CHARMAINE C.

BUGTONG
FEBRILE
SEIZURE
 FEBRILE SEIZURE
• is a convulsion in a child caused by a spike in
body temperature, often from an infection.
• They occur in young children with normal
development without a history of neurologic
symptoms. It can be frightening when your
child has a febrile seizure, and the few
minutes it lasts can seem like an eternity.
• A febrile seizure usually occurs between 6 months
and 5 years of age.
• Usually, children have a rectal temperature greater
than 102 degrees Fahrenheit.
• Usually, the seizure would occur during the first day
of the fever. ... Most children only have 1 or
2 febrile seizures in childhood.
 CLASSIFICATIONS
1. Simple febrile seizures
This most common type lasts from a few seconds to
15 minutes. Simple febrile seizures do not recur
within a 24-hour period and are not specific to one
part of the body.
 CLASSIFICATIONS:

2.Complex febrile seizures

> This type lasts longer than 15
minutes, occurs more than once
within 24 hours or is confined to one
side of your child's body.
 CAUSES

• Infection
 The fevers that trigger febrile seizures are usually
caused by a viral infection, and less commonly by a
bacterial infection. Influenza and the virus that
causes roseola, which often are accompanied by
high fevers, appear to be most frequently
associated with febrile seizures
 Post-immunization seizures

The risk of febrile seizures may

increase after some childhood
immunizations. These include the
diphtheria, tetanus and pertussis or
measles-mumps-rubella vaccinations.
A child can develop a low-grade
fever after a vaccination
 RISK FACTORS
• Young age
>Most febrile seizures occur in children between 6
months and 5 years of age, with the greatest risk
between 12 and 18 months of age.
• Family history
> Some children inherit a family's tendency to have
seizures with a fever. Additionally, researchers have
linked several genes to a susceptibility to febrile
seizures.
 What to do if your childe has a
seizure
1. Placethe child on a soft surface, such as a bed.
2. Prevent choking by laying the child on his or her
side or stomach.
3. Ensure that the child is breathing adequately.
What to do if your childe has a seizure

4. Never place anything in the child’s mouth

during a convulsion.
5. Gently clean saliva or other debris from the
child’s mouth with a soft cloth.
6. Check the time when the seizure begins and
note how long it lasts.
 WHAT TO DO IF YOUR CHILD HAS A SEIZURE?

7. Administer any treatment that your doctor has

prescribed to stop seizure if this is a recurrence of
febrile seizure. Call for help if the seizure does not
stop within three to five minutes or the child does not
fully regain consciousness.
8. When fully awake, give your child a medication
(e.g., acetaminophen, ibuprofen) to reduce fever.
 Medical Management:
Antipyretic drugs that are typically used include:
• Acetaminophen
• Ibuprofen
Nondrug approaches to fever include putting the
child in a warm or tepid bath, using cool compresses,
and undressing the child.
 Medical Management
• Giving your child infants' or children's acetaminophen
or ibuprofen at the beginning of a fever may make your
child more comfortable, but it won't prevent a seizure.
• Rectal diazepam (Diastat) or nasal midazolam might be
prescribed to be used as needed for children who are
prone to long febrile seizures. These medications are
typically used to treat seizures that last longer than five
minutes or if the child has more than one seizure within
24 hours. They are not typically used to prevent febrile
seizures.
 Medical Management
• Caregivers should be cautioned not to use a cold
water bath, which is uncomfortable and which, by
inducing shivering, may paradoxically elevate body
temperature.
• As long as the temperature of the water is slightly
cooler than the temperature of the child, a bath
provides temporary relief.
 Autism
Spectrum
Disorder
 Autism spectrum disorder (ASD)

• It is a developmental disability
caused by differences in the brain.
People with ASD often have
problems with social communication
and interaction, and restricted or
repetitive behaviors or interests.
• It is a complex disorder that is not diagnosed
medically but by behavioral observation and
screening.
• Recent studies showed that one out of 110 children
worldwide is considered to have some form of
autism; this incidence is ten times higher than ten
years
Plan of Care Revolves around

