low)
(FBC) test to check for normal range. About 5%
such disorders as of people that are tested
Hemoglobin 11.2 anaemia, infection, will have a minor blood
and many other count abnormality.
(Low)
diseases. It is
actually a panel of
tests that Abnormal numbers of a
White 6.53
examines different specific type of blood cell
Blood Cell (Normal)
parts of the blood can be indicative of
specific problems. The
information provided
here must be used as a
Lymphocyte 2.18 guide only. If you have
(Normal) an abnormal blood
count, your doctor will
determine what
treatment is necessary.
Platelet 434
(High)
Blood Urine Na+ 136 To screen patient Creatinine is a more
Serum and diagnose their powerful tool to measure
(Normal)
Electrolyte health status kidney impairment than
(BUSE) Urea, because your
K+ 4.6 blood Urea can be
affected by other things,
(Normal)
such as the volume of
your blood. But
Urea 5.2 Creatinine denotes
muscle damage, and can
(Normal) be high in rare conditions
where there is extensive
muscle destruction
Creat 41.4
(Low)

Ca+ 2.13
(Low)

Informant:
 Interviewing client

 Interviewing client’s mother

 Staff Nurses

 Case Note

 Medication Chart

 Nursing Assessment

 Observation Chart

Interviewed by:

 Student Nuring Year 2, Norsyhkerra Binti Nawir

Date:

 11 August 2020

 12 August 2020

 13 August 2020

NURSING CARE PLAN (Nursing Diagnosis NANDA)

Nursing problems:

 Fever
 Risk of injury
 Risk for ineffective airway clearance
 Deficient of knowledge
 Impaired verbal communication

List of nursing diagnosis:

 No Date Nursing Diagnosis Date Resolved

22 July 2020 Altered body temperature related to 24 July 2020

1 diseases process as evidenced by
temperature patient is 38.6 °C.

24 July 2020 Risk of injury related to seizure activity. 25 July 2020

2

25 July 2020 Risk for ineffective airway clearance 26 July 2020

3 related to disease

26 July 2020 Deficient of knowledge related to lack 27 July 2020

4 exposure to information about ongoing
care as evidence by mother ask question
related to disease

27 July 2020 Impaired verbal communication related 28 July 2020

5 to cognitive impairment as evidence by
inability to tolerate orally well during
interview for my case study

NURSING CARE PLAN

N NURSING GOAL / NURSING INTERVENTION EVALUATION

O DIAGNOSIS EXPECTED
( WITH RATIONALE )
OUTCOME
1 Altered body After 4 hour of 1. Monitor the child’s After 4 hour
temperature nursing temperature at tympanic or nursing
related to interventions, the rectal interventions,
diseases process temperature of the the temperature
Rationale : Most febrile seizure
as evidenced by patient will of the patient
happen when the temperature is
temperature decrease from was decrease to
higher than normal and close
patient is 38.6°C to 36.8°C. 36.8 ° C
monitoring of temperature is
38.6 °C
essentials.
2. Administer tepid sponging
toward the child
Rationale : External sponging
will reduces the body
temperature and increase
comfort.

3. Remove unnecessary
clothing or cover that could
only aggravate heat
Rationale : These decrease
warmth and increase evaporative
cooling

4. Assess neurologic
response, noted level of
consciousness and
orientation and presence of
posturing seizure
Rationale : To evaluate effects
or degree of hyperthermia and to
have a baseline data

5. Assess for hydration status

Rationale : A high body
temperature increases the
metabolic rate hence increases
the insensible fluid loss.

6. Advise the mother to avoid

applying cold water or
alcohol to the child
Rationale : Extreme cooling can
result in shock to a child with an
immature nervous system and
while applying alcohol can cause
dry skin.
 7. Administer antipyretic as
ordered by the physician for
example paracetamol
Rationale : Aids in lowering
down the temperature

2 Risk of injury After 7 hours of 1. Maintain side-lying After 7 hours of

related to nursing position and keep padded nursing
seizure activity interventions, client side rails up with the bed in interventions,
will be free from lowest position. client free from
injury of seizure Rationale : Can maintains injury of seizure
activity airway patency and the padding activity
protects the child form injury
during seizure

2. Avoid restraining the child

or putting anything in their
mouth
Rationale : Restraining a child
can result in trauma due to the
amount of forced exerted and
inserting objects in mouth
increase the stimuli

3. Assess and record seizure

activity and location. Note
the duration of seizures,
parts of the body involve and
progression of seizure.
Rationale : Documentation of
information is essential for the
prevention of injury or
complications as result of a
seizure

4. Assess skin for pallor,

flushed or cyanosis and
monitor respiratory rate.
Depth and signs of
respiratory distress
Rationale : Once seizures are
 prolonged and respiration is
compromised, this will provide
information on possible signs of
aspiration of secretions.

