Manejo não farmacológico da enfermagem em pacientes pediátricos com febre e hipertermia: uma revisão sistemática / Non-pharmacological nursing management of pediatric patients with fever and hyperthermia: a systematic review / Manejo de enfermería no farmacológico del paciente pediátrico con fiebre e hipertermia: una revisión sistemática

Objetivo: descrever o manejo não farmacológico do enfermeiro frente ao paciente pediátrico com febre ou hipertermia. Método: a revisão seguiu o PRISMA, contou com estudos empíricos, que abordassem o manejo não farmacológico em crianças com febre, estudos entre 2013 e 2023. As bases de dados foram Adolec, BVS, Embase, LILACS, Web of Science e a biblioteca SciELO, com os descritores "criança", "hipertermia", "febre", "enfermagem" e "enfermagem pediátrica". Resultados: selecionado 7 estudos, descrevem que o manejo não farmacológico são massoterapia, compressas, água morna e sabonete com Marshmallow. O uso de antitérmico (paracetamol) e outra medida não farmacológico foi evidenciada como efetiva. Há lacuna de protocolos para guiar os profissionais para o atendimento da criança com febre, além dos profissionais se basearem em suas crenças na assistência. Conclusão: o uso não farmacológico foi eficaz em conjunto com antitérmico. Há necessidade de outros estudos e desenvolvimento de protocolos para guiar os profissionais na assistência.

Objective: to describe the nurse's non-pharmacological management of pediatric patients with fever or hyperthermia. Method: the review followed PRISMA and included empirical studies that addressed non-pharmacological management in children with fever, studies between 2013 and 2023. The databases were Adolec, BVS, Embase, LILACS, Web of Science and the SciELO library, with the descriptors "child", "hyperthermia", "fever", "nursing" and "pediatric nursing". Results: 7 studies were selected, describing non-pharmacological management as massage therapy, compresses, warm water, and soap with Marshmallow. The use of antipyretics (paracetamol) and other non-pharmacological measures were shown to be effective. There is a lack of protocols to guide professionals in caring for children with fever, in addition to professionals relying on their beliefs in care. Conclusion:non-pharmacological use was effective in conjunction with antipyretics. There is a need for further studies and development of protocols to guide professionals in helping.

Objetivos:describir el manejo no farmacológico de la enfermera del paciente pediátrico con fiebre o hipertermia. Método: la revisión siguió PRISMA, incluyó estudios empíricos que abordaron el manejo no farmacológico en niños con fiebre, estudios entre 2013 y 2023. Las bases de datos fueron Adolec, BVS, Embase, LILACS, Web of Science y la biblioteca SciELO, con los descriptores "niño", "hipertermia", "fiebre", "enfermería" y "enfermería pediátrica". Resultados: se seleccionaron 7 estudios que describen manejo no farmacológico como terapia con masajes, compresas, agua tibia y jabón con Marshmallow. Se demostró eficaz el uso de antipiréticos (paracetamol) y otras medidas no farmacológicas. Faltan protocolos que orienten a los profesionales en el cuidado de niños con fiebre, además de que los profesionales se basen en sus creencias sobre el cuidado. Conclusión: el uso no farmacológico fue efectivo en conjunto con antipiréticos. Es necesario realizar más estudios y desarrollar protocolos que orienten a los profesionales en la prestación de asistencia.

Precisión de las características definitorias del diagnóstico de enfermería termorregulación ineficaz en recién nacidos / Accuracy of the defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns

