SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED TO:RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

IN PARTIAL FULFILLMENTOF

M.SC (N) IN CHILD HEALTH NURSING

SUBMITTED BY:MATHRU CHAYA. V1ST YEAR M.SC (N)

UNDER THE GUIDANCE OF:MRS. SHEELA BERNET

VICE PRINCIPAL & HODCHILD HEALTH NURSING

NARAYANA HRUDAYALAYA COLLEGE OF NURSINGNO: 258/A, BOMMASANDRA INDUSTRIAL AREA

ANEKAL TALUK, BANGALORE-99

1 NAME OF THE CANDIDATE AND ADDRESS

MATHRU CHAYA. VNARAYANA HRUDAYALAYACOLLEGE OF NURSINGNO: 258/A, BOMMASANDRAINDUSTRIAL AREAANEKAL TALUK, BANGALORE-99

2 NAME OF THE INSTITUTION NARAYANA HRUDAYALAYACOLLEGE OF NURSING,BANGALORE

3COURSE OF STUDY AND

SUBJECT1ST YR M.SC (N)CHILD HEALTH NURSING

4 DATE OF ADMISSION TO COURSE

04 / 06 / 2012

5 TITLE OF THE TOPIC “A STUDY ON THE EFFECTIVENESS OF TEPID SPONGING WITH ANTIPYRETIC DRUG VERSUS ONLY ANTIPYRETIC DRUG IN THE MANAGEMENT OF FEVER AMONG CHILDREN IN SELECTED HOSPITAL, BANGALORE”

STATEMENT OF THE PROBLEM :

A study on the effectiveness of tepid sponging with antipyretic drug versus only

antipyretic drug versus only antipyretic drug in the management of fever among

children in selected hospital, Bangalore

ANNEXURE-I

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Fever has always been a matter of great concern among the health care personnel’s

physician’s and at the top of all, the parents of pediatric patients . Though fever is

protective! Severe reactions to high fevers in the form of febrile seizures, possible brain

damage or even death have been found. Heat production associated with fever increases

oxygen consumption, CO2 production and cardiac output. 1

Thus, fever can aggrevate cardiac insufficiency in children with chronic lung disease

metabolic instability in children with DM and increased frequency of seizures in those

idiopathic epilepsy. Emotionally, it adds on to the anxiety of already stressed parents and

therefore early management of fever becomes an important issue.8

According to Tortora and Grabowski fever is a condition that occurs often in sick

patients. Fever can be beneficial, but the harmful effects of fever outweigh the benefits

thereof. The management of fever in critically ill patients will continue to present a

challenge to nurses.9 The use of critical thinking in nursing allows nurses to provide safe

and effective care. Rowsey (1997:206) stated how important it is that the nurse understands

the physiology of the fever cascade. There are many views on whether to cool a patient or

not, and what methods of cooling should be used. As a professional person, the critical care

nurse needs to provide clinically effective care, based on the best evidence available

concerning fever management.12

Fever is a common occurrence in any pediatric care setting. The word ‘fever’ is

derived from the Latin word “Fovere”, meaning, “to warm” and commonly means an

elevation in the body temperature. Fever isn't an illness in itself; it’s thought to be part of

your body's natural response to a viral or bacterial infection. The body’s temperature

regulating set point is increased to a higher than normal level, resulting in an increase in

overall body temperature beyond 98.6 degree F (37 degree C). A low grade fever is a slight

elevation of body temperature to 38 degree C, moderate fever is between 38.1 – 39 degree

C and above 39 degree C is defined to be high grade fever.1

Ancient doctrine states that, the fever was designed to drive the excess phlegm out of

the body. All infections can produce fever, which begins with the release of endogeneous

pyrogens into the circulation after an infection or immunologically mediated event.8

Fevers are usually caused by viral infections that go away on their own, such as the

common cold. Sometimes a fever can be caused by something more severe, such as an ear,

bladder or kidney infection1. On rare occasions a fever can be a sign of a serious illness

such as a severe bacterial infection of the blood (septicaemia), urinary tract, lung