5. Stay with the child during

the phase of seizure and
reorient when awake.
Rationale : Provides support
and prevents any injury to child

6. Advice parents to remain

calm during seizure activity
of the child
Rationale : Allows parents to
function properly to protect the
child from injury

7. Educate the parents

regarding precautionary
measures during a seizure
Rationale : Guarantees safe
and effective interventions to
avoid the incidence of injury
3 Risk for After 5 hours 1. Assess the child’s airway After 5 hours of
ineffective nursing using the look, listen and feel nursing
airway clearance interventions, client approach. interventions,
related to will be able to Rationale : This will ensure that client able to
disease maintain a patent seizure does not affect the maintain a
airway supply of oxygenated blood to patent airway
the brain and prevent the
development of hypoxia

2. Monitor respiratory rate,

rhythm, depth, and effort of
respirations.
Rationale : Provides a baseline
data for evaluating adequacy of
ventilation.
3.Auscultate lungs for the
presence of normal or
adventitious breath sounds.
Rationale : Abnormal breath
sounds can be heard as fluid and
mucus accumulate. This may
indicate airway is obstructed

4. Place the child on a flat

surface or on the bed then
turn the head on the side
during seizure episode.
Rationale : Turning the child’s
head to the side help in
maintaining a patent airway by
promoting drainage of secretions
and avoid aspirations to the
lungs

5. Loosen any restrictive

clothing, especially on the
neck, chest and abdomen.
Rationale : This will facilitate
ease of breathing and maintain
an unobstructed airway
6. Ensure patient to the
empty mouth of dentures or
foreign objects if aura occurs
and to avoid chewing gum
and sucking lozenges if
seizures occur without
warning.
Rationale : Lessens risk of
aspiration or foreign bodies
lodging in the pharynx.

7. Provide supplemental
oxygenation as indicated.
Rationale : Oxygen therapy is
prescribed to improve oxygen
saturation and reduce possible
complications
4 Deficient of After 3 hours 1. Assess parent’s After 3 hours of
knowledge nursing perceptions and knowledge nursing
related to lack intervention, about disease condition, intervention,
exposure to parents will be able fears and misconceptions parents able to
information to understand and about disorder, nature and understand and
about ongoing obtain information frequency of seizures obtain
care as evidence regarding care of Rationale : Provides information information
by mother ask the child regarding the long-term care of regarding care of
question related child and how to deal with the child
to disease seizure

2. Educate parents that a

having seizure is more of a
symptom of fever than a
long-term condition
Rationale : Understanding this
information can help the parent
understand the responsibility to
take for future care

3. Instruct the patient not to

get out of bed without
assistance and explain the
need to have someone with
the patient if an event
occurs.
Rationale : To be prepared that
client will not be alone when
having a seizure

4. Advise parents to
supervise the child in the
bathroom and avoid
exposure to incidents that
can triggered a seizure.
Rationale : To provides
precautions to prevent injury as
a result of a seizure

5.Discuss any activity

restrictions such as sports,
rough play, need for
someone in attendance.
Rationale : Promotes
knowledge of activity based on
individual child and seizure
activity and response to therapy

6. Provide clear, thorough,

and understandable
explanations and
demonstrations.
Rationale : Parents are better
able to ask questions when they
have basic information about
what to expect.

