Transcript Fever - Aidsmap

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
o
above 37.5 C (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 most
children
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
©TALC
 High fevers may lead to
febrile convulsion
(seizures or ‘fits’)
©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 Is he withdrawn and/or reluctant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 twotenths degree (.1,.2,.3,.4)
 Point where mercury ends indicates the
temperature
 Write it down straight away with time
taken
34
5
35
5
36 5
37 5
38
5
39 5
40
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:
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
Any general danger sign
OR
Stiff neck
OR
Bulging Fontanelle
(IMCI, 2002)
Suspected Meningitis
Home Based Carers
 Administer one dose of
paracetamol (Panado) for
fever 38oC or above
Professional Nurses
 Child needs dose of IM
Ceftriaxone
 Test blood sugar
 Refer urgently!
 Give one dose of
paracetamol (Panado) for
fever 38oC or above
(IMCI, 2002)
If No Suspected Meningitis
Assess the child - Look, Listen, Feel for the following:
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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
©TALC
 Apply cloths soaked in tepid
water to the child
 Do NOT let the child
start shivering
©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
©TALC
 Ensure infections are treated as
early as possible
Remember!!
Fever is a very useful sign of infection
Fevers must be managed properly
to prevent distress and complications
BUT, the child’s behaviour is the best
sign of how sick a child is :A child may have:
©TALC
NO fever with infection e.g. pneumonia, meningitis
(especially in malnutrition)
HIGH fever with a mild cold