prepared by: dr: omayah nassar - nursing lijan

Controlling Elevated Temperatures

• Prepared By:

• Dr: Omayah Nassar

https://www.gponline.com/fever-children-red-flag-symptoms/paediatrics/article/1427362


• An elevated temperature is one

of the most common symptoms

of illness in children

https://www.gleneagles.com.sg/healthplus/article/fever-in-children

• Body temperature is regulated by a thermostat-like mechanism in the hypothalamus.

• This mechanism receives input from centrally and peripherally located receptors.

https://www.rchsd.org/health-articles/fever-and-taking-your-childs-temperature/

• When temperature changes occur, these receptors relay the information to the thermostat, which either increases or decreases heat production to maintain a constant set point temperature.


• Set point: The temperature

around which body temperature is

regulated by a thermostat-like

mechanism in the hypothalamus

https://www.onio.com/article/fever-in-children-when-to-see-a-doctor.html

• Fever (hyperpyrexia): An elevation in set point such that body temperature is regulated at a higher level

• defined as temperature above 38° C (100.4° F)

http://medicalrepublic.com.au/managing-fever-children-worry/20545

• Most fevers in children are of

brief duration with limited

consequences and are viral in origin.

https://www.netdoctor.co.uk/conditions/pregnancy-and-family/a9125/fever-in-children/

•Hyperthermia: Body

temperature exceeding the set point,

which usually results from the body

or external conditions creating more

heat than the body can eliminate,

such as in heat stroke, aspirin

toxicity, seizures, or hyperthyroidism

https://www.vectorstock.com/royalty-free-vector/little-boy-having-hyperthermia-vector-8779765

• Shivering is the body's way of maintaining the elevated set point by producing heat.

• Compensatory shivering greatly increases metabolic requirements above those already caused by the fever

https://www.amazon.com/Shiver-Shivering-Sinners-Explicit/dp/B07K3766C7

Therapeutic Management

Because the set point is normal in hyperthermia but increased in fever, different approaches must be used to lower body temperature successfully.

Therapeutic Management of Fever

• The principal reason for treating fever is the relief of discomfort.

Relief measures include pharmacologic and environmental intervention.


Pharmacologic measures:

The most effective intervention is the use of Antipyretics to lower the set point.

Antipyretics

nonsteroidal anti inflammatory drugs

(NSAIDs).


• One nonprescription NSAID, ibuprofen, is approved for fever reduction in children as young as 6 months old.

• The duration of fever reduction is generally 6 to 8 hours and is longer with the higher dose.

https://www.singlecare.com/blog/children-pain-relievers-fever-reducers/


• Aspirin should not be given to children because of its association in children with influenza virus or chickenpox and Reye syndrome.

https://nurseslabs.com/reyes-syndrome/


• Environmental measures

• The nurse can use environmental measures to reduce fever if they are tolerated by the child and if they do not induce shivering.


• Traditional cooling measures:

• Wearing minimum clothing

• Exposing the skin to air

• Reducing room temperature; increasing air circulation

• Applying cool, moist compresses to the skin (e.g., the forehead)

https://sg.theasianparent.com/home-remedies-for-fever


• Traditional cooling measures:

• Cooling procedures (such as sponging or tepid baths) are ineffective in treating febrile children (these measures are effective for hyperthermia) either when used alone or in combination with antipyretics, and they cause considerable discomfort


• Seizures associated with a fever occur in 3% to 4% of all children, usually in those between 6 months and 6 years old.

• About 30% of children have subsequent febrile seizure

Therapeutic management for Hyperthermia

• Unlike in fever, antipyretics are of no value in hyperthermia because the set point is already normal.

Cool applications to the skin help reduce the core temperature.

Cooled blood from the skin surface is conducted to inner organs and tissues


• Frequent temperature monitoring is essential to prevent excessive cooling of the body.

• Cool compresses decrease high temperature.


For tepid tub baths, it is usually best to start with warm water and gradually add cool water until the desired water temperature of 37°C (98.6° F) is reached .

The temperature of the water only has to be 1C (or 2° F) less than the child's temperature to be effective.

https://www.babycentre.co.uk/a40/bathing-your-baby-safely


The child is placed directly in the tub of tepid water for 15 to 20 minutes while water is gently squeezed from a washcloth over the back and chest or gently sprayed over the body from a sprayer.

https://www.wikihow.com/Deal-With-a-Child%27s-Fever-Naturally


• After the tub or sponge bath, the

child is dried and dressed in

lightweight pajamas, a nightgown,

or a diaper and placed in a dry bed.

• The child is dried by gently

rubbing the skin surface with a

towel to stimulate circulation.

https://www.wikihow.com/images/thumb/2/24/Deal-With-a-Child%27s-Fever-Naturally-Step-8-Version-2.jpg/v4-460px-Deal-With-a-Child%27s-Fever-Naturally-Step-8-Version-2.jpg


In the bed or crib, cool washcloths or towels are used, exposing only one area of the body at a time. Continue sponging for approximately 20 minutes

https://www.shutterstock.com/search/bath+baby+asian?safe=true&image_type=all


• The temperature is retaken 30

minutes after the tub or sponge

bath

• Adequate hydration is essential.

• Most children's needs can be met

through additional oral fluids.

https://www.bloomingbath.com/blooming-bath-lotus.html

Family Teaching and Home Care

Fever is one of the most common problems for which parents seek health care.

High levels of parental anxiety (fever phobia) surrounding potential complications of fever (such as seizures and dehydration) are prevalent and can result in overusing antipyretics

https://www.iowaclinic.com/primary-care/most-accurate-thermometers/


• Parents need to know that sponging is indicated for elevated temperatures from hyperthermia rather than fever

• The use of ice water and alcohol are inappropriate, potentially dangerous solutions


• Parents should know how to take the child's temperature, how to read the thermometer accurately, and when to seek professional care.

Aplastic strip or digital thermometers, may be better suited for home use.

https://www.indiamart.com/proddetail/ms-digital-thermometer-11747022688.html


If the use of ibuprofen is indicated, the parents need instructions in administering the drug.

Emphasize accuracy in both the amount of drug given and the time intervals at which the drug is administered.


Reduce the child activity

Encourage small, frequent sips of clear liquids.

Dress the child in light clothing; use a light blanket for children who are cold or shivering

https://maryannjacobsen.com/5-things-parents-should-know-about-starting-and-stopping-sippy-cups/

Family-Centered CareCall emergency Immediately If:

Your child is younger than 2 months old.

The fever is over 40.6° C (105° F).

https://andrewjprokop.wordpress.com/2014/05/14/9-1-1-and-sip/

Family-Centered Care

Call emergency Immediately If:

• If the child looks or acts very sick, including a stiff neck, persistent vomiting, purplish spots on the skin, confusion, trouble breathing

https://parenting.firstcry.com/articles/viral-fever-in-children-symptoms-causes-treatment/

• Please watch this video:

• Video link

• https://www.youtube.com/watch?v=QV7j-XQ7wv8

https://www.youtube.com/watch?v=QV7j-XQ7wv8

References

• Hockenberry, M. J.,Wilson, D. & Rodgers, C., (2017). Wong's Essentials of Pediatric Nursing (10th ed.). St. Louis, MO: Elsevier Mosby

prepared by: dr: omayah nassar - nursing lijan

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