• providing remedy from

specific symptoms and
improving quality of life
 Nursing Management
1. The nurse must be able to familiarize the combination
of symptoms associated with autism of the patient.
2. The nurse is the coordinator of therapies and
interventions that meet the specific needs of individual
children.
3. During the treatment session, the nurse’s main goal is to
provide safety. The nurse must ensure that unnecessary
things that may harm the child are removed from the area.
It is also important to let the other staff members know of
the child’s special needs
4. Apply appropriate behavioral strategies are
implemented. One example is the applied
behavioral analysis (ABA).
5. Listen to the child, his parents and the
caregivers. As a nurse, you have to be an
effective channel of communication among
these people.
 Medical Management:
1. Prescription of anti-psychotic drugs anxiolytics, and
anticonvulsant drugs.
2. The medical management mostly involves the management
of the symptoms as well as repetitive behavior that may harm
the child.
3. Diet modification must also be stressed since these children
must have some kind of special diet that will fit their lifestyle.
Changing the diet or adding vitamin supplements may improve
digestion and eliminate food intolerances or allergies, which
may contribute to behavioral problems in autistic patients
4. The physician must provide ample information
about the special needs of the child and the available
resources for the family to get in the community.
5. Proper follow-up on psychiatrists and child
developmental specialists must be done routinely in
order to prevent untoward physical and mental
disabilities. Children with autism may have medical
problems, mostly cardiac problems that must also be
addressed equally during the course of care
Attention Deficit
Hyperactivity
Disorder
 Attention deficit hyperactivity
disorder (ADHD)

• Also called attention deficit disorder

(ADD)
• it is a syndrome characterized by
degrees of inattention, impulsive
behavior, and hyperactivity
Patients with this condition may manifest one or
more of the following sub types:
• Inattention
-Inattention means a person wanders off task
- lacks persistence
- has difficulty sustaining focus,
- disorganized;
- and these problems are not due to defiance or lack
of comprehension.
• Hyperactivity
-means a person seems to move about
constantly, including in situations in
which it is not appropriate; or
excessively fidgets, taps, or talks
excessively
• Impulsivity
- Impulsivity means a person makes hasty
actions that occur in the moment without
first thinking about them and that may
have high potential for harm;
- or a desire for immediate rewards or
inability to delay gratification
 Etiology
• Developmental lag
>Children with ADHD experience a developmental delay in
areas of the brain important for controlling action and
attention.
• Biochemical changes
> A new study at Örebro University in Sweden shows that
children with ADHD have nearly 50 percent less of a
protein that is important for attention and learning; the
finding may mean that there are other biochemical
disturbances in the brains of individuals with ADHD than
was previously believed.
• Food sensitivities
> Dietary studies have found a strong
connection between food and ADHD
symptoms, these studies are small and
have their limitations, as most nutrition
studies do, but they all produce
remarkable results.
• Genetics
>ADHD tends to run in families and, in
most cases, it's thought the genes you
inherit from your parents are a
significant factor in developing the
condition.
 RISK FACTORS
• Brain injury
• Exposure to environmental risks (e.g.,
lead) during pregnancy or at a young age
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight
 Clinical Manifestations
Inattention
You might not notice it until a child goes to
school; in adults, it may be easier to notice at
work or in social situations
 the person might procrastinate,
do not complete tasks like homework or
chores
 frequently move from one uncompleted
activity to another.
Hyperactivity
Children with hyperactivity may fidget and
squirm when seated
 get up frequently to walk or run around
 have trouble playing quietly or doing quiet
hobbies
talk excessively.
Impulsivity
>Symptoms of this include impatience
>having a hard time waiting to talk or
react
>frequently interrupt or intrude on
others
 Complications
• Tourette syndrome
>A neurological disorder characterized by repetitive
muscle or vocal tics.
• Depression
>Depression frequently occurs in children with
ADHD.
• Oppositional defiant disorder (ODD)
> Generally defined as a pattern of negative, defiant
and hostile behavior toward authority figures.
• Bipolar disorder
>Bipolar disorder includes depression as well as manic
behavior.
• Conduct disorder.
>This is marked by antisocial behavior such as stealing,
fighting, destroying property, and harming people or animals
• Anxiety disorders.
>Anxiety disorder may cause overwhelming worry,
nervousness
Assessment and Diagnostic Tests:

