1. Risk for trauma / injury r / t weakness, altered consciousness, loss of muscle coordination.
Goal: injury / trauma does not occur.
Expected outcomes:
Factors that cause known, maintaining the rule of treatment, improve environmental safety.
Interventions:
- Assess the family, a variety of precipitating seizures stimulus.
- Observation of general condition, before, during, and after the seizure.
- Record the type of seizure activity and some times occur.
- Do a neurological assessment, vital signs after the seizure.
- Protect clients from trauma or seizures.
- Provide comfort for the client.
- Collaboration with doctors in the provision of anti comvulsan.
2. Risk for ineffective airway clearance r / t neuromuscular damage.
Goal: ineffective airway clearance does not occur.
Expected outcomes:
The airway clear of obstruction, vesicular breath sounds, no mucosal secretions, respiration within normal limits.
Interventions:
- Observation of vital signs.
- Adjust the position of the client bed semi-Fowler.
- Perform suction mucus.
- Collaboration with physicians in therapy.
3. Risk for recurrent seizures r / t increase in body temperature.
Goal: Seizure activity is not repeated.
Expected outcomes:
Seizures can be controlled, the body temperature back to normal.
Interventions:
- Assess the precipitating factors of seizures.
- Involve the family in the provision of action to clients.
- Observation of vital signs.
- Protect children from the trauma.
- Give a cold compress on the forehead and underarm area.
4. Impaired physical mobility r / t damage the perception, decreased strength.
Goal: Damage to physical mobilization is resolved.
Expected outcomes:
Active physical mobility, seizures do not exist, the client needs resolved.
Interventions:
- Assess the level of mobilization of the client.
- Assess the level of damage to the mobilization of the client.
- Assist clients in fulfillment.
- Train clients in accordance mobilization capacity of the client.
- Involve the family in meeting the needs of clients.
5. Knowledge Deficit: Family r / t the lack of information.
Goal: Knowledge of family increases.
Expected outcomes:
Family understand the disease process febrile seizures, the client's family did not ask again about the disease, treatment and condition of the client.
Interventions:
- Assess the level of family education.
- Assess the level of knowledge of the client's family.
- Explain to the client's family about febrile seizure disease through health education.
- Give a chance to the families to ask for things not understood.
- Involve the family in any action on the client.