NCP for Febrile Convulsions : Assessment and Nursing Diagnosis

Nursing Care Plan for Febrile Convulsions


Definition

Febrile Seizures is an occurrence in infants or children who usually occurs between the ages of 3 months to 5 years was associated with fever but never proven the existence of intra-cranial infection or a particular cause . ( Consesnsus Statement On Febrile Siezures , 1980).



Classification

1. Simple febrile seizures :

• Age 6 months to four years.
• Long seizures are not more than 15 minutes.
• Seizures are common.
• Seizures occurred 16 hours after the onset of fever.
• EEG normal one week after the seizure.
• Neurological examination before and after abnormal spasm.
• Seizure frequency generation in a single year is not more than four times.

2. Complex febrile seizures :

• Seizure time more than 15 minutes.
• Seizure frequency more than once in 24 hours.
• Children have a neurological disorder or a history of febrile seizures before.
• Seizure frequency generation in one year more than four times.

3. Epilepsy provoked by fever.

• Is that not all febrile seizures above criteria.

Originator or Risk Factors :

• High fever caused by upper respiratory tract infection, pneumonia, gastroenteritis and urinary tract infections.
• History of febrile seizures in parents or siblings.
• Developmental delay.
• Problems in the newborn period.
• Children in special care.
• Children with low levels of Na.
• Family history of epilepsy.

Pathophysiology

In a state of fever 1oC temperature rise will lead to increased basal metabolism 10-15 % and oxygen demand increased by 20%, resulting in a change in the balance of cell membranes of neurons and in a short time, diffusion of sodium and potassium ions through the membrane before, with the result of off an electric charge. Remove the charge is so large that it can spread throughout the cell and surrounding cell membrane with the aid of the so-called "neurotransmitters" and there was a seizure.


Differential diagnosis

• Another cause febrile seizures should be removed, especially meningitis and encephalitis.
• Children with high heat can arise delirium, chills and fever, cyanosis so as to resemble seizures.

Prognosis
Dependent factors :

• A history of seizures without fever disease in the family.
• Families with neurological disorders.
• Prolonged seizures or convulsions locally.

If there are two of these three factors will then later on febrile seizures is approximately 13%.



Nursing Care Plan for Febrile Convulsions

Nursing Assessment

1. Client identity

• Age is usually six months to four years, male gender women with a ratio of 2 : 1 , the highest incidence in children aged two years.

2. The main complaint

• Seizures because of the fever.

3. History of present illness

• Time of occurrence of seizures less than five minutes.
• Seizures are general.
• Seizures occurred within 16 hours after the onset of fever.
• No neurological abnormalities both clinical and laboratory.

4. Past medical history

• The presence of predisposing factors of febrile seizures among other head trauma, infection, and reactions to immunization.

5. Family history of disease

• 25-50 % of febrile seizures have a heredity factor families affected by the presence of febrile seizures, neurological diseases or other diseases.

6. Previous history

• History of pregnancy : maternal illness, bleeding, and medications used.
• Labor History : spontaneous birth or by action, antepartum hemorrhage, premature rupture of membranes, Aspixia.

Activity Daily Live

1). Food or liquids

• Patients will complain sensitive to foods that stimulate seizure activity, tooth decay, the presence of gingival hyperplasia , as a result of side effects of drugs.

2). Activity and Rest

• Patients complain of fatigue, general weakness, limitation of activities and changes in muscle tone.

3). Elimination

• Incontinensia
• Ictal face : an increase in pressure and tone springter blader.
• Post- ictal : muscle relaxation.

4). Psycho - social history

• Psycho : anamnesis of the child's temperament, cognitive abilities, and the response of pain conditions as well as hospitalization.
• Social : anamnesis the source of economic status and family, and the family response patterns of daily childcare.

Test and Diagnosis

1). Vital signs

• Decreased awareness
• Ictal phase : Increased pulse, respiration, blood pressure and temperature.
• Post ictal : normal V5 sometimes depression.

2. Physical Examination

• Head : head shape disproportion, generalized seizures, tonic clonic seizures and headaches.
• Eyes : Dilated pupils, eye movements and rapid eyelid, and conjunctival reflexes down red light.
• Mouth : Excessive production of saliva, vomiting and Cyanosis oral mucosa.
• Nose : The existence nostril breathing, Cyanosis.
• Neck : the tetanus occurs stiff neck.
• Chest : Ictal phase : Cyanosis, decreased respiratory movement and the pull intercostae. Post ictal : Apnoe or breath deep and slow.
• Abdomen : Ictal phase : Improved muscle tone blader and spingter. Post ictal : relaxation and hyper peristaltic muscles.
• Extremities : Ictal phase : spasms in upper and lower extremities and cyanosis of the fingers and toes. Post ictal : muscle relaxation and pain and weakness in the muscles.

