1. Emergency Nursing Care of the Child and Family with Elevated temperature

2. Elevated temperature
Elevated temperature: is one of the most common symptoms of illness in children.
To facilitate an understanding of fever, the following terms are defined:
Set point -the temperature around which body temperature is regulated by a thermostat-like mechanisms in the hypothalamus.

3. Elevated temperature
Fever - an elevated in set point such that body temp is regulated at a higher level ; may be defined as temp higher than 38c as infections.
Hyperthermia - a situation in which body temp exceeds set point, which usually results from the body or external conditions creating more heat than the body can eliminate, such as in heatstroke, aspirin toxicity, seizures or hyperthyroidism.

4. Measures to reduce elevated temp.
I. Fever: the principle reason for treatment fever is the relief of discomfort.
Relief measures include pharmacologic or environmental intervention.
Antipyretic drugs include:
1. Acetaminophen (Tylenol): is the preferred drug,
Doses should be administered four to five times daily but should not exceed five doses in 24hrs..

5. Measures to reduce elevated temp.
It is important to recognize its full toxic potential in both acute overdose and excessive therapeutic administration.
Several cases of hepatotoxicity in children who received overdoses of the drug as part of therapeutic administration have been reported.

6. Antipyretic drugs 2. Aspirin should not be given to children.
3. NSAIDs, ibuprofen is approved for fever reduction in children as young as 6 months of age.
Dosage is based on the initial temperature level: 5mg/kg of body weight for temp less than 39.1c or 10 mg/kg for temp greater than 39.1c.
The recommended dosage for pain is 10 mg/kg every 6-8 hours..
The temperature is usually retaken 30 minutes after the antipyretic is given to assess its effect

7. Measures to reduce elevated temp.
Environment measures to reduce fever may be used if tolerated by the child and if they do not induce shivering
Treatment of shivering is by warming the body, especially on extremities.
Traditional cooling measures are effective if employed approximately 1 hour after an antipyretic is given as:
Wearing minimum clothing.
Exposed the skin to the air.
Reducing room temperature.
Increasing air circulation.
Applying cool, moist compresses to the skin.

8. Measures to reduce elevated temp.
Hyperthermia:
Antipyretics are of NO value, because the set point is already normal.
Cooling measures are used which help to reduce core temperature
Commercial cooling devices as cooling blankets or mattresses are available .
Traditional; cool compresses have been used, tepid tub baths is usually start with warm water and gradually add cool water.
After the tub or sponge bath, the child is dried and dressed in lightweight pajamas and placed in a dry bed.
The temp retaken 30 min after the tub bath.

9. Measures to reduce elevated temp
Whether a temp elevation in the critically ill child is caused by fever or hyperthermia, it should be treated more aggressively.
The metabolic rate increases 10% for every 1c increase in temp and 3 to 4 times during shivering, increasing oxygen, fluid, and caloric requirements.
In all children with elevated temp ,attention to adequate hydration is essential. Most children's needs can be met through addition oral fluids.

10. Febrile seizures

11. Febrile seizures
Seizures are caused by malfunction of the brain's electrical system that result from cortical neuronal discharge.
The manifestations of seizures are determined by the site of origin and may include:
Unconsciousness or altered consciousness,
Involuntary movements,
Change in perception, behaviors, sensations, and posture.

12. Febrile seizures
Seizures are the most commonly observed neurologic dysfunction in children and can occur with a wide variety of conditions involving the CNS
Seizures associated with a fever occur in 3% - 4% of all children, usually those 6 months to 3 years of age with increased frequency in children younger than 18 months.
Boys are affected about twice as often as girls, and there appears to be an increased susceptibility in families.
Most febrile seizures are generalized and last less than 5 minutes.
The cause is still uncertain.

13. Febrile seizures
In most cases the severity but not the rapidity of the temperature elevation seems to be a factor.
The fever usually exceeds 38.8 c and occurs during the temperature rise rather than after a prolonged elevation.
Febrile seizures usually accompany an upper respiratory or gastrointestinal infection.

14. Therapeutic management
If the seizures continues, treatment consists of controlling the seizure with diazepam( valium) and reducing the temp by acetaminophen.
For children who have febrile seizures administration of antipyretic does not prevent recurrences.
In children with simple febrile seizures, prophylactic antiepileptic therapy is Not recommended.

15. Nursing considerations
Nursing intervention should focus on ways in which care and comfort can be provided during a febrile illness.
The most important intervention are parental education and emotional support.
Parents need education regarding protecting the child from harm and observing exactly what happens to the child during the event.
If a febrile seizure lasts more than 5 minutes, parents should seek medical attention immediately, should call for emergency assistance and not try to take a child in a car if he or she actively seizing.
Little risk of neurologic deficit, epilepsy, mental retardation , or altered behavior has been observed as sequelae of febrile seizures