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Running Head: FEBRILE SEIZURES Febrile Seizures in the Pediatric Population Presented to Dr. Warren- Dorsey and Dr. Dionne Raley In partial fulfillment of the requirements of NURS 640 Primary Health Care of Children in the Family Coppin State University Helene Fuld School of Nursing December 02, 2013 FEBRILE SEIZURES Definition of the Problem The National Institute of Neurological Disorders and Strokes (NINDS) define febrile seizures as “convulsions brought on by a fever in infants or small children” ("Febrile seizures fact," 2013). Febrile seizures is a common pediatric form of seizure which affects “2–5% of all children and usually appearing between 3 months and 5 years of age” (Fetveit, 2008). Although in most cases it is nonthreatening, febrile seizures contribute to pediatric emergency room visits worldwide. Children with febrile seizures generally present with a “body temperature above 37.8-38.5°C (100.3-101.3°F)” (Scanlon & Cook, 2010). Epidemiology In a study conducted by Sfaihi et al (2012), based on 482 pediatric patients with febrile seizures, epidemiology reports conveyed that 55.2% of the study participants exhibited simple febrile seizures, while 44.8% of the participants exhibited complex febrile seizures. The researchers of this study also “observed a slight predominance of febrile seizures in the male participants” (Sfaihi, Maaloul, Kmiha, Aloulou, Chabchoub, Kamoun, & Hachicha, 2012). Also noted in the study was a genetic link of 14.7% familial febrile seizures. The study concludes that there is a minor risk of death and or long term complications from febrile seizures. It is important to note that although high temperatures are usually associated with febrile seizures, patients with known risk factors may develop seizures regardless of the presence of a fever. Analysis of the Topic Febrile seizures in pediatric populations are generally classified into 3 categories; simple, complex and symptomatic febrile seizures. The signs and symptoms of each category may overlap, but unique characteristics of each category will aid lead to an accurate diagnosis and management. A common sign seen in all three categories of seizure is that usually the age and 2 FEBRILE SEIZURES 3 fever range is the same. It is common for “the majority of children with febrile seizures to be between the ages of 6 months and 5 years, and also have rectal temperatures greater than 102 degrees Fahrenheit” (Baumann, 2013). While identifying common trends of febrile seizures is important, it is equally essential to note the differences in the 3 categories of febrile seizures to help the nurse practitioner in making an accurate diagnosis and management. Generally, simple febrile seizures occur in a child who is neurologically well developed by history, and the seizure episode lasts for less than fifteen minutes. Simple febrile seizures occur without the presence of diseases such as “meningitis, encephalitis, or any other illness affecting the brain. In this scenario, the seizure is described as either a generalized clonic or a generalized tonic-clonic seizure” (Baumann, 2013). In contrast to simple febrile seizures, complex febrile seizures may last longer than fifteen minutes, and the patient may have several episodes of seizures within a close time period. Unlike simple and complex febrile seizures in which the patient is generally neurologically well developed, symptomatic febrile seizures occur in the presence of an established neurological anomaly, and or an acute disease. A good history and physical assessment will assist the nurse practitioner to identify neurological disorders, and or acute illness contributing to the onset of the febrile seizure. Literature Support Numerous research studies have been undertaken to assess the causes of febrile seizures in the pediatric population. Fetveit (2008) writes that “no specific level of fever is required to diagnose a febrile seizure” (p. 17). Thus a febrile seizure may occur in a patient regardless of how high the patient’s temperature gets. This is important to note because nurse practitioners can educate their patients on the benefits or the lack of use of prophylactic antipyretics. In fact, FEBRILE SEIZURES “there is little evidence to suggest that the use of antipyretics prevent recurrent febrile seizures” (Fetveit, 2008). Several research studies indicate that there is a familial association with patients who have repeat febrile seizures. According to Prosad, Blaikley, and Chinthapalli (2012) “a positive family history is seen in 25-40% of children, and frequency in siblings of children with febrile convulsions ranges from 9-22%” (p.38). The familial link may explain why an otherwise neurologically well-developed child may go on to develop epilepsy. Although most febrile