OBJETIVO: Identificar las medidas de precisión de las características definitorias del diagnóstico de enfermería termorregulación ineficaz en los recién nacidos. MÉTODO: Estudio de precisión diagnóstica de diseño transversal realizado en unidades de maternidad de medio y alto riesgo, localizada en la ciudad de Fortaleza-CE. Se evaluaron 216 recién nacidos para la identificación de las características definitorias del diagnóstico en estudio. Las medidas de precisión de las características definitorias se obtuvieron a partir de un modelo de 2 clases latentes con efectos aleatorios para el cálculo de los valores de sensibilidad y especificidad. RESULTADOS: Las características de frecuencia respiratoria aumentada y piel caliente al tacto presentaron valores de sensibilidad más altos (99,9%) y de especificidades menores (79 y 75%) y las características fluctuaciones de la temperatura corporal por encima y por debajo de los parámetros normales e hipertensión fueron las de mayor especificidad (80,4%) y sensibilidad (100%), respectivamente. CONCLUSIÓN: La característica fluctuación de la temperatura corporal por encima y por debajo de los parámetros normales puede ser más adecuadas para confirmar la presencia del diagnóstico, por haber presentado un mayor valor de especificidad

OBJECTIVE: To identify the measures of accuracy for defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns. METHOD: Diagnostic accuracy study with cross-sectional design performed in medium and high-risk maternity units, located in Fortaleza city/Brazil. A total of 216 newborns were evaluated to identify the defining characteristics of the diagnosis under study. The measures of accuracy for defining characteristics were obtained from a latent class model with random effects for the calculation of sensitivity and specificity values. RESULTS: The characteristics of increased respiratory rate and warm skin to the touch had higher sensitivity values (99.9%) and lower specificity (79 and 75%) and the characteristics of body temperature fluctuations above and below the normal parameters and hypertension had the highest specificity (80.4 and 100%, respectively). CONCLUSION: The characteristic fluctuation of the body temperature above and below the normal parameters may be better to confirm the diagnosis, having presented a higher specificity value

Evaluation of Evidence-Based Guidelines for Fever Management in Critically Ill Adult Patients With Brain Injury.

PURPOSE: The aim of this study was to evaluate the effectiveness of evidence-based guidelines for fever management of critically ill adult patients with brain injury. METHODS: We used a pretest-posttest design with 48 patients 19 years or older admitted to an intensive care unit after surgery for brain injury. We applied evidence-based guidelines only to an experimental group of 24 patients and compared with 24 control patients who did not receive evidence-based guidelines. Experimental and control groups were matched 1:1 using the Acute Physiology and Chronic Health Evaluation II score. Data included the proportion of patients with reduced fever and time to normalized temperature. RESULTS: The proportion of patients whose temperature fell to normal after fever was 4.5 times higher in the experimental group than in the control group. The time it took the patients' highest fever to fall to normal during their intensive care unit stay was 4.84 times faster in the experimental group than in the control group (hazard ratio, 4.84; 95% confidence interval, 1.79-13.11; P = .002). CONCLUSION: Evidence-based guidelines for fever management in patients with a brain injury can be used in nursing practice with rapid response, improving healthcare efficiency and contributing to better outcomes for critically ill patients.

Behavior of Parents Seeking Care From Emergency Services Due to Fever in Children.

PURPOSE: To explore the behavior of parents, with and without health training, seeking care from emergency services due to their child's fever. DESIGN AND SETTING: A qualitative study based on Grounded Theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children 0 to 12 years old who received care for fever in the emergency primary care services of two Spanish municipalities. METHODS: Data saturation was achieved after eight focus groups segmented by gender, place of residence, and education (57 participants). Data analysis followed the constant comparative method and coding process. FINDINGS: The parents attended the emergency department when fever was high or persistent and to determine the cause. The reasons for avoiding the emergency department differed; whereas the health professional parents avoided consulting other colleagues as they felt questioned, for parents who were not healthcare professionals, there was a fear of acquiring an infection. CONCLUSIONS: Parents' search for healthcare differs according to their background and education. CLINICAL RELEVANCE: These results provide key information for the design of care plans to improve health care and patient satisfaction.

Nursing problems in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome in a Dutch burn centre: A 30-year retrospective study.