3. General examination

• Electrolytes : Electrolyte imbalance predispose to seizures.
• Glucose : Hypoglycemia predispose to seizures.
• BUN : Increased BUN is a potential seizure.
• CBC : Aplastic Anemia can occur as a side effect of drug administration.
• LP : to detect the presence of abnormal pressure and signs of infection.
• Skull X - ray : the existence of space and lesions persisted.
• EEG : The focus of seizure activity.
• CT scan : Local cerebral abscess detect tumor lesions with or without contrast.

Nursing Diagnosis for Febrile Convulsions

1. Increased body temperature relation : the presence of pyrogens which disrupt the thermostat, the average increase in metabolism and disease dehydration.
2. Risk for Ineffective airway clearance related to neuromuscular damage and obstruction tracheo - broncial.
3. Knowledge Deficit : family related to misinterpretation and lack of information.
4. Self-concept Disturbance (low self esteem) related to epilepsy and wrong perceptions and uncontrolled.

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Nursing Care Plan for Impaired Swallowing

Impaired Swallowing. Swallowing is a unique process that requires good performance of the muscles in the throat , face, tongue, and palate. The presence of the disease, disorders or abnormalities in one of these organs will interfere with the process of swallowing.

Difficulty swallowing or dysphagia. It is usually a sign of a problem in the throat or esophagus (esophageal), tube-shaped muscle that moves food and liquid from the back of the mouth to the stomach. Although dysphagia can happen to anyone, but generally only occur in the elderly, infants, and those who have problems with the nervous system or brain.

There are many causes that can lead to throat or esophagus does not function normally. It could be because of some small things, but some other things that might cause it is a serious disorder. If only having one or two times only, not to worry, the possibility of not having a medical problem. But if trouble swallowing continuously, it is likely to suffer a serious problem that requires proper handling.

In normal circumstances, the muscles in the throat and esophagus will squeeze or contract to move food and liquids from the mouth to the stomach without obstacles. There are two types of problems that can make it difficult for food and liquid move into the esophagus, namely :

1. The muscles and nerves that help move food through the throat and esophagus does not work properly. This can happen because :

• Suffered a stroke, brain or spinal injury.
• Problems with the nervous system, such as post - polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease as well. It could also be caused after diphtheria, syphilis, poisoning, bibulous, and hysteria.
• Immune system problems that cause swelling or inflammation, and weakness, such as polymyositis or dermatomyositis.
• Esophageal spasms. This means that the muscles of the esophagus suddenly pressing. Sometimes this can prevent the food to reach the stomach.
• Scleroderma. In this condition, the tissues of the esophagus become hard and narrow. Scleroderma can also make the muscles become weak lower esophagus, which can cause food and stomach acid back up into the throat and mouth.

2. There is something blocking the throat or esophagus. This may occur because :

• Gastroesophageal reflux disease (GERD). When stomach acid up into your esophagus, it can cause ulcers in the esophagus, which then can cause scars or wounds. These scars can make a narrow esophagus.
• Esophagitis. It is an inflammation of the esophagus. It can be caused by many things, such as GERD or an infection or because the pill is stuck in the esophagus. In addition, difficulty swallowing can also be caused by allergic reactions to certain foods or things other airborne.
• Diverticula. It is a small sac that grows on the wall of the esophagus or throat.
• Esophageal tumors. Growth in the esophagus may be cancerous or noncancerous.
• Lymph nodes and tumors that suppress the esophagus.

In addition , dry mouth could make matters worse dysphagia . This is because you may not have enough saliva to help the food from the mouth to enter the esophagus . Dry mouth can be caused by the influence of the consumption of drugs or other health problems.


Dysphagia can come and go at any time, mild or severe, or worse than would occur continuously. If experiencing dysphagia, may be :

• Food or liquid could not swallow at swallowing the first experiment.
• Vomiting, choking, or coughing when swallowing.
• Food or liquid back up into the throat, mouth, or nose after swallowing.
• Feeling like food or fluid trapped in one or several parts of the throat or chest.
• Pain when swallowing.
• Pain or distress in the chest or stomach.
• Weight loss due to not getting enough food or fluid intake.

Nursing Care Plan for Dysphagia : Impaired Swallowing
will depend on what is causing dysphagia. Treatment for dysphagia includes :

• Exercise for the muscles to swallow. If there is a problem with the brain, nerves, or muscles, may need to do exercises to train the muscles to work together to help swallow. Also may need to learn how to good posture or how to put food in the mouth in order to swallow either.
• Change in eating food. The doctor may suggest to avoid or change certain types of foods and liquids to make the process easier to swallow.
• Dilation (widening). In this treatment, the device is placed into the esophagus, then carefully will expand the narrow areas of the esophagus. Perhaps this treatment should be done several times.
• Endoscopy. In some cases, a long, thin scope can be used to retrieve the object that is stuck in the esophagus.
• Food that is stuck mashed with similar chemicals such as papain, that blob can continue down the food into the stomach.
• Surgery. If there is something blocking the esophagus (such as a tumor or diverticula), may need surgery to remove it. Surgery is also sometimes used in people who have a problem that affects the muscles of the esophagus (achalasia).
• Drugs. If experiencing dysphagia associated with GERD, the heat in the stomach, or esophagitis, prescription drugs can help prevent stomach acids enter the esophagus. Infections of the esophagus are often treated with antibiotic drugs.