seizures are completely benign, the physical outlook of a patient having a febrile seizure can leave on looking parents or family members skeptical about the long term prognosis. An abundance of literature exists to inform and educate patients, family members and healthcare providers of febrile seizures; pathophysiology and management. It is essential that the nurse practitioner provides information to the parents/family members to relieve the anxiety. On the other hand caution must be taken to not overwhelm the loved ones with information. A recurrence of febrile seizures leads to the diagnosis of epilepsy. Differential Diagnosis Making an assessment of febrile seizure requires the nurse practitioner to review pertinent history of the patient. A comprehensive assessment should include the chief compliant, history of the presenting illness, allergies, medication use, as well as family and social history. The information gathered would guide the nurse practitioner into arriving at an accurate diagnosis. Differential diagnosis for the patient presenting with a febrile seizure may include but not limited to the following; - Acute Disseminated Encephalomyelitis, - Acute Stroke 4 FEBRILE SEIZURES 5 - Anterior Circulation Stroke - Aseptic Meningitis - Basilar Artery Thrombosis - Benign Childhood Epilepsy - Complex Partial Seizures - First Seizure: Pediatric Perspective - Meningococcal Meningitis - Neonatal Meningitis - Neonatal Seizures - Partial Epilepsies - Posterior Cerebral Artery Stroke - Seizures and Epilepsy: Overview and Classification - Simple Partial Seizures - Tonic-Clonic Seizures - Viral Encephalitis - Viral Meningitis (Baumann, R. , 2013). Management of Febrile Seizures by the Family Nurse Practitioner The role of the nurse practitioner in managing febrile seizures is to identify the underlying cause of the fever, and then treat the source of the fever. This may include ordering laboratory procedures such as CBC with differential, to rule in or out bacteremia, or a urinalysis with culture and sensitivity to determine if the child has a urinary tract infection. In essence, “no specific studies are indicated for a simple febrile seizure” (Baumann, 2013).Based on the FEBRILE SEIZURES presenting symptoms and illness, the nurse practitioner can direct diagnostics and management towards the underlying cause of the fever. However, if a patient presents with persistent febrile seizures, and all diagnostic workup fails to reveal the source of the fever, then the nurse practitioner can initiate a referral to a neurology specialist. The nurse practitioner may forward previous diagnostic work up to the neurologist, to help expedite a diagnosis. A referral to a specialist may heighten the parents of the child’s anxiety that something more serious may be going. It is important therefore that the nurse practitioner continues to provide assurance to the patient’s parents/guardian. For instance providing data about local support groups could be a step in the right direction. In the event that a neurologist decides to start the patient on seizure medications, the nurse practitioner will still manage the overall care of the patient, but will work in collaboration with the neurologist to ensure the optimal outcome for the patient. For instance, if the neurologist starts the patient on phenobarbital or Depakote, then the nurse practitioner will ensure that serum medication levels are drawn routinely to monitor efficacy of medication therapy. 6 FEBRILE SEIZURES 7 References Baumann, R. (2013). Pediatric febrile seizures. Retrieved from http://emedicine.medscape .com/article/1176205-overview Febrile seizures fact sheet. (2013). Retrieved from http://wwwninds.nih.gov/disorders/febrile _seizures/detail_febrile_seizures.htm Fetveit, A. (2008). Assessment of febrile seizures in children. European Journal of Pediatrics , 167(1), 17-27. Sfaihi, L., Maaloul, I., Kmiha, S., Aloulou, H., Chabchoub, I., Kamoun, T., & Hachicha, M. (2012). Febrile seizures: an epidemiological and outcome study of 482 cases. Child’s Nervous System, 28(10), 1779-1784. Prosad, P., S., Blaikley, S., & Chinthapalli, R. (2012). Clinical update: Febrile convulsion in childhood. Community Practitioner, 85(7), 36-8. Scanlon, A., & Cook, S. S. (2010). Febrile seizures, genetic (generalized) epilepsy with febrile seizures plus, and dravet's syndrome. Journal for Specialists in Pediatric Nursing, 15(2), 154-9. Febrile seizures fact sheet. (2013). Retrieved from http://www.ninds.nih.gov/disorders/febrile _seizures/detail_febrile_seizures.htm Fetveit, A. (2008). Assessment of febrile seizures in children. European Journal of Pediatrics , 167(1), 17-27. Prosad, P., S., Blaikley, S., & Chinthapalli, R. (2012). Clinical update: Febrile convulsion in childhood. Community Practitioner, 85(7), 36-8. FEBRILE SEIZURES 8