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Fever is among the most common symptom usually seen in infections and can often be a
cause for concern for apprehensive parents. In children, a fever can appear quite suddenly
and resolve just as quickly although significantly high temperatures may be recorded during
the episode. Although a fever may be a sign of the body’s natural defenses against an
infection, there are times when a fever can occur without any clear indication of an infection.
High fevers may lead to fits (convulsions), often indicating a need for immediate medical
intervention.

What are febrile convulsions?

A febrile convulsion is a seizure in young children caused by a sharp rise in body

temperature (fever). Febrile convulsions otherwise called febrile seizures (fever seizures) or
febrile fits (fever fits) can cause a lot of concern among parents because of its sudden onset
and frightening nature.. A convulsion triggered by sudden fever is usually harmless and
normally does not indicate a long term or ongoing problem like epilepsy. It is important to
note that episodes such as these occur in relation to a rapid rise in temperature, & is not
related to the duration of the fever or the degree of temperature.

What causes of fever seizures?

As previously mentioned, most fever fits occur as a result of a sudden rise in body
temperature but it may also develop as the fever is declining.

Usually, the fevers that trigger febrile convulsions are caused by an infection in the infant’s
body, such as middle ear infections, or other bacterial or viral infections of the nose &
throat. A less common, but more serious cause of such fevers is an infection of the child’s
brain & spinal cord, such as meningitis. The risk of fever seizures can also increase after
some common childhood immunizations.

What are the symptoms of febrile fits?

A child experiencing a febrile convulsion may display the following signs and symptoms:

• A fever, usually higher than 38.9 C

• Loss of consciousness
• Jerking of the arms & legs
• Eyes rolled back in the head
• Difficulty breathing
• Vomiting & urinating
• Crying or moaning
• Seizure: “A clinical event in which there is a sudden disturbance of neurological
function in association with an abnormal or excessive neuronal discharge.” (Lissauer,
2002).
• A febrile convulsion is a seizure occurring in a child aged from six months to five
years, precipitated by a fever arising from infection outside the nervous system in a
child who is otherwise neurologically normal. Febrile convulsions have long been
recognised, but only in recent years more fully understood. Hippocrates, writing in
the 4th century BC, described such a convulsion, clearly differentiating it from rigors
and breath holding attacks. He noted that both generalised and partial seizures can
 occur, and realised that there was a strong association with age, high fever and a
precipitating infection. (Great Ormond Street Hospital for Children NHS Trust).
•
• Febrile convulsions are a common paediatric presentation to A&E departments,
occurring in about 3% of children between the ages of six months and five years. The
seizure usually occurs early on in a viral infection when the temperature is rising
rapidly, and typically lasts less than five minutes. It is the abrupt rise in temperature
rather than the high level that is important. The seizures are tonic or tonic-clonic,
with loss of consciousness and muscular rigidity forming the tonic stage. This may be
preceded by a frightened cry from the child. Cessation of respiratory movements and
incontinence of urine and faeces may occur during this stage, which lasts about 30
seconds. The clonic stage that follows is characterised by repetitive movements of
the limbs and face.
•
• Management of the fitting febrile child:

Clothing should be removed and the child covered with a sheet.

The child should be placed on its side, or prone with its head to one side, since vomiting
with aspiration is a hazard.
Rectal diazepam is the drug of choice, producing an effective blood concentration of
anticonvulsant within ten minutes.
All children with a first febrile convulsion should be admitted to hospital to a) exclude
meningitis and b) educate the parents.
A urine specimen should be taken to exclude infection, and a blood glucose level should
be taken.
A lumbar puncture may be performed if the child is less than eighteen months old shows
signs of meningitis or sepsis.

