16.10 Febrile Seizures

A febrile seizure is a generalized seizure that occurs in pediatric clients between the ages of six months to five years old who have a fever of 100.4 ℉ or greater. Additionally, the seizure is not associated with an infection of the central nervous system and the client does not have a history of a seizure disorder or other medical condition that can cause seizures. Febrile seizures can be further categorized as simple or complex. Simple febrile seizures are a single seizure and last less than 15 minutes. Complex febrile seizures are multiple seizures over a 24-hour period or a single seizure lasting longer than 15 minutes. Febrile status epilepticus refers to a febrile seizure lasting longer than 30 minutes.^[1]

Risk factors for the development of febrile seizures are as follows^[2]:

• History of neurological impairment or developmental delay
• Viral infections, especially roseolovirus
• Family history of seizures
• Low levels of zinc and iron in the blood
• Maternal smoking
• Maternal stress
• Age, with premature infants having the greatest risk
• Recent vaccine administration or receiving multiple vaccines at one time

Research indicates that having febrile seizures as a child also increases the risk for developing a seizure disorder later on in life.^[3]

Pathophysiology

The exact pathophysiology of febrile seizures is unknown, but it is thought to be associated with neurons becoming more excited due to the increase in body temperature. This neuronal excitation, along with the immaturity of the brain in young children, increases the susceptibility to seizures. Complications of febrile seizures are rare.^[4]

Assessment (Recognizing Cues)

Physical Exam

The signs and symptoms of a febrile seizure depend on the type of seizure. A simple febrile seizure presents with tonic-clonic movements. Tonic refers to the stiffening of muscles whereas the clonic phase consists of jerking of the extremities. After the seizure, the client may be drowsy. A complex febrile seizure more commonly affects one side of the body. After the seizure, the client may be weak or temporarily paralyzed on that same side. Other signs and symptoms that can be seen in both simple and complex febrile seizures are loss of consciousness, cyanosis, difficulty breathing, and foaming at the mouth. It is essential to obtain a detailed description of the event from the caregiver who witnessed the seizure. This should include not only how quickly the seizure occurred after fever development but also the length and appearance of the seizure and any other precipitating events.^[5],[6]

Common Laboratory and Diagnostic Tests

If the client’s signs and symptoms are consistent with a simple febrile seizure, diagnostic testing may not be required. If the client exhibited signs and symptoms of a complex febrile seizure, diagnostic testing such as an electroencephalogram (a tracing of brain activity) may be ordered to assess for a seizure disorder. If the provider suspects a central nervous system infection caused the seizure, a lumbar puncture with examination of cerebrospinal fluid may be ordered. Imaging tests may be ordered if there are signs of increased intracranial pressure or other neurologic abnormalities found during the physical examination. Lab testing may also be ordered for clients with signs of dehydration due to fever.^[7]

Nursing Diagnosis (Analyzing Cues)

Nursing priorities for clients with febrile seizures include maintaining safety during seizures and managing fever and any other associated symptoms.

Nursing diagnoses for clients with febrile seizures are created based on the specific needs of the client, their signs and symptoms, and the etiology of the disorder. These nursing diagnoses guide the creation of client-specific care plans that encompass client outcomes and nursing interventions, as well the evaluation of those outcomes. These individualized care plans then serve as a guide for client treatment. Possible nursing diagnoses for clients with febrile seizures are as follows^[8]:

• Risk for injury r/t altered level of consciousness and inability to control movements
• Risk for ineffective airway clearance r/t excessive oral secretions
• Hyperthermia r/t associated viral condition

Outcome Identification (Generate Solutions)

Outcome identification encompasses the creation of short- and long-term goals for the client. These goals are used to create expected outcome statements that are based on the specific needs of the client. Expected outcomes should be specific, measurable, achievable, relevant, and timebound (SMART) within a set time frame based on the application of appropriate nursing interventions. Sample expected outcomes for clients with febrile seizures include the following^[9]:

• The client will be free from injury resulting from a seizure.

• The client will not display signs of aspiration after the seizure.

• The client will exhibit a temperature that is within normal limits for age within 24 hours of treatment.

Interventions (Generate Solutions & Take Action)

Medical Interventions

There is no cure or specific treatment for febrile seizures other than supportive care. Antipyretics such as acetaminophen may be used to manage fever, but they cannot prevent febrile seizures from occurring. For clients experiencing febrile status epilepticus, benzodiazepines are prescribed to stop the seizure.^[10]

Nursing Interventions

Registered nurses develop interventions based on the expected outcomes of the client. Prior to implementation, the nurse must determine if all previously planned interventions are still suitable based on the current situation of the client. When caring for a client with febrile seizures, nursing interventions can be divided into nursing assessments, nursing actions, and client teaching as described in the following subsections.^{[11],[12],[13]}

Nursing Assessments

• If a witnessed seizure occurs, note and document the duration and characteristics. Assess the airway and ensure patency during the seizure. After the seizure, assess the client’s mental status as the pediatric child should quickly return to their baseline.
• Frequently monitor the temperature of an ill child, especially the child with a history of febrile seizures.
• Assess for the presence of dehydration, as this can commonly result due to illness and an elevated temperature.
• Assess for other signs of infection to help ascertain the cause of the fever.

Nursing Actions

• Ensure that the client with febrile seizures receives a referral to a neurologist.
• Ensure safety in the event of a febrile seizure, including placing the child on their side to prevent aspiration of oral secretions and removing nearby objects that could cause an injury. The child should not be restrained during the seizure, as this can lead to trauma. Side rails on a hospital bed should be elevated and padded if a client has a history of a febrile seizure. Remove restrictive clothing during a seizure to facilitate breathing. Suction excess secretions to prevent aspiration. Apply oxygen per provider order to ensure adequate oxygenation to the brain and other vital organs.
• Administer antipyretics per provider order.
• Administer benzodiazepines per provider order.
• Ensure the child is not left alone after experiencing a seizure, as they will require reorientation upon awakening.

Client Teaching

• Educate the family of the client that although febrile seizures are frightening to witness, they have a good prognosis and generally do not lead to chronic neurological issues.
• Educate the parents/caregivers of the client to remain calm during a febrile seizure so they can provide proper care and ensure safety of the child.
• Educate the caregivers of the client on methods to keep their child safe during a febrile seizure.

Evaluation (Evaluate Outcomes)

Evaluation of client outcomes refers to the process of determining whether or not client outcomes were met by the indicated time frame. This is done by reevaluating the client as a whole and determining if their outcomes have been met, partially met, or not met. If the client outcomes were not met in their entirety, the care plan should be revised and reimplemented. Evaluation of outcomes should occur each time the nurse assesses the client, examines new laboratory or diagnostic data, or interacts with another member of the client’s interdisciplinary team.