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Nursing Care Plan for Dysphagia : Impaired Swallowing

Nursing Diagnosis for Dysphagia -Impaired Swallowing


Swallowing is a complex process that allows the movement of food and liquids from the mouth to the stomach. This process involves structures in the mouth, pharynx, larynx and esophagus.

Complaints of difficulty in swallowing (dysphagia) is one of the symptoms of the disorder or disease in the oropharynx and esophagus. These complaints will arise when there is interference with the movement of the muscles of swallowing and impaired transport of food from the mouth to the stomach. Types of foods that cause dysphagia can provide information regarding disorders that occur.


Purpose

1. General Purpose

• Knowing nursing care in patients with Dysphagia.

2. Special Purpose
To know the nursing care for patients who experience such as :

• Definition of Dysphagia.
• Etiology of Disphagya.
• Pathophysiology of Disphagya.
• Diagnosis and treatment Disphagya.
• Disphagya nursing care to patients.

Nursing Care Plan for Dysphagia


Definition

Disphagya is difficulty in swallowing and getting food from the esophagus into the stomach. Dysphagia can cause all sorts. Important to know the difference dysphagia, because orofaring and esophageal disorders. If not carefully observed, the symptoms are very similar.

On the problems of the esophagus, dysphagia sometimes there is, in the event of esophagitis or esophageal obstruction. Problems of the esophagus is usually also accompanied by regurgitation. Hypersalivation never or rarely occurs and when there is usually a result of a foreign object is actually a pseudo - hypersalivation.


Etiology

Disphagya can be found on some of the causes that can cause the condition include:

• Stroke.
• Progressive neurological disease.
• The tube on trachestomy.
• Paralise or absence of movement of the vocal cords.
• Tumors in the mouth.
• Surgery of the head.

Pathophysiology

Normally people swallow solid food or drinking liquids and swallow saliva or mucus produced by the body hundreds of times every day. The swallowing process has four stages : the first stage of preparation in the mouth, where food or solids mobilized / manipulated and chewed in preparation for swallowing. During the oral stage, the tongue pushing food or solids into the back of the mouth, and began to swallow response. Pharyngeal phase began immediately after food or liquid pass through the pharynx (the tube that connects the mouth to the esophagus) into the esophagus or gastrointestinal tract. The last stage is the stage of esophageal, food or liquid pass through the esophagus into the stomach. Although the first and second stages have some control voluntair, stages three and four occur by itself without realizing it. If the swallowing process stalled due to various reasons, will result in difficulty swallowing.





Nursing Assessment

Nursing assessment needs to be done in patients with swallowing disorders or disphagya include :

• History of the disease.
• History of stroke.
• History of the use of medical devices : tracheostomy, nasogastric tube, mayo tube, ETT, post endoscopy examination.
• History surgery laryx blood, pharynx, esophagus, thyroid.
• Postoperative mouth area.

Physical examination :

• Mouth shape is not symmetrical.
• Looks an inflammation of the pharynx.
• The presence of Candida in the oral / mouth.
• Edema of the pharynx.

Nursing Diagnosis and Nursing Interventions

1. Impaired swallowing related to muscle weakness due to swallowing paralise

Outcomes :
Patients can demonstrate the proper method of swallowing food without causing despair.


Intervention :
a. Review the patient's ability to swallow , note the extent of facial paralysis.
b. Increase efforts to be able to perform effective ingestion such as helping the patient hold his head.
c. Place the patient in a sitting position / upright during and after eating.
d. Stimulation lips to open and close the mouth manually by pressing lightly on the lips / under the chin.
e. Place the food in the mouth is not ill / disturbed.
f. Tap the deepest part of the cheek with a spatula to know the weakness of the tongue.
g. Give eat slowly in a quiet environment.
h. Start by giving a semi-liquid food orally , soft foods when patients can not swallow water.
i. Help the patient to choose foods that are small or do not need to chew and easy to swallow.
j. Instruct the patient to use a straw to drink liquids.
k. Suggest to participate in the exercise program.


2. Imbalanced Nutrition Less than Body Requirements related to lack of adequate food intake.

Outcomes :
Adequate nutritional intake.

Intervention :
a. Instruct the patient to eat slowly and chew food thoroughly.
b. Feeding little and often with foods that are not irritating.
c. Serve food in interesting ways.
d. Avoid eating or drinking foods that contain irritant substances.
e. Measure body weight each day and record the increase.
f. Observation of the patient's intake of nutrients and review the things that hinder / complicate the swallowing.

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