• Treatment of the febrile child:

Fever should be treated to promote the comfort of the child and to prevent dehydration.
Paracetamol is the preferred anti-pyretic and fluid levels should be maintained. Ibuprofen
can be given if the fever does not respond to paracetamol.
Rectal diazepam should be administered as soon as possible after the start of the
convulsion, and should not be given after the convulsion has stopped.
•
•
• Information should be supplied by the hospital to parents, explaining the nature of
febrile convulsions, including information about the prevalence and prognosis.
Parents should be instructed on the management of fever, the management of a
convulsion and the administration of rectal diazepam. Finally, they should be
reassured. During further febrile illnesses, parents should be advised to keep the
childs temperature low, by removing warm clothing, tepid sponging and giving an
antipyretic (paracetamol or ibuprofen) such as Calpol. Parents of children with an
increased risk of seizure recurrence should be supplied with rectal diazepam to
administer for any further seizure lasting more than five minutes. Parents should
receive written as well as verbal advice on the first aid management of a further
convulsion. Following convulsion, a doctor should always be consulted in order to
determine that the cause is simply a viral infection, and not something more serious
such as meningitis.
•
Definition

Febrile seizures are convulsions of sudden onset due to abnormal electrical activity in the
brain that is caused by fever. Fever is a condition in which body temperature is elevated
above normal (generally above 100.4°F [38°C]).

Description

Febrile seizures were first distinguished from epileptic seizures in the twentieth century. The
National Institutes of Health defined febrile seizures in 1980 as "an event in infancy or
childhood usually occurring between three months and five years of age, associated with
fever, but without evidence of intracranial infection or defined cause."

There are three major subtypes of febrile seizures. The simple febrile seizure accounts for 70
to 75 percent of febrile seizures and is one in which the affected child is age six months to
five years and has no history or evidence of neurological abnormalities, the seizure is
generalized (affects multiple parts of the brain), and lasts less than 15 minutes, and the
fever is not caused by brain illness such as meningitis or encephalitis. The complex febrile
seizure shares similar characteristics with the exception that the seizure lasts longer than 15
minutes or is local (affects a localized part of the brain), or multiple seizures take place and
accounts for about 20 to 25 percent of all febrile seizures. Lastly, about 5 percent of febrile
seizures are diagnosed as symptomatic, in cases in which the child has a history or evidence
of neurological abnormality.

The seizure activity itself is generally characterized as clonic (consisting of rhythmic jerking
movements of the arms and/or legs), or tonic-clonic (commencing with a stiffening of the
body followed by a clonic phase).

Demographics

Fever is the most common cause of seizures in children, occurring in 2 to 5 percent of

children from six months to five years of age. First onset usually occurs by two years of age,
with the risk decreasing after age three; most children stop having febrile seizures by the
age of five or six. Male children have been shown to have a higher incidence of febrile
seizures. The majority of children who experience a febrile seizure will only have one in their
lifetime; approximately 33 percent will go on to have more than one.

Causes and Symptoms

Under normal circumstances, information is transmitted in the brain by means of electrical

discharges from brain cells. A seizure occurs when the normal electrical patterns of the brain
become disrupted. A febrile seizure is caused by fever, most commonly a high fever that has
risen quickly. The average fever temperature in which febrile seizures take place is 104°F
(40°C). Conversely, a healthy person's body temperature fluctuates between 97°F (36.1°C)
and 100°F (37.8°C).

Fevers are caused in most cases by viral or bacterial infections, such as otitis media (ear
infection), upper respiratory infection, pharyngitis (throat infection), pneumonia, chickenpox,
and urinary tract infection. Other conditions can induce a fever, including allergic reactions,
ingestion of toxins, teething, autoimmune disease, trauma, cancer, excessive sun exposure,
or certain drugs. In some cases no cause of the fever can be determined.
Febrile seizures generally last between one and ten minutes. A child experiencing a febrile
seizure may exhibit some or all of the following behaviors:

• stiff body
• twitching or jerking of the extremities or face
• rolled-back eyes
• unconsciousness
• inability to talk
• problems breathing
• involuntary urination or defecation
• vomiting
• confusion, sleepiness, or irritability after the seizure

