Component Task: Responding to Childhood Emergencies: Convulsion/Seizures

This is the act of giving immediate intervention by the Paediatric nurse/nurse to a child with convulsions/seizures.

Aims

·         Abort/stop the convulsion/seizure

·         Maintain a patent airway and breathing

·         Prevent injury

·         Prevent/reduce complications

·         Allay fear and anxiety

Types

·         Management of focal/partial seizures

·         Management of generalised onset seizures

Requirements

a.      Tray containing the following:

·         Padded spatula

·         Anti-convulsant

·         Thermometer, BP apparatus, Pulse oximeter

·         Nasal prongs/oxygen mask

·         Ambu bag/self inflating mask

·         IV cannula and giving set

·         IV fluid (1/5th NS in 4.3% DS, NS, RL, 10% dextrose) h. Syringe (Tuberculin, 2ml, 5ml, 50ml) and needles

b.      Suction Apparatus

c.      Oxygen cylinder/source

d.      Drip stand

e.      Appropriate PPEs

f.        Infusion pumps/infusion flow meter

g.      Glucometer and strips

Steps

1.        Reassure child and caregiver

2.      Call for help

3.      Perform five moments of hand hygiene as and when required

4.      Avoid overcrowding and nurse child in a safe environment

5.      Calculate the prescribed anticonvulsant according to body weight

6.      Administer prescribed anticonvulsant IV or rectally (insert the lubricated syringe 4-5cm deep and hold the buttocks for 3-4 minutes)

7.       Assess airway, breathing and circulation

8.      Administer oxygen if necessary

9.      Assess the level of consciousness using AVPU

10.    Nurse the unconscious child in the left lateral position and suction when necessary

11.      Loosen any tight clothing, remove jewelry and other accessories

12.    Check random blood sugar (RBS) levels and manage appropriately (10% IV glucose solution as bolus according to body weight – 5ml/kg)

13.    Check vital signs and record

14.    Give suppository paracetamol if temperature is very high

15.    Keep child warm

16.    Monitor the frequency, duration and parts of the body involved in the seizure for 30 minutes

17.    Reassure child/caregiver of competent care

18.    Inform Ward Manager and Paediatrician

19.    Document all procedures and observations in the nurses’ notes & seizure chart (manual or electronic)