(pneumonia) or brain (meningitis)22. Heat exhaustion, extreme sunburn, malignant tumor

may also cause fever. Occasionally, the child may develop a fever as a symptom of a

specific condition rather than as a result of an infection. For example, certain blood

disorders and autoimmune disorders may cause a fever. In this case, the fever lasts for

longer than one associated with an infection. Fever can also be a side effect of some

childhood immunisations such as diphtheria, tetanus and acellular pertusis or

pneumococcal vaccines.10

There are certain methods to reduce the increased body temperature which includes-

using a damp washcloth on child’s forehead, using lukewarm tub bath or a sponge bath, as

the water evaporates from the skin and cool the child and bring the temperature down,

Offering the child plenty of fluids and chilled foods, such as ice pops and yogurt, to help cool

the body from the inside out and keep her hydrated. Keeping the fan at a low setting and have

it circulate the air around the child rather than blow directly on the face. Removing layers of

clothing so your child can lose heat more easily through the skin. Dressing the child in one

light layer of cloth. Staying indoors in a cool place.16

The complications of fever include severe dehydration, hallucination and Febrile

seizures, sometimes if fever is neglected it may result in death of the child. Therefore

appropriate management should be applied to prevent complications16.

Based on the Global Statistics 2010 estimates, about 80.7 million fever cases and 10.6

million deaths due to fever, febrile seizures are estimated to have occurred in 2007; of these

68% of the cases and 42% of the deaths occurred in the economically developing world.

In India the fever estimation has reached to 68% in 2008 and in Karnataka there are 38% of

population suffering from fever. Over 700 deaths have been confirmed in Bangalore city in

2012 due to dengue fever.2

According to Nancy, Canol Lilly, Lemore, care of children with fever focuses on

reducing the elevated body temperature, thereby preventing the occurrence of fever

complications by various nursing measures which are- The room temperature should be

maintained as normal, Ventilation should be provided by opening the windows, Providing

calm and quiet environment to the child, Recording the vital signs once in 15 to 30

minutes, Applying cold compress or tepid sponging or ice caps, Using antipyretics as

prescribed by the physician, Providing oral care as mouth becomes dry due to elevated

temperature and use emollients or cold creams, Providing psychological support to the

child.8

Another article written by La Coosse WI, 2000, department of pediatrics, children

hospital of Lowa stated the principle management in bringing down the temperature

quickly from 103 degree F to 100 degree F by few the steps such as: Tepid sponging or Ice

sponging, Ice water enema in severe conditions, Removing the blanket to reduce the

temperature, Fluids to prevent dehydration, Adjustments of clothing, Administration of

antipyretics as per doctor’s order, Identifying the underlying causes and treating them4.

The accurate determination of body temperature is the key to the diagnosis and

treatment of febrile illness in children. Temperatures can be measured by using oral, rectal,

Axillary or tympanic method. Axillary temperature is commonly taken in newborns, infants

and children.3

So as John Ruskin had said century ago, “I hold it indisputable that the first duty of

a state is to see to it that every child is well housed, clothed, fed, educated and kept fit.”

This leads to the importance for every member of the state to have a proper awareness and

understanding about healthy child rearing practices. This includes care of children with

fever, as fever is an important manifestation of almost all childhood illnesses. So it is really

meaningful to know hoe caregivers think, worry and act whenever their children are sick

with fever21.

6.1: NEED FOR STUDY

“Fever is nature’s engine which she brings into the field to remove her enemy”

are the words of 17th century physician Sydenham, which health professionals need to heed.