Approximately one third of children who have had a febrile seizure will experience recurrent
seizures. Several risk factors are associated with recurrent febrile seizures; children who
exhibit all four are at a 70 percent chance of developing recurrent seizures, while those who
have none of the risk factors have only a 20 percent chance. The risk factors include:

• family history of febrile seizures

• young age of the child (i.e. less than 18 months of age)
• seizure occurs soon after or with onset of fever
• seizure-associated fever is relatively low

Causes

The direct cause of a febrile seizure is not known; however, it is normally precipitated by a
recent upper respiratory infection or gastroenteritis. A febrile seizure is the effect of a
sudden rise in temperature (>39°C/102°F) rather than a fever that has been present for a
prolonged length of time.[1]

Febrile seizures represent the meeting point between a low seizure threshold (genetically
and age-determined; some children have a greater tendency to have seizures under certain
circumstances) and a trigger, which is fever. The genetic causes of febrile seizures are still
being researched. Some mutations that cause a neuronal hyperexcitability (and could be
responsible for febrile seizures) have already been discovered.

When to Call the Doctor

A healthcare provider should be contacted after a febrile seizure. A visit to the emergency
room is warranted if the accompanying fever is greater than 103°F (39.4°C) in a child older
than three months or 100.5°F (38°C) in an infant of three months or younger or if the
seizure is the child's first. Emergency medical personnel (telephone 911) should be called if
a febrile seizure lasts more than five minutes; if the child stops breathing; if the child's skin
starts to turn blue; or if the fever is greater than 105.8°F (41°C), a condition called
hyperpyrexia.

Diagnosis

A key focus of diagnostic tests will be to determine the underlying cause of the fever. A
comprehensive medical history including the fever's duration and course, other symptoms
the child is experiencing, prior or current medical conditions, recent vaccinations or
exposure to communicable diseases, and the child's current behaviors may point to the
fever's origin. A temperature below 100.4°F (38°C) suggests another cause for the seizure.
The caregiver who was present with the child while he or she was having the seizure will be
asked questions relating to the child's behaviors in an attempt to determine the type of
seizure.

Physicians may administer tests to rule out conditions other than fever that could have
caused the seizure, such as epilepsy, meningitis, or encephalitis. Children who suffer from
recurrent febrile seizures are not diagnosed with epilepsy, a seizure disorder that is not
caused by fever. In the case of children under 18 months of age, a lumbar puncture (spinal
tap) may be recommended to rule out meningitis because symptoms are often lacking or
subtle in children of that age. Because of the benign nature of the simple febrile seizure,
tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI), or
electroencephalogram (EEG) are not usually recommended.

Treatment

During a seizure parents or caregivers need to remain calm and take steps to make sure the
child remains safe. During the period after the seizure the child may be disoriented and/or
sleepy (called the postictal state), but quick recovery from this state is normal, and medical
treatment is not normally needed.

During a Seizure

If a parent or caregiver observes a child having a seizure, there are a number of measures
that should be taken to ensure the child's safety. These include:

• staying calm
• laying the child on his or her side or front to prevent vomited matter from being
aspirated into the lungs
• loosening any tight clothing or items that could constrict breathing
• marking the start and end time of the seizure
• clearing the surrounding area of unsafe items
• attending to the child for the duration of the seizure
• clearing the child's airway if it becomes obstructed with vomited material or other
objects

Parents or caregivers should not attempt to stop the seizure or slap or shake the child in
attempt to wake him/her. The child may move around during the seizure, and parents
should not try to hold the child down. If the child vomits, a suction bulb can be used to help
clear the airway.

After a Seizure

A healthcare professional should be called immediately after the seizure in the event that
further treatment or tests are required. Hospitalization is not normally required unless the
child is suffering from a serious infection or illness or the seizure itself was abnormally long.
Parents or caregivers may be instructed to take certain measures at home to reduce the
child's fever, such as administering fever-reducing drugs (called antipyretics) such as
acetaminophen (Tylenol) or ibuprofen (Advil). There is, however, no evidence that shows
fever-reducing therapies reduce the risk of another febrile seizure occurring. If the child is
suffering from a bacterial infection that is the cause of the fever, he or she may be placed on
antibiotics.