OBJECTIVE: Multiple studies have been published on toxic epidermal necrolysis (TEN) and Stevens-Johnsen syndrome (SJS). Nursing care is an important part of the treatment of TEN patients. Unfortunately, limited information on nursing in TEN/SJS patients has been published in the current literature. Nursing research is needed to improve the complex nursing care required for these rare patients. Therefore, the objective was to assess nursing problems in TEN patients in a burn centre setting over a 30-year period. METHODS: The data for this study were gathered retrospectively from nursing records of all patients with TEN/SJS admitted to Burn Centre Rotterdam between January 1987 and December 2016. Dutch burn centres were recently accepted as expertise centres for TEN patients. Nursing problems were classified using the classification of nursing problems of the Dutch Nursing Society. RESULTS: A total of 69 patients were admitted with SJS/TEN. Fifty-nine patient files were available. The most frequently reported nursing problems (>20% of the patients) were wounds, threatened or disrupted vital functions, dehydration or fluid imbalance, pain, secretion problems and fever. Furthermore, TEN-specific nursing problems were documented, including oral mucosal lesions and ocular problems. The highest number of concomitant nursing problems occurred during the period between days three and 20 after onset of the disease and varied by nursing problem. CONCLUSIONS: The most frequently reported nursing problems involved physical functions, especially on days three to 20 after onset of the disease. With this knowledge, we can start nursing interventions early in the treatment, address problems at the first sign and inform patients and their families or relatives of these issues early in the disease process. A next step to improve nursing care for TEN patients is to acquire knowledge on the optimal interventions for nursing problems.

Web-Based Tools for Educating Caregivers About Childhood Fever: A Randomized Controlled Trial.

OBJECTIVES: Fever is a common reason for an emergency department visit and misconceptions abound. We assessed the effectiveness of an interactive Web-based module (WBM), read-only Web site (ROW), and written and verbal information (standard of care [SOC]) to educate caregivers about fever in their children. METHODS: Caregivers in the emergency department were randomized to a WBM, ROW, or SOC. Primary outcome was the gain score on a novel questionnaire testing knowledge surrounding measurement and management of fever. Secondary outcome was caregiver satisfaction with the interventions. RESULTS: There were 77, 79, and 77 participants in the WBM, ROW, and SOC groups, respectively. With a maximum of 33 points, Web-based interventions were associated with a significant mean (SD) pretest to immediate posttest gain score of 3.5 (4.2) for WBM (P < 0.001) and 3.5 (4.1) for ROW (P < 0.001) in contrast to a nonsignificant gain score of 0.1 (2.7) for SOC. Mean (SD) caregiver satisfaction scores (out of 32) for the WBM, ROW, and SOC groups were 22.6 (3.2), 20.7 (4.3), and 17 (6.2), respectively. All groups were significantly different from one another in the following rank: WBM > ROW > SOC (P < 0.001). CONCLUSIONS: Web-based interventions are associated with significant improvements in caregiver knowledge about fever and high caregiver satisfaction. These interventions should be used to educate caregivers pending the demonstration of improved patient-centered outcomes.

Testing effectiveness of the revised Cape Town modified early warning and SBAR systems: a pilot pragmatic parallel group randomised controlled trial.