It is a common symptom of childhood illness, and much time and effort is spent in the

pursuit of reducing high temperature.1 Although antipyretic drugs are the main form of

treatment, physical treatments play a vital role in reducing the temperature of febrile

children. Such treatments include tepid sponging, removing clothing & cooling the

environment. Of these treatments, tepid sponging has been effective.3

Tepid sponging with antipyretic drugs is extensively studied to reduce temperature

by conduction of heat from the skin into cooler water. This sponging action ensures that the

water film is constantly moving, replacing the water in contact with the skin with the fresh

layer of cooler water, thus maximizing heat conduction. Convection currents and

evaporation further enhance heat loss.11

An experimental study on Evaluating the sponging and antipyretic medication to

reduce body temperature in febrile children in was conducted in SSK Tepecik Teaching

Hospital, Turkey. Two hundred and twenty-four children aged 6 months to 5 years, with

axillary temperature were randomly treated with sponging and with medication. During the

first 30 min of intervention, sponging was found to be more effective than the medications.

After 60 min, the effects of each medication with sponging with tepid water became

superior in reducing body temperature. Comparing the effect , it was seen that the tepid

sponging with antipyretic efficacy were significantly more than paracetamol 3 h after

intervention (P < 0.05). For the management of fever over 39 degrees C, it is therefore

recommended to give children an antipyretic drug, and at the same time to begin sponging

to provide a rapid and sustained antipyresis.12

Another study on The effectiveness of tepid sponging, in addition to antipyretic

medication, in the reduction of temperature in febrile children living in a tropical

environment, was assessed in a prospective, randomized, open trial. Seventy-five children

aged between 6 and 53 months who attended the casualty department of the Children's

Hospital, Bangkok, Thailand, with fever (rectal temperature > or = 38.5 degrees C) of

presumed viral origin were randomized to received either tepid sponging and oral

paracetamol (sponged group) or paracetamol alone (control group). After the intervention

It was concluded that tepid sponging, in addition to antipyretic medication, is clearly more

effective than antipyretic medication alone in reducing temperature in febrile children

living in a tropical climate.13

A randomised controlled trial was done in bombay on Early Management of Fever

with Benefits of CombinationTherapy. 150 children of 6months to 14 year age children

were selected. The reduction of body temperature in the tepid sponging and antipyretic

drug group was significantly faster than only antipyretic group and only paracetamol group.

It was concluded that addition of tepid sponging to paracetamol was highly effective in

early reduction of temperature with minimal discomfort.7

Fever is the most frequently and easily occuring and may lead to cause of death if

not treated. The effectiveness of tepid sponging as a treatment alongside antipyretics varies

between studies, with some finding that is of no benefit and others suggesting that it is

helpful. Inspite of this fact there has always been a dearth of studies related to fever

management in India.2

Therefore, this study is conducted to know the effectiveness of tepid sponging with

antipyretic drug versus only antipyretic drug among febrile children & to study the level of

comfort associated with it. Considering all the above mentioned facts, I have selected this

study to compare the effectiveness of tepid sponging with antipyretic drug versus only

antipyretic drug in under five children.

6.2: REVIEW OF LITERATURE:

A thorough literature review focusing on prior research related to the topic of the

study provides a strong foundation. Hence a survey literature is one of the vital parts of

any research endeavour. It is considered as a systematic and critical review of the most

important published scholarly literature on a particular topic.

The review of literature is classified under three different headings for a better

understanding and broader view about fever in children.

The reviewed literature for the present study has been organized as follows:

1. Literature review on fever and its management.

2. Literature review on tepid sponging with antipyretic drug.

3. Literature review on effects of tepid sponging.

Literature review on the management of the fever

The word ‘fever’ is derived from the latin word “Fovere”, meaning, “to warm”

and commonly means an elevation in the body temperature. Fever isn't an illness in itself;

it’s thought to be part of your body's natural response to a viral or bacterial infection. The

body’s temperature regulating set point is increased to a higher than normal level, resulting

in an increase in overall body temperature beyond 98.6 degree F (37 degree C). A low

grade fever is a slight elevation of body temperature to 38 degree C, moderate fever is

between 38.1 – 39 degree C and above 39 degree C is defined to be high grade fever.1