• Diagnosis can be made after the child is three (3)

years old but often is not made until the child
reaches school age and has trouble settling into the
routine of being in the classroom setting.
• Medical examination> Medical examination may
help rule out other possible causes of symptoms.
• ADHD criteria from the Diagnostic and Statistical
Manual of Mental Disorders> DSM-5, published by the
American Psychiatric Association, has a list of the
criteria that confirms the diagnosis of ADHD
• ADHD rating scales> The ADHD Rating Scale is
a parent-report or teacher-report inventory
created by DuPaul and colleagues consisting of
18 questions regarding a child’s behavior over
the past 6 months.
 Management
• Behavioral psychotherapy
> Behavioral psychotherapy often is effective when
used in combination with an effective medication
regimen; behavioral therapy or modification programs
can help diminish uncertain expectations and increase
organization.
• Cognitive therapy for adults with ADHD
>Metacognitive therapy involves the principles
and techniques of cognitive and behavioral
therapies to enhance time management; in doing
so, these have made adult patients with ADHD
better able to counter the anxiety and depressive
symptoms they experience in task performance
• Psychosocial interventions
> A number of psychosocial treatments are
effective; these include behavioral parent
training (BPT) and behavioral classroom
management (BCM);these are best used in
conjunction with psychopharmacological
approaches.
 Pharmacologic Management:
• Stimulants
>Stimulant medications, such as methylphenidate (Ritalin,
Concerta) and dextroamphetamine (Dexedrine), have often
been used; when given in large amounts, these medications
may suppress the appetite and affect the child’s growth.
• Atomoxetine
>Atomoxetine (Strattera) has become a second-line and, in
some cases, first-line treatment in children and adults with
ADHD because of its efficacy and classification as a
nonstimulant
• Tricyclic antidepressants.
>Tricyclic antidepressants (imipramine, desipramine,
nortriptyline) have been found effective in numerous studies
in children with ADHD; however, because of potential
adverse effects, they are rarely used for this purpose.
• Modafinil
>Modafinil (Provigil) has recent placebo-controlled data
supporting its efficacy in children with ADHD; this
medication may currently be used as a third- or fourth-line
treatment
• Nursing Management:
> Nurses must be knowledgeable enough in
taking care of patients with ADHD;
environmental and behavioral settings
should be taken into consideration .
 Nursing Assessment
• Assessment of ADHD typically involves the comprehensive
evaluation of information gathered from a number of sources,
including parents/carers, family members, teachers, partners
and colleagues, depending on the age of the patient.
• Clinical examination
>Clinical examination aims to identify the presence of other
illnesses with symptoms that overlap with those of ADHD; this
typically involves inspections for vision or hearing impairments,
neurodevelopmental immaturity in relation to gross and fine
motor functions and motor or vocal tics, and retardation.
• Interview> A healthcare professional will
interview the person with suspected ADHD along
with any relevant family members, carers, partners,
teachers, employers or friends, to ascertain
observations of symptoms/behaviours in different
settings, developmental, medical and psychiatric
history, and patterns of ADHD or related
comorbidities present in the family.
• Observations
>For children and adolescents, teachers in particular
may be especially well placed to identify symptoms of
ADHD in children and support symptom reports from
parents.
• Rating scales
> A number of rating scales are available to help
assess general behaviour and psychosocial
functioning, ADHD symptomatology and
comorbidities
 Nursing Diagnosis
• Defensive coping related to feelings of inadequacy and need
for acceptance from others.
• Impaired social interaction related to developmental
disabilities (hyperactivity).
• Altered thought processes related to personality disorders.
• Risk for parental role conflict related to children with attention
deficit hyperactivity disorder.
• Risk for injury related to psychological (orientation ineffective).
• Risk for delay in growth and development related to mental
illness (hyperactivity), lack of concentration.
 Nursing Interventions
The nurse‘s role in caring for the patient with
ADHD involves the following interventions:
• Accept the child or individual as what he is.
• Approach the child at his current level of
functioning
• Use simple and direct instructions
• Implement scheduled routine every day
• Avoid stimulating or distracting
settings.
• Give positive reinforcements.
• Encourage physical activity.