reference for child health nursing

1. CONVULSION DISORDER
PRESENTED BY:
MANISHA PRAHARAJ

2. DEFINITION
Convulsion is the involuntary
contraction or series of contractions
of voluntary muscles. It occurs due
to disturbances of the brain
functions resulting from abnormal
excessive electrical discharges from
brain.

3. ETIOLOGY
1. Early neonatal period –
 Birth asphyxia
 Obstructed labor
 Hypoglycemia
 IVF
2. Neonatal period –
 Hypocalcemia
 Kernicterus
 Developmental malformation
 Meningitis
 Metabolic errors

4. 3. Infant and young children –
Febrile convulsion
CNS infections
Post infectious & post vaccinal
encephalopathy.
Metabolic disturbances.
Traumatic
Intracranial space occupying lesions.
Drugs and poisons.
Idiopathic epilepsy

5. FEBRILE SEIZURE
Febrile convulsion refers to the
seizures associated with fever but
excluding those related to CNS
infections. It is the commonest cause
of convulsions in early childhood. It is
related to abrupt increase in body
temperature rather than degree of
temperature.

6. TYPES -
1. Typical febrile seizure –
 These are generalized than focal and last
less than 10 mins. It is usually found in
children between 6 months to 5 years of
age.
The fits occur within 24 hours of onset of
fever and usually single per febrile episode.
There is no reoccurrence between 12 – 18
hours of attack.
CSF study and EEG are normal after attack.

7. CAUSES -
 Family history of convulsion usually
present.
 Higher incidence occurs in twins and
children of consanguineous parents.
 The condition may have genetic
predisposition or may be due to
immature neuronal membrane response
to rise to body temperature.

8. 2. Atypical febrile convulsion –
 They predispose to idiopathic epilepsy.
The children may have focal convulsion of
more than 20 mins duration even
without significant fever.
 There may be abnormal EEG for two
weeks after the attack.

9. MANAGEMENT
 Anticonvulsive drugs. Diazepam 0.3mg/kg IV
Phenobarbitol 5mg/kg IM.
 Sodium valproate 10 -20 mg/kg/day.
 Antipyretics to reduce fever.
 Clear airway and administer oxygen if needed.
 Hydration and nutritional status to be
maintained by IV solutions.
 Rest and comfortable position should be given.
Maintain the personal hygiene.

10. EPILEPSY -
 It is recurrent, episodic, paroxysmal
transient disturbances of brain function
due to abnormal electrical activity of
neurons.
 it is manifestated as abnormal, motor,
sensory or psychomotor phenomena
and often with impaired or loss of
consciousness.

11. CLASSIFICATION -
Epilepsy
Partial seizure Generalized seizure
Tonic clonic
seizure
Absence
seizure
Simple partial
seizure
Complex
partial seizure

12. CLINICAL MANIFESTATION
Generalized tonic clonic seizure –
It has four phases –
1. An aura
2. Tonic spasm phase
3. Clonic phase
4. Postictal phase

13. An aura –
A peculiar sensation with dizziness occurs
in about one third epileptic children
before tonic – clonic seizure.
Tonic spasm phase –
Child’s entire body becomes stiff, face
may become pale and distorted, eyes
fixed in one position, back may be
arched, head turned to backward or in
one side, arms are fixed and hands are
clenched.

14.  child fall on ground.
Loss of consciousness.
 frothy discharge from mouth.
Ineffective breathing and cyanosis.
Weak and irregular pulse.
Duration of this phase is 30 secs.

15. Clonic phase –
 it is manifestated with rhythmic jerky
movements due to alternating
contraction of muscle group, which
usually starts from one part and
generalized including face muscle.
 The child may pass stool and urine
involuntarily.
 May have tongue bite.
Duration is from few minutes to few
hours.

16. Postictal state –
 the child is usually become sleepy,
confused or exhausted.
May complaint of headache.
The child may not be able to recall the
episode.

17. Absence seizure (petit mal) –
 it rarely appears before 5 years of age.
 the child may loss contact with
environment for few seconds.
 may appear day dreaming.
 may discontinue the activity suddenly.
 seizure may present as rolling of eyes,
nodding of head, slight head movement
and smacking of lips.

18. STATUS EPILEPTICUS
 It is a state of continuing recurrent
seizure that prolonged for more than 30
minutes or occurs in series without
regaining consciousness in between
attack.
 it is a case of medical emergency.
 The child may have cardiac arrest.

19. MYOCLONIC
SEIZURE(INFANTILE SPASM)
This seizure occurs in infants usually
between 3 to 8 months of age.
It associated with cerebral hemorrhage
and mental retardations.
The child present with sudden forceful
myoclonic contraction involving muscles
of trunk, neck and extremities.
The duration is less than 1 min.

20. NEONATAL SEIZURE
Neonatal seizure are present as subtle,
multi focal clonic, focal clonic, generalized
tonic and myoclonic types.
Subtle seizure may be present with eye
blinking, fluttering and buccolingual
movement.

21. DIAGNOSIS
History taking and physical examination.
Neurological examination.
CSF test
Blood examination
Urine examination.
EEG, CT scan, MRI

22. MANAGEMENT -
 Management is depends on identified
cause.
Management mainly done with –
 drug therapy
Diet therapy
Surgical management

23. DRUG THERAPY -
Antiepileptic drugs –
Phenobarbital – 3 to 5 mg/kg/day.
Diphenylhydantoin – 5 to 8 mg/kg/day.
Carbamazepine – 10 to 20 mg/kg/day
Diazepan – 0.2 mg/kg/dose IV
Sodium valproate – 15 to 20 mg/kg/day
Ethosuximide – 10 to 20 mg/kg/day

24. DIET THERAPY -
Ketogenic diet given to raise the seizure
threshold with calculated amount of
proteins and fats without carbohydrates.
This child should not given IV fluid with
dextrose.

25. SURGICAL MANAGEMENT -
Corpus callostomy
Focal resection of parts of part cerebral
cortex.

26. NURSING DIAGNOSIS -
Risk for injury related to convulsion
episode.
Ineffective breathing related to spasm of
respiratory muscles.
Soicial isolation related to misconception.
Altered self esteem related to lack of
control over seizure.
Knowledge deficit related to long term
care.