BACKGROUND: Nurses' recognition of clinical deterioration is crucial for patient survival. Evidence for the effectiveness of modified early warning scores (MEWS) is derived from large observation studies in developed countries. METHODS: We tested the effectiveness of the paper-based Cape Town (CT) MEWS vital signs observation chart and situation-background-assessment-recommendation (SBAR) communication guide. Outcomes were: proportion of appropriate responses to deterioration, differences in recording of clinical parameters and serious adverse events (SAEs) in intervention and control trial arms. Public teaching hospitals for adult patients in Cape Town were randomised to implementation of the CT MEWS/SBAR guide or usual care (observation chart without track-and-trigger information) for 31 days on general medical and surgical wards. Nurses in intervention wards received training, as they had no prior knowledge of early warning systems. Identification and reporting of patient deterioration in intervention and control wards were compared. In the intervention arm, 24 day-shift and 23 night-shift nurses received training. Clinical records were reviewed retrospectively at trial end. Only records of patients who had given signed consent were reviewed. RESULTS: We recruited two of six CT general hospitals. We consented 363 patients and analysed 292 (80.4%) patient records (n = 150, 51.4% intervention, n = 142, 48.6% control arm). Assistance was summoned for fewer patients with abnormal vital signs in the intervention arm (2/45, 4.4% versus (vs) 11/81, 13.6%, OR 0.29 (0.06-1.39)), particularly low systolic blood pressure. There was a significant difference in recording between trial arms for parameters listed on the MEWS chart but omitted from the standard observations chart: oxygen saturation, level of consciousness, pallor/cyanosis, pain, sweating, wound oozing, pedal pulses, glucose concentration, haemoglobin concentration, and "looks unwell". SBAR was used twice. There was no statistically significant difference in SAEs (5/150, 3.3% vs 3/143, 2.1% P = 0.72, OR 1.61 (0.38-6.86)). CONCLUSIONS: The revised CT MEWS observations chart improved recording of certain parameters, but did not improve nurses' ability to identify early signs of clinical deterioration and to summon assistance. Recruitment of only two hospitals and exclusion of patients too ill to consent limits generalisation of results. Further work is needed on educational preparation for the CT MEWS/SBAR and its impact on nurses' reporting behaviour. TRIAL REGISTRATION: Pan African Clinical Trials Registry, PACTR201406000838118. Registered on 2 June 2014, www.pactr.org.

A guide to providing wide-ranging care to newborns.

Here's how to refine your care, which includes an assessment of neonatal feedings, the evaluation of jaundice and fever, and the prevention of SIDS.

Nursing Protocol for Stroke Increases Survival, Reduces Disability.

Fever, hyperglycemia, and swallowing problems were treated in the first 72 hours following stroke.

Improving Pediatric Temperature Measurement in the ED.

OVERVIEW: ED care providers have long debated which of the various methods of temperature measurement of pediatric patients is best. While the efficacy and accuracy of temporal artery, tympanic membrane, axillary, and infrared temperature measurement have been studied, the gold standard has been rectal temperature measurement. But despite its accuracy, this method causes children with noninfectious complaints and their families unnecessary distress and adds significant time to the triage process. In response, a group of ED staff nurses at a multihospital health system conducted an evidence-based quality improvement project to determine the best practice for accurate temperature measurement in children younger than five years who presented to the ED. The project included an exhaustive literature search, a review of relevant studies, the development of a table of evidence, a presentation of the findings, and recommendations for practice change. This article describes the project and the adoption of temporal artery thermometry, a painless, noninvasive screening method that provided consistently accurate temperature measurement as well as increased patient and nurse satisfaction and a shorter triage process.

Recognition and management of febrile convulsion in children.

Febrile convulsion is characterised by convulsion associated with fever in an infant or child aged between six months and six years. The febrile illness causing the convulsion should not be secondary to an intracranial infection (meningitis or encephalitis) or acute electrolyte imbalance. Most cases of febrile convulsion are short lived and self-terminating. However, a few cases of prolonged febrile convulsion may need anticonvulsant medication to stop the seizure. Management is mainly symptomatic, although anticonvulsants may have a role in a small number of children with complex or recurrent febrile convulsion. Referral to paediatric neurologists may be necessary in cases of complex or recurrent febrile convulsion, or in those where a pre-existing neurological disorder exists. One third of children will develop a further febrile convulsion during subsequent febrile illness. Nurses have a vital role in managing children with febrile convulsion, educating parents about the condition and dispelling myths. This article outlines the presentation, management, investigations and prognosis for febrile convulsion, indicating how nurses working in different clinical areas can help to manage this common childhood condition.

Triage nurse's assessment of a child with a fever.

Fever in children is a common presentation to the emergency department and in most instances has no adverse consequences. The role of the triage nurse is to have thorough knowledge of up to date practices in caring for the child with fever, and to accurately assess and manage the child. Using evidence based practice to apply appropriate triage categories, effective care including accurate and informed education of parents. Every nurse working on triage should maintain current knowledge and have continuous education concerning the child with fever and the unwell child to promote best patient outcomes and maintain best practice standards.