7. Instruct patient or parent

to keep the padded bed rails
up at all times except
at meal times or when
assisted out of bed.
Rationale : To be prepared
from sudden attack of any
seizure
5 Impaired verbal After nursing 1. Learn patient needs and After nursing
communication interventions, client pay attention to nonverbal interventions,
related to will be able to have cues client able to
cognitive a progression to Rationale : Nurse should set speak clearly and
impairment as speak clearly and aside enough time to attend to can give his
evidence by able to give all of the details of patient care. cooperation
inability to cooperation toward Care measures may take longer towards
tolerate orally questions to complete in the presence of a questions
well during communication deficit
interview for my
case study
2. Maintain a calm, unhurried
manner. Provide ample time
for the child to respond
Rationale : Hurrying up the
child’s speech will make it less
clear and communications will be
impaired

3. Keep distractions such as

television and video at hand
phone at a minimum when
talking to the child
Rationale : Removing such
distractions maintain the focus of
the child, and decreases stimuli
going to the brain for
interpretation

4. Provides an alternative
means of communication
Rationale : Alternative such as
flash cards, whiteboards, hand
signs, or picture allows the client
to express oneself if speaking is
difficult to obtain

5. Involve family and

significant others in the plan
 of care as much as possible
Rationale : Enhances
participation and commitment to
plan

6. Coordinate the child with

speech therapist as indicated
Rationale : A speech therapist
helps the child in learning to
speak slowly and how to
coordinate their lips and tongue
to form speech sounds

7. Use short sentences, and

ask only 1 question at a time.
Rationale : To make the client
understand and catch a word
that we say and the client will
not get confuse with too many
question

B. Summary

In summary, Febrile infection-related epilepsy syndrome (FIRES) is a rare

catastrophic epileptic encephalopathy with a yet undefined aetiology, affecting healthy
children. It is characterized by acute manifestation of recurrent seizures or refractory status
epilepticus preceded by febrile illness, but without evidence of infectious encephalitis. FIRES
is mostly irreversible and its sequelae include drug-resistant epilepsy and neuropsychological
impairments. The treatment of FIRES represents a significant challenge for clinicians and is
associated with low success rates. Early introduction of ketogenic diet seems to represent
the most effective and promising treatment. This review aims to highlight the most recent
insights on clinical features, terminology, epidemiology, pathogenesis, diagnostic challenges
and therapeutic options.

Thus, from 10th August 2020 to 14th August 2020, my group was posting in 4B ward
at Hospital Wanita dan Kanak-Kanak in Likas for 1 weeks. During that weeks, I took one of
Paediatrics case to fulfil of my Clinical Posting. I have chooses Febrile Infection Related To
Epilepsy Syndrome (FIRES) as my case study and my patient was Mr. S. I took this
opportunity during 1 weeks of my clinical posting at 4B ward to take a good care for Mr. S
with nursing care plan related to FIRES. Through this case study, I gain so many new
knowledge and learn a lot of things about my case study.

Therefore, I would like to say thank you to my patient’s mother that allowed me to
take her child’s cases as my case study. She was so friendly and always give me the
information which helped me to finish my case study by giving a lot of her details and being
professionally during the interviewing even though when the 1 st day I met Mr. S, he cannot
speak clearly and sometimes cannot give cooperation during the interview session, but when
it was my last day at that ward, Mr. S manage to speak to me and he can answer my
question slowly. Finally, I also want to give a big thanks to my clinical supervisor at that
time, Ms Rose that guided me to finish my case study even though it was so rush at that
week to take a case and I would like to thank to my examiner Ms. Chong, that give us time
to finish our case study successfully. THANK YOU!

C. References

 Berman et all (2016) Fundamentals of Nursing 10th edition, Pearson Public Sdb
Bhd.

 Tan WW & Chan DWS et all (2015) Management of febrile illness-related

epilepsy syndrome.
 https://www.dovepress.com/febrile-infection-related-epilepsy-syndrome-fires-
prevalence-impact-an-peer-reviewed-fulltext-article-NDT

 Williams P.J. & Broughton P.F (2019), Mayo Foundation for Medical Education
and Research (MFMER).
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-
causes/syc-20350093

 Schachter SC. (2017), The epilepsies and seizures, National Institute of

Neurological Disorders and Stroke.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-
Through-Research/Epilepsies-and-Seizures-Hope-Through

 Ananth CV & Keyes KM, (2020), Epilepsy Diagnosis.org, International League

Against Epilepsy.
https://www.epilepsydiagnosis.org/aetiology/febrile-infection-related-epilepsy-
overview.html

Student Signature & Date :

( 26 August 2020 )
Supervisor’s Comments :

End of Case Study