Treating the Fever

The treatment of pediatric fever varies according to the age of the child and the fever's
cause, if known. Physicians recommend that newborns less than four weeks of age with
fever be admitted to the hospital and administered antibiotics until a complete workup can
be done to rule out bacterial infection or other serious illness. The same is recommended for
infants ages four to 12 weeks if they appear ill. Infants of this age who otherwise appear well
can often be managed on an outpatient basis with antipyretics and antibiotics in the case of
bacterial infection.

For children ages three months and older, the course of treatment depends on the extent
and cause of the fever. Most fevers and associated conditions can be managed on an
outpatient basis. Low-grade fevers often do not need to be treated in otherwise healthy
children. Antipyretics may be suggested to lower a fever and make the child more
comfortable but will not affect the course of an underlying infectious disease. Aspirin should
not be given to a child or adolescent with a fever since this drug has been linked to an
increased risk of the serious condition called Reye's syndrome. Antibiotics may be
administered if the child has a known or suspected bacterial infection.

Alternative Treatment

There are some outpatient treatments that parents or caregivers may administer to reduce
their febrile child's discomfort, although there is no evidence that indicates such treatments
reduce the risk of febrile seizures. These include dressing the child lightly, applying cold
washcloths to the face and neck, providing plenty of fluids to avoid dehydration, and giving
the child a lukewarm bath or sponging the child in lukewarm water.

Prognosis

The risk of complications associated with febrile seizures is very low. Some of the
complications that may occur are:

• biting the tongue

• choking on items that were in the mouth at the start of the seizure
• injury from falling down
• aspirating fluid or vomit into the lungs
• developing recurrent febrile seizures
• developing recurrent seizures unrelated to fever (epilepsy)
• complications related the underlying cause of the fever

Children who have had a febrile seizure are at an increased risk of having another;
approximately one third of febrile seizure cases become recurrent. The risk of recurrent
seizures decreases with age: infants younger than 12 months have a 50 percent chance of
having a second seizure, while children over the age of 12 months have a 30 percent
chance. The risk of a child going on to develop epilepsy is slightly increased at
approximately 2–5 percent, compared to 1 percent for the general population; such a risk is
increased in children who have a history of neurological abnormalities such as cerebral palsy
or developmental delays and in children whose seizures recur or are prolonged. Research
has shown that febrile seizures do not affect a child's intelligence level or achievement in
school.
Prevention

In some cases, a febrile seizure may be the first indication that a child is ill. Prevention is,
therefore, not always possible. While the use of anticonvulsants such as Phenobarbital or
Valproate has been shown to prevent recurrent febrile seizures, these drugs are associated
with significant side effects such as adverse behaviors, allergic reaction, and organ injury,
and have not been shown to benefit simple febrile seizures. Only rarely is anticonvulsant
therapy recommended for a child with febrile seizures because of the generally benign
nature of the seizures and the risk of side effects from the drugs. In some cases oral
diazepam (Valium) can be administered at the first sign of fever to reduce the risk of febrile
seizures; about two-thirds of children who receive this drug experience side effects such as
sleepiness and loss of coordination. The majority of children who have had a febrile seizure
do not need drug therapy. Parents may be directed to administer over-the-counter
antipyretics at the first sign of fever.

Parental Concerns

A febrile seizure can be a frightening experience for both the child and his or her parents. It
is important that parents be educated about the low risk of simple febrile seizures and the
measures that can be taken to ensure their child's safety during and after a seizure.

Types

There are two types of febrile seizures.

• A simple febrile seizure is one in which the seizure lasts less than 15 minutes
(usually much less than this), does not recur in 24 hours, and involves the entire
body (classically a generalized tonic-clonic seizure).
• A complex febrile seizure is characterized by longer duration, recurrence, or focus
on only part of the body.

