Fever Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria...
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Transcript of Fever Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria...
Fever
Paediatric Palliative Care
For Home Based Carers
Funded by
British High Commission, Pretoria
Small Grant Scheme
What is Fever?
A raise in body temperature
above 37.5oC (IMCI 2002)
During infections, the body is able to raise its temperature which helps to fight germs
So fever is one of the most common signs of infection in ALL children
Children with HIV
More infections than mostchildren
More fevers than most children
Fever may be a sign of: Chest infections Ear infections Skin infections Diarrhoea Meningitis Oral infections HIV Infection
©TALC
Fever in Children
Fevers may cause discomfort to the child
Fevers increases loss of water through the skin
This increases the chance of dehydration in children
High fevers may lead to febrile convulsion (seizures or ‘fits’)
©TALC
©TALC
Signs and Symptoms
How would you know
whether Sofiso has
a fever?
©TALC
Has Sofiso got a fever?
Touch the Child
Forehead, stomach or other parts of body may feel hot to the touch
He may or may not be sweating
Is his heart rate (pulse) fast?
©TALC
Has Sofiso got a fever?
Look at the Child
Is he withdrawn and/or reluctant
to move?
Is he irritable?
Is he breathing fast?
©TALC
Has Sofiso got a fever?
Take the temperature
Our eyes and hands are very helpful in
assessing fever
But, thermometers are more accurate
and may be used to answer:
How high is the child’s temperature? Has the treatment effectively lowered the
temperature? Has the fever risen?
©TALC
Using Thermometers Try to keep the child calm before taking temperature
Wash thermometer with cold soapy water and/or alcohol
Shake thermometer hard until reading is below 36 degrees
Place bulb end of thermometer well up in to armpit, holding arm down over it and elbow in to baby’s side
Hold position for 4-5 minutes, whilst singing songs/telling story
NEVER leave the child with the thermometer – he WILL move!
Remember!!
Mercury is poisonous
If a thermometer is broken, this is extremely dangerous
ALWAYS store a thermometer in a safe place where it will not be broken
Reading Thermometers
Hold thermometer in a good light Rotate until you see a silver line of
mercury Line up mercury with numbers, marked
in full degrees (36,37,38) and every two-tenths degree (.1,.2,.3,.4)
Point where mercury ends indicates the temperature
Write it down straight away with time taken
34 35 36 37 38 39 40 5 5 5 5 5 5
What to Do?
Fever is usually a sign of infection in the child
So you need to:
Manage the fever Identify what may be causing the fever
Any underlying infections can then
be treated and managed appropriately
Does the Child have Fever?
If carer reports history of fever
or temperature is 37.5oC or
above:
Ask:
For how long?
If more than 7 days, has fever been present every day?
©TALC
Risk of Meningitis Look and Feel for: Stiff neck Bulging fontanelle
Suspected Meningitis if:
Any general danger signOR
Stiff neckOR
Bulging Fontanelle
(IMCI, 2002)
Suspected Meningitis
Home Based Carers
Administer one dose of paracetamol (Panado) for fever 38oC or above
Refer urgently!
Professional Nurses
Child needs dose of IM Ceftriaxone
Test blood sugar
Give one dose of paracetamol (Panado) for fever 38oC or above
(IMCI, 2002)
If No Suspected MeningitisAssess the child - Look, Listen, Feel for the following:
Sore Throat Ear ache, pus from ear Difficulty breathing, noisy breathing Cough (+/- sputum) Diarrhoea Pain on passing urine Severe headache, neck stiffness, bulging fontanelle Skin Inflammation, sores, rashes Pain in joints
Then give Paracetamol (Panado) and discuss with Professional Nurse
Managing Fevers
Regular administration of medication to:
bring temperature down
keep temperature down
reduce discomfort
encourage drinking and eating
Giving Paracetamol for Fever
Age or Weight Syrup (120mg/5ml)
Tablet (500mg)
2 months up to 1 Year
2.5 - 5 ml -
1 Year up to 5Years
5 – 10 ml -
6-12 Years 10 – 20 ml Half to 1 tablet
Every 4-6 Hours AND No more than 4 Times a Day!
Managing Fevers NEVER wrap up a child with
fever
Undressing the child allows heat to escape
Ensure cool, fresh air or fan the child
Apply cloths soaked in tepid water to the child
Do NOT let the child start shivering
©TALC ©TALC
Managing Fevers
Encourage the child to keep drinking to prevent dehydration
If breast fed, continue breastfeeding
For non-breast fed children, encourage drinks or small, frequent sips
©TALC
Has it helped?Using these interventions can help to reduce a fever
But, you need to be sure they have!
Keep checking the child (touch, looking, thermometer)
Continue regular fluids
Continue Paracetamol (Panado) until you are sure the fever is over
Febrile Convulsions Children adjust less quickly to high body temperatures
Temperature above 38.5 0C or a rapid change in temperature may lead to febrile convulsion
Most common in children 6 months to 5 years
Usually only last 1-2 minutes
Signs and Symptoms: Collapse Eyes rolling upward Foaming at mouth Stiffening of the body Uncontrolled jerking movements Breathing difficulty in severe cases
Handling Febrile Convulsions Keep calm
Reassure care giver
Ensure area around child is clear and safe
Never restrain the child or place anything in mouth
Loosen clothing around neck and body
Position child with head lower than body if possible
Child may lose consciousness but will usually ‘come round’ without help
If the convulsion lasts longer than 5 minutes, the child needs emergency help
After a Febrile Convulsion The child may sleep
Ensure child is on his side
Give Paracetamol (Panado) if the child is conscious/ able to swallow
Apply cool cloths to body
NEVER put child in a bath
Take child to a clinic for further investigation and treatment of cause
Note!
If a child has a seizure and is not between 6 months and 5 years,
this is likely to be caused by something other than fever
Education
Care Givers need to be taught
how to recognise and manage
temperatures in order to:
Alleviate the child’s discomfort
Prevent dangerously high
temperatures
Ensure infections are treated as early as possible
©TALC
Remember!!
Fever is a very useful sign of infection
Fevers must be managed properlyto prevent distress and complications
BUT, the child’s behaviour is the bestsign of how sick a child is :-
A child may have:
NO fever with infection e.g. pneumonia, meningitis (especially in malnutrition)
HIGH fever with a mild cold
©TALC