{
  "name": "Febrile Seizures",
  "slug": "febrile-seizures",
  "url": "https://nursingplex.com/care-plans/febrile-seizures",
  "category": "Pediatric",
  "summary": "Fever-triggered seizures in young children; safety, antipyretics and parent teaching.",
  "nursing_diagnoses": [
    "Risk for injury",
    "Hyperthermia",
    "Anxiety"
  ],
  "overview": [
    "A febrile seizure is a convulsion in a child between about 6 months and 5 years triggered by fever, without central nervous system infection or another identified cause. Simple febrile seizures are generalized, last under 15 minutes and do not recur within 24 hours; complex ones are focal, prolonged or repeated in the same illness. The rate of temperature rise matters more than the peak, which is why the seizure is often the first sign that the child is ill.",
    "Simple febrile seizures are benign. They do not cause brain damage, they do not mean epilepsy, and antipyretics given around the clock do not prevent them. The real nursing work is threefold: keep the child safe during the event, rule out meningitis and other serious causes of fever, and defuse the parents' terror with clear, repeated education. Parents almost universally believe their child was dying, and that fear drives unnecessary emergency visits and medication overuse afterward."
  ],
  "key_facts": [
    {
      "label": "Simple vs complex",
      "text": "Simple: generalized, under 15 minutes, once in 24 hours. Complex: focal, over 15 minutes, or repeated — requires further workup."
    },
    {
      "label": "During a seizure",
      "text": "Side-lying, nothing in the mouth, no restraint, protect the head, time it, note the features."
    },
    {
      "label": "Call EMS",
      "text": "Seizure lasting more than 5 minutes, repeated seizures, difficulty breathing, or persistent color change."
    },
    {
      "label": "Meningitis screen",
      "text": "Bulging fontanel, nuchal rigidity, petechial rash, persistent lethargy or a toxic appearance — lumbar puncture is indicated."
    },
    {
      "label": "Prognosis",
      "text": "About one in three has another febrile seizure; the risk of later epilepsy is only slightly above the general population after a simple seizure."
    }
  ],
  "nursing_priorities": [
    "Protect the child from injury and maintain the airway during and after the seizure.",
    "Identify and treat the source of fever, and exclude meningitis or encephalitis.",
    "Lower temperature safely for comfort and maintain hydration.",
    "Reduce parental anxiety with accurate information and rehearsed first aid.",
    "Recognize complex features and status epilepticus that require escalation."
  ],
  "assessment": {
    "subjective": [
      "Parent's description of the event: onset, movements, duration, color change, eye deviation and level of responsiveness afterward",
      "History of recent illness, immunizations, exposures and prior seizures",
      "Family history of febrile seizures or epilepsy",
      "Parental fear that the child was dying or has brain damage",
      "Reports of decreased drinking and fewer wet diapers"
    ],
    "objective": [
      "Generalized tonic-clonic movements, eye rolling, stiffening, cyanosis around the mouth during the event",
      "Documented seizure duration and post-ictal drowsiness with gradual return to baseline",
      "Temperature, often above 38.5 °C, with tachycardia and flushed skin",
      "Source of fever on exam: otitis media, pharyngitis, viral exanthem, urinary infection",
      "Neurologic exam: level of consciousness, focal deficit, pupils, tone, fontanel",
      "Meningeal signs — nuchal rigidity, positive Kernig or Brudzinski, petechial rash",
      "Signs of dehydration: dry mucous membranes, poor skin turgor, reduced urine output",
      "Injuries sustained during the event"
    ],
    "related_factors": [
      "Rapid rise in body temperature in an immature, seizure-susceptible brain",
      "Viral or bacterial febrile illness",
      "Genetic predisposition and family history",
      "Age between 6 months and 5 years",
      "Altered consciousness with loss of protective reflexes during the seizure"
    ]
  },
  "goals": [
    "The child will remain free of injury and aspiration during and after any seizure.",
    "The child will maintain a patent airway with oxygen saturation above 94% throughout the event and recovery.",
    "The child's temperature will be reduced to a comfortable range and hydration maintained.",
    "The child will return to baseline neurologic status within the expected post-ictal period.",
    "Parents will demonstrate correct seizure first aid and state exactly when to call emergency services."
  ],
  "interventions": [
    {
      "title": "1. Safety during a seizure",
      "points": [
        "Stay with the child, turn them onto their side, and note the exact start time — timing determines treatment.",
        "Do not restrain the movements and never put anything in the mouth, including fingers, spoons or medication.",
        "Clear hard objects away, pad or cushion the head, loosen tight clothing around the neck, and lower the child to a safe surface.",
        "Observe and record the details: where the movements started, whether they were symmetric, eye position, color, incontinence and duration.",
        "Keep suction and oxygen available; suction the mouth only after movements stop if secretions obstruct.",
        "Give rescue benzodiazepine as ordered for a seizure lasting beyond 5 minutes and prepare for status epilepticus management."
      ]
    },
    {
      "title": "2. Post-ictal care and neurologic monitoring",
      "points": [
        "Maintain side-lying position until fully awake and check vital signs and oxygen saturation frequently.",
        "Assess level of consciousness and reorient the child gently as they wake; allow uninterrupted rest.",
        "Document how long recovery takes and report focal weakness or a prolonged failure to return to baseline.",
        "Keep the bed low with rails padded and up, and keep the child under direct observation.",
        "Check for injuries to head, mouth and limbs sustained during the event."
      ]
    },
    {
      "title": "3. Fever management and finding the source",
      "points": [
        "Give weight-based acetaminophen or ibuprofen for comfort, and explain honestly that antipyretics do not prevent recurrence.",
        "Remove excess clothing and blankets and keep the room cool; never use alcohol baths or ice water, which cause shivering and raise core temperature.",
        "Offer frequent small volumes of oral fluid or oral rehydration solution once fully awake; track intake and output.",
        "Assist with the diagnostic workup — blood, urine and possibly cerebrospinal fluid — guided by age, appearance and seizure features.",
        "Perform a lumbar puncture workup as ordered when meningitis cannot be excluded, especially in infants or partially treated children."
      ]
    },
    {
      "title": "4. Parent education and anxiety reduction",
      "points": [
        "Acknowledge how frightening the seizure was before delivering any teaching; parents cannot absorb facts while still panicking.",
        "Explain plainly that simple febrile seizures do not cause brain damage and rarely lead to epilepsy.",
        "Rehearse first aid step by step, including turning the child on their side, timing the seizure and not putting anything in the mouth.",
        "State the emergency criteria clearly: seizure over 5 minutes, a second seizure, trouble breathing, ongoing blue color, or failure to wake up.",
        "Teach accurate temperature measurement and correct weight-based dosing, and discourage alternating or excessive antipyretics.",
        "Provide written instructions and teach rescue medication use with return demonstration if one is prescribed for prolonged seizures."
      ]
    }
  ],
  "patient_teaching": [
    "During a seizure: place the child on their side, clear the area, do not restrain, put nothing in the mouth, and time it.",
    "Call 911 for a seizure over 5 minutes, more than one seizure, trouble breathing, or a child who will not wake up.",
    "Simple febrile seizures do not cause brain damage and most children outgrow them by about age 5.",
    "Fever medicine is for comfort — it does not prevent seizures, so do not overdose trying to stop one.",
    "Dress the child lightly, keep them cool, and offer fluids often during a fever.",
    "Return for a stiff neck, rash that does not blanch, persistent drowsiness, or repeated vomiting."
  ]
}