The simple seizure represents the majority of cases and is considered to be less of a cause
for concern than the complex.[citation needed]

Simple febrile seizures do not cause permanent brain injury; do not tend to recur frequently
(children tend to outgrow them); and do not make the development of adult epilepsy
significantly more likely (about 3–5%), compared with the general public (1%)
Template:Shinnar S, Glauser TA: Febrile Seizures. J Child Neurol 17S:S44, 2002. Children
with [1] febrile convulsions are more likely to suffer from afebrile epileptic attacks in the
future if they have a complex febrile seizure, a family history of afebrile convulsions in first-
degree relatives (a parent or sibling), or a preconvulsion history of abnormal neurological
signs or developmental delay. Similarly, the prognosis after a simple febrile seizure is
excellent, whereas an increased risk of death has been shown for complex febrile seizures,
partly related to underlying conditions.[4]

Symptoms

During simple febrile seizures, the body will become stiff and the arms and legs will begin
twitching. The patient loses consciousness, although their eyes remain open. Breathing can
be irregular. They may become incontinent (wet or soil themselves); they may also vomit or
have increased secretions (foam at the mouth). The seizure normally lasts for less than five
minutes.[5]
Treatment

The vast majority of patients do not require treatment for either their acute presentation
with a seizure or for recurrences. The best way to manage is to control the temperature with
acetaminophen (Paracetamol) or by sponging. When anticonvulsant therapy is judged by a
doctor to be indicated, anticonvulsants can be prescribed. Sodium valproate or clonazepam
are active against febrile seizures, with sodium valproate showing superiority over
clonazepam

1 Hyperthermia

Benign Febrile Convulsion is a convulsion triggered by a rise in body temperature. Fever is

not an illness and is an important part of the body’s defense against infection. Antigens or
microorganisms cause inflammation and the release of pyrogens which is a substance that
induces fever.

Nursing Nursing Expected

Assessment Planning Rationale
Diagnosis Interventions Outcome
Subjective: Hyperthermi Short term: >Assess >To obtain Short term:
a underlying baseline
Ө After 4 hours of condition and date. The patient’s
nursing body temperature
Objective: interventions, temperature. >To note for shall have
the patient’s progress and decreased
the patient temperature >Monitor and evaluate from 39°C to
manifested: will decrease recorded vital effects of normal range
from 39°C to signs. hyperthermi of 36.5°C to
normal range of a. 37°C.
> febrile temp 36.5°C to 37°C. >Remove
= 39°C
unnecessary >To Long Term:
Long Term: clothing that decrease or
>flushed skin could only totally
and warm to The patient
After 2 days of aggravate heat. diminish shall have
touch pain.
nursing been able to
interventions, >Promote be free of
> convulsion the patient will adequate rest >Reduces complications
be able to be periods. metabolic and maintain
> RR = 34 free of demands or core
bpm complications >Provide TSB oxygen. temperature
and maintain within normal
the patient core >Advise to >To promote range.
may manifest: temperature increase fluid surface
within normal intake. cooling.
> high fever range.
>Loosen >To help
> weakness clothing. decrease
body
>Administer IV temperature.
fluids at
prescribed rate. >To provide
 Monitor proper
regulation rate ventilation
frequently. and promote
release of
>Administer heat through
antipyretics as evaporation.
ordered.
>To promote
fluid
management
.

>
Antipyretics
lower core
temperature.

2 Imbalanced Nutrition

The nutritional requirements of the human body reflect the nutritional intake necessary to
maintain optimal body function and to meet the body’s daily energy needs. Malnutrition
(literally, “bad nutrition”) is defined as “inadequate nutrition,” and while most people
interpret this as undernutrition, falling short of daily nutritional requirements. The etiology of
malnutrition includes factors such as poor food availability and preparation, recurrent
infections, and lack of nutritional education.

