Fever

REPORT INTRODUCTION

Febrile / FEVER

A. Understanding Fever
A fever means the body temperature above the normal limit of normal, can be caused by abnormalities in the brain itself or by toxic substances that affect the central temperature regulation, bacterial diseases, brain tumor or dehydration. (Guyton, 1990).
Fever is a situation where an increase in temperature up to 380 C or more. There is also a restriction that take more than 37.80 C. Meanwhile, when the body temperature of more than 400C is called a high fever (hyperpyrexia). (Julia, 2000)


B. Etiology of Fever
Fever occurs when spending exceeds heat formation. Fever may be associated with infections, collagen diseases, malignancies, metabolic diseases and other illnesses. (Julia, 2000). According to Guyton (1990) fever can be caused by abnormalities in the brain itself or toxic substances that affect the central temperature regulation, bacterial diseases, brain tumor or dehydration.

C. Clinical Manifestations
Signs and symptoms of fever include:
1. Child's fussy (temperature higher than 37.8 C - 40 C)
2. Skin redness
3. Warm to the touch
4. Increased frequency of respiratory
5. Shiver
6. Dehydration
7. Loss of appetite

D. Pathophysiology of Fever
Fever occurs as the body's response to an increase in the set point, but there is an increase in body temperature due to the formation of excessive heat but is not accompanied by an increase in the set point. (Julia, 2000)
Fever is the body's defense mechanism (immune response) or zatasing children against infections that enter the body. If there is an infection or foreign substance into the body would stimulate the immune system to release pyrogen. Pyrogens are fever-causing substances, there are coming from inside the body (endogenous pyrogens) and outside the body (exogenous pyrogens) that can be derived from infection by microorganisms or an immunologic reaction to a foreign body (non-infectious).
The next pyrogens carry messages through the receiver (receptors) found on the body to be delivered to the center of the hypothalamic thermostat. In this pyrogen hypothalamus gets stimulated release of arachidonic acid and the resulting increase in the production of prostaglandins (PGEZ). This will raise the reaction temperature by means of peripheral blood vessels constrict and inhibit the secretion of the sweat glands. Hot expenditure decreased, there was an imbalance of formation and heat expenses.
This is the cause of fever in children. High temperatures will stimulate the activity of "soldiers" of the body (macrophages and T lymphocytes) to fight foreign substances by increasing proteolysis resulting in an amino acid that plays a role in the formation of antibodies or immune system. (Sinarty, 2003)
While the properties of chills or fever may be a crisis / flush.
Chills. When setting the thermostat to a sudden change from the normal level to a value that is higher than normal as a result of tissue damage, pyrogen substance or dehydration. Body temperature usually takes a few hours to reach the new temperature.
Crisis / flush. When the factors causing high temperatures to suddenly removed, the hypothalamic thermostat suddenly are at a low value, perhaps even return to normal levels. (Guyton, 1999)

E. Patways
Attached.

F. Management of Fever
1. In Physical
a. Keep an eye on the client's condition: Temperature measurement at regular intervals every 4-6 hours. Consider whether the child restless sleep, are often surprised, or delirium. Note also whether the child's eyes tend to glance up or if the child has a seizure. Fever accompanied by seizures that are too long can be harmful to the developing brain, because oxygen can not reach the brain. Cut off the supply of oxygen to the brain will result in the destruction of brain cells. In such circumstances, a lifelong disability can occur in the form of damage to certain intellectual functions.
b. Open excessive clothing and blankets
c. Taking into account the air flow in the room
d. Airway should be opened to prevent a loss of oxygen supply to the brain which will cause damage to cells - brain cells.
e. Give fluids by mouth, drink as much as possible
Drinks can be given water, milk (child diarrhea adjust), juice tea or water. Their purpose is to make the body fluid that evaporates due to the increase in body temperature obtained instead.
f. Enough sleep so that your metabolism decreases
g. Apply with plain water on the forehead, armpits, groin. The goal is to lower the body temperature of the surface of the child's body. The fall in body temperature on the surface of the body may occur due to body heat is used to evaporate water on the cloth compresses. Do not use ice water because it will make the blood vessels constrict and the heat can not get out. Using alcohol can cause irritation and intoxication (poisoning).
h. Currently, commonly used with warm compresses is lukewarm. Compress warm water or lukewarm then the outside temperature was warm and the body will interpret the outside temperature is hot enough. Thus, the body will lose control of the thermostat in the brain that control body temperature does not increase anymore. In addition, beyond a warm environment will make the blood vessels in the skin edges dilated or having vasodilatation, will also make the skin pores open so that will make it easier to heat emitting from the body.
2. Drugs Antipyretics
Centrally acting antipyretic lower the temperature in the temperature control center in the hypothalamus. Antipyretic useful to prevent the formation of prostaglandins by inhibiting the enzyme cyclooxygenase hypothalamic set point so that the degraded back to normal which ruled produce heat above normal heat and reduce spending no more.
Hint antipyretic administration:
a. Infants 6-12 months: ½ - 1 teaspoon of syrup paracetamol
b. Children 1-6 years: ¼ - ½ paracetamol 500 mg or 1-1 ½ teaspoon of syrup paracetamol
c. Children 6-12 years: 1 ½ tablets of paracetamol 5oo mg or 2 tablespoons of the syrup paracetamol.
Paracetamol tablets can be crushed and diluted with water or sweet tea. Febrifuge in given 3 times daily. Use a spoon to measure drug dose 5 ml each spoon.

G. Nursing Theory
Fever is very risky, the patient needs to be hospitalized, while nursing the patient to be considered is the risk of increased body temperature, fluid and electrolyte balance disorders, lack of parental knowledge about the disease.
a. The risk of increased body temperature
Often occurs when the body's metabolism increases, the need to be given anti pyretic to do a warm compress when the body temperature less than 37 C but when the heat more than 38oC are given extra pamol with given cold compresses.
b. Disorders of fluid and electrolyte balance
Common in children also experience anorexia as well as fever, fatigue, dizziness so that this situation led to a lack of nutrient inputs which then facilitates the onset of complications that need to be done with a liquid infusion of glucose and NaCl and the provision of supplementary food and soft foods that are easy to digest such as soft porridge.
c. Lack of parental knowledge about the disease
Be given counseling to families about how to cope if the child has seizures and fever that children avoid injuries and reduce panic parents. Besides, it also explain about the disease and its dangers.

H. Examination Support
Attached.

REFERENCES
1. Betz, Sowden. (2002). Pediatric Nursing Handbook, 2nd Edition. Jakarta, EGC.
2. Engel, Joyce. (1998). Pediatric Assessment. Ed. 2. Jakarta, EGC
3. Guyton, Arthur C. (1990). Human physiology danmekanisme disease. Ed. 3. Jakarta, EGC.
4. Guyton, Arthur C. (1997). Textbook of Medical Physiology. Ed. 9. Jakarta, EGC.
5. Ngastiyah. (1997). Sick Child Care, 2nd Edition. Jakarta, EGC.
6. Julia Klaartje Sometimes, SpA (2000). Right Methods to Overcome Fever. www. Google. Com
7. Sinarty hartanto. (2003). Fever Children Need Apply. www. Pediatrics. Com / knal.php
8. Sophia Theophilus. (2003). What to Look For When Child Fever.