Nursing Nursing Expected

Assessment Planning Rationale
Diagnosis Interventions Outcome
Subjective: Imbalance Short term: >Review >To obtain Short term:
Nutrition: patient’s records. baseline
Ө Less than After 4 hours of data. The patient
the body nursing >Assess shall have
Objective: requiremen interventions, underlying >To identified
t related to the patient’s condition. determine measures to
economical will identify specific promote
the patient factors.
manifested: measures to >discuss eating interventions. nutrition and
promote habits and follow the
nutrition and encourage diet >To achieve treatment
> body follow the
weakness for age. health needs regimen.
treatment of the patient
regimen > Note total daily with the Long Term:
> weight of proper food
7.9kg intake includes
Long Term: patterns and timediet for his The patient
of eating. disease. shall have
> loss of After 2 days of demonstrated
appetite nursing >To reveal behaviours or
>Consult
interventions, physician for change that lifestyle
> poor the will further should be changes to
muscle tone demonstrate assessment and made in the regain
behaviours or recommendation client’s appropriate
the patient lifestyle regarding food dietary weight.
may manifest: changes to preferences and intake.
regain nutritional
> abnormal appropriate support. >For greater
laboratory weight. understandin
studies g and further
assessment
> pallor of specific
food.

3 Ineffective Tissue Perfusion

The circulation to the tissues is not getting enough oxygen or nourishment. Decrease in
oxygen resulting in the failure to nourish the tissues at the capillary level.

Nursing Nursing Expected

Assessment Planning Rationale
Diagnosis Interventions Outcome
Subjective: Ineffective Short term: > Establish > To gain Short term:
tissue rapport. patient and
Ө perfusion After 4 hours of S.O.’s trust The patient
realated to nursing > Monitor VS. and promote shall have
Objective: decreased intervention, cooperation. demonstrated
Hgb the patient will > Determine behaviour
concentratio demonstrate factors related to > To monitor lifestyle
The patient n in blood as behaviour
manifested: evidenced individual patients change.
lifestyle situation. status.
by low Hgb changes to Long term:
>Body count in CBCimprove
temperature result > Evaluate for > To gain
circulation. signs of infection information The patient’s
changes.
especially when regarding S.O. shall
Long term: immune system the have
>Skin condition.
discoloration is compromised. verbalized
After 2 days of understandin
nursing > Discuss >To observe g of the
The patient intervention, for possible condition.
may manifest: individual risk
the patient’s factors. risk factors.
S.O. will
> Anemia verbalize > Elevate head of> This
understanding bed at night. information
 of the > Discuss the would be
condition. importance of a necessary
healthy diet.. for the
client’s S.O.

> To
increase
gravitational
blood flow.

>To promote
a healthy
diet to help
increase RBC
synthesis
and Hgb
count for
faster
recovery.

4 Risk for Infection

The immune system is the body’s defense against bacteria, viruses, and other foreign
organisms or harmful chemicals. It is very complex and it has to work properly to protect us
from the harmful bacteria and other organisms in the environment which may infect our
body. If the immune system is compromised, it can affect the normal production of WBC
from the bone marrow. If there is an increase in number of WBC, therefore it may increase
the possibility to increase infection

Nursing Nursing Expected

Assessment Planning Rationale
Diagnosis Interventions Outcome
S=Ø Risk for Short Term: >Establish good >To gain Short Term:
(spread) of working their trust
O = the infection After 3 hours of relationship with and After 3 hours
patient nursing the client and cooperation of nursing
manifested: interventions, S.O. interventions,
the patient will >For the patient
>body verbalize >Monitor and comparative shall have
weakness understanding record vital signs baseline verbalized
of ways on how data understandin
>fatigue to prevent > Determine pt’s g of ways on
spread of individual >To know how to
infection. strength when to prevent
>poor muscle
tone assist client spread of
Long Term: >Provide infection.

=The patient peaceful >To promote

After 1week of optimum
may manifest: nursing environment level of Long Term:
interventions, functioning
>elevated the patient will >Provide After 1week
body be free from adequate rest >To prevent of nursing
temperature infections and and sleep. fatigue and interventions,
further conserve the patient
>Hgb = 112 complications >Emphasize energy shall have
importance of been free
>WBC = 22.9 hand washing >.to prevent from
occurrence infections and
>Provide safety of further further
>RBC = 3.97 complications.
measures infections
>HCT = 0.34
>Monitor I & O >To prevent
falls and
>Platelet injuries
count = 234 >Check IV and
Regulate IVF
>To note for
>Advice pt to imbalances
increase oral fluid
intake when >To ensure
allowed proper
hydration

> To replace
fluid
electrolyte
loss

5 Risk for Injury

A seizure or convulsion is the visible sign of a problem in the electrical system that controls
your brain. A single seizure can have many causes, such as a high fever and lack of oxygen.
Hemoglobin is a protein in red blood cells that carries oxygen. Therefore, Low levels of
hemoglobin in the human body may reult to seizure. During episodes of convulsion, patients
are prone to injuries since they may strike different objects due to uncontrollable muscle
spasms.

Nursing Nursing Expected

Assessment Planning Rationale
Diagnosis Interventions Outcome
Subjective: Risk for Short term: >establish rapport > To gain Short term:
injury patient’s
Ө related to After 4 hours of >monitor and trust The SO shall
possible nursing record Vital Signs have modified
Objective: convulsion. interventions, >To obtain environment
the SO will > ascertain knwlge baseline as indicated
the patient modify of safety needs/ data to enhance
may manifest environment as injury prevention safety.
the following: indicated to > to prevent
enhance safety. > note clients injuries in
home,
>Fever Long term: gender, age, community, Long term:
developmnt stage, and work
>Convulsion After 2 days of decision makng setting The SO shall
nursing ability, level of have
>Low interventions, cognition/competen>affects verbalized
the SO will ce client’s understandin
>Low Hgb verbalize ability to g of individual
Level = 112 understanding >provide health protect factors that
of individual care within a self/others contribute to
factors that culture of safety and possibility of
contribute to influence injury.
possibility of > identify choice of
injury. interventions/safet interventions
y devices / teachings

> discuss >to prevent

importance of self errors
monitoring of resulting in
conditions/ client injury,
emotions promote
client safety
and model
safety
behaviors for
client/SO

>to promote
safe physical
environment
and
individual
safety

>it can
contribute to
occurence of
injury

Diazepam

Generic Name: diazepam

Brand Names: Apo-Diazepam (CAN), Diastat, Diazemuls (CAN), Diazepam Intensol, Valium

Pregnancy Category D

Controlled Substance C-IV

Drug classes:
 • Benzodiazepine
• Anxiolytic
• Antiepileptic
• Skeletal muscle relaxant (centrally acting)

Therapeutic actions

Exact mechanisms of action not understood; acts mainly at the limbic system and reticular
formation; may act in spinal cord and at supraspinal sites to produce skeletal muscle
relaxation; potentiates the effects of GABA, an inhibitory
neurotransmitter; anxiolytic effectsf GABA, an inhibitory neurotransmitter; anxiolytic effects
occur at doses well below those necessary to cause sedation, ataxia; has little effect on
cortical function.

Indications

• Management of anxiety disorders or for short-term relief of symptoms of anxiety

• Acute alcohol withdrawal; may be useful in symptomatic relief of acute agitation,
tremor, delirium tremens, hallucinosis
• Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due to local
pathology (inflammation of muscles or joints) or secondary to
trauma;spasticity caused by upper motoneuron disorders (cerebral palsy and
paraplegia); athetosis, stiff-man syndrome
• Parenteral: Treatment of tetanus
• Antiepileptic: Adjunct in status epilepticus and severe recurrent convulsive seizures
(parenteral); adjunct in seizure disorders (oral)
• Preoperative (parenteral): Relief of anxiety and tension and to lessen recall in
patients prior to surgical procedures, cardioversion, and endoscopic procedures
• Rectal: Management of selected, refractory patients with epilepsy who require
intermittent use to control bouts of increased seizure activity
• Unlabeled use: Treatment of panic attacks

Contraindications and cautions

• Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-

angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or
palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis when used in
first trimester; neonatal withdrawal syndrome reported in newborns); lactation.
• Use cautiously with elderly or debilitated patients; impaired liver or renal function;
and in patients with a history of substance abuse.

Available forms

Tablets—2, 5, 10 mg; SR capsule—15 mg; oral solution—1 mg/mL, 5 mg/5 mL; rectal
pediatric gel—2.5, 5, 10 mg; rectal adult gel—10, 15, 20 mg; injection—5 mg/mL

Dosages

Individualize dosage; increase dosage cautiously to avoid adverse effects.

PEDIATRIC PATIENTS

Oral

> 6 mo: 1–2.5 mg PO tid–qid initially. Gradually increase as needed and tolerated. Can be
given rectally if needed.

Rectal

< 2 yr: Not recommended.

2–5 yr: 0.5 mg/kg.

6–11 yr: 0.3 mg/kg.

>12 yr: Use adult dose; may give a second dose in 4–12 hr.

Parenteral

Maximum dose of 0.25 mg/kg IV administered over 3 min; may repeat after 15–30 min. If no
relief of symptoms after three doses, adjunctive therapy is recommended.

• Tetanus (> 1 mo): 1–2 mg IM or IV slowly q 3–4 hr as necessary.

• Tetanus (> 5 yr): 5–10 mg q 3–4 hr.
• Status epilepticus (> 1 mo–< 5 yr): 0.2–0.5 mg slowly IV q 2–5 min up to a maximum
of 5 mg.
• Status epilepticus (> 5 yr): 1 mg IV q 2–5 min up to a maximum of 10 mg; repeat in
2–4 hr if necessary.

Nursing considerations

Assessment

• History: Hypersensitivity to benzodiazepines; psychoses, acute narrow-angle

glaucoma, shock, coma, acute alcoholic intoxication; elderly or debilitated patients;
impaired liver or renal function; pregnancy, lactation
• Physical: Weight; skin color, lesions; orientation, affect, reflexes, sensory nerve
function, ophthalmologic examination; P, BP; R, adventitious sounds; bowel sounds,
normal output, liver evaluation; normal output; LFTs, renal function tests, CBC

Interventions

• WARNING: Do not administer intra-arterially; may produce arteriospasm, gangrene.

• Change from IV therapy to oral therapy as soon as possible.
• Do not use small veins (dorsum of hand or wrist) for IV injection.
 • Reduce dose of opioid analgesics with IV diazepam; dose should be reduced by at
least one-third or eliminated.
• Carefully monitor P, BP, respiration during IV administration.
• WARNING: Maintain patients receiving parenteral benzodiazepines in bed for 3 hr;
do not permit ambulatory patients to operate a vehicle following an injection.
• Monitor EEG in patients treated for status epilepticus; seizures may recur after initial
control, presumably because of short duration of drug effect.
• Monitor liver and renal function, CBC during long-term therapy.
• Taper dosage gradually after long-term therapy, especially in epileptic patients.
• Arrange for epileptic patients to wear medical alert ID indicating that they are
epileptics taking this medication.
• Discuss risk of fetal abnormalities with patients desiring to become pregnant.

Teaching points

• Take this drug exactly as prescribed. Do not stop taking this drug (long-term therapy,
antiepileptic therapy) without consulting your health care provider.
• Caregiver should learn to assess seizures, administer rectal form, and monitor
patient.
• Use of barrier contraceptives is advised while using this drug; if you become or wish
to become pregnant, consult with your health care provider.
• It is advisable to wear a medical alert ID indicating your diagnosis and treatment (as
antiepileptic).
• You may experience these side effects: Drowsiness, dizziness (may lessen; avoid
driving or engaging in other dangerous activities); GI upset (take drug with food);
dreams, difficulty concentrating, fatigue, nervousness, crying (reversible).
• Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions,
palpitations, swelling of the ankles, visual or hearing disturbances, difficulty voiding.