Fever which is also called as pyrexia is a common symptom of illness and there is

evidence to indicate that elevated temperature helps the body to fight against the disease. In

children, this response is seen is quickly.8

Fevers are usually caused by viral infections that go away on their own, such as the

common cold. Sometimes a fever can be caused by something more severe, such as an ear,

bladder or kidney infection. On rare occasions a fever can be a sign of a serious illness such

as a severe bacterial infection of the blood (septicaemia), urinary tract, lung (pneumonia) or

brain (meningitis).22 Heat exhaustion, extreme sunburn, malignant tumor may also cause

fever. Occasionally, the child may develop a fever as a symptom of a specific condition

rather than as a result of an infection. For example, certain blood disorders and autoimmune

disorders may cause a fever. In this case, the fever lasts for longer than one associated with

an infection.Fever can also be a side effect of some childhood immunisations such as

diphtheria, tetanus and acellular pertusis or pneumococcal vaccines.10

There are certain methods to reduce the increased body temperature which includes-

using a damp washcloth on child’s forehead, using lukewarm tub bath or a sponge bath, as

the water evaporates from the skin and cool the child and bring the temperature down,

Offering the child plenty of fluids and chilled foods, such as ice pops and yogurt, to help cool

the body from the inside out and keep her hydrated. Keeping the fan at a low setting and have

it circulate the air around the child rather than blow directly on the face. Removing layers of

clothing so your child can lose heat more easily through the skin. Dressing the child in one

light layer of cloth. Staying indoors in a cool place.16

The complications of fever include severe dehydration, hallucination and Febrile

seizures, sometimes if fever is neglected it may result in death of the child. Therefore

appropriate management should be applied to prevent complications.16

According to Nancy, Canol Lilly, Lemore, care of children with fever focuses on

reducing the elevated body temperature, thereby preventing the occurrence of fever

complications by various nursing measures which are- The room temperature should be

maintained as normal, Ventilation should be provided by opening the windows, Providing

calm and quiet environment to the child, Recording the vital signs once in 15 to 30

minutes, Applying cold compress or tepid sponging or ice caps, Using antipyretics as

prescribed by the physician, Providing oral care as mouth becomes dry due to elevated

temperature and use emollients or cold creams, Providing psychological support to the

child.18

Another article written by La Coosse WI, 2000, department of pediatrics, children

hospital of Lowa stated the principle management in bringing down the temperature

quickly from 103 degree F to 100 degree F by few the steps such as: Tepid sponging or Ice

sponging, Ice water enema in severe conditions, Removing the blanket to reduce the

temperature, Fluids to prevent dehydration, Adjustments of clothing, Administration of

antipyretics as per doctor’s order, Identifying the underlying causes and treating them4.

The accurate determination of body temperature is the key to the diagnosis and

treatment of febrile illness in children. Temperatures can be measured by using oral, rectal,

Axillary or tympanic method. Axillary temperature is commonly taken in newborns, infants

and children.3

Literature review on tepid sponging with anti pyretic drug

Tepid sponge bath is considered as one of the best cooling treatments. This method is

recommended for febrile individuals, especially those with fever ranging from 101.2 F or

higher. It is effective in relieving fever by reducing high temperature and also helpful in

alleviating pain or discomfort.6

Tepid Sponge Bath Procedure according to ANSI (The American National Standards

Institute).

A tepid sponge bath can reduce fever and stress when performed correctly. Most

generally, this type of care is offered in a hospital setting to lower an elevated temperature

but can be completed easily at home. "Textbook of Basic Nursing" advises that the bath

must be administered for at least 30 minutes to be effective. Constant monitoring of the

patient's body temperature is essential, so that it does not drop below normal.

The preparation includes: Explaining to the patient what you will be doing. The bath

is ineffective if the patient is nervous or frightened. Record the temperature before

beginning the bath. Gather the needed supplies: bath basin, several washcloths, towels and

a bath sheet. Fill the bath basin with tepid water, 80 to 90 degrees Fahrenheit. You may

need to refill the basin several times throughout the bath, to prevent the water from

becoming too cool.

Soak four washcloths in the tepid water and wring out the excess. Place one washcloth

under each of the patient's arms and one on each side of his groin. The blood vessels are

close to the skin in these areas, and this will help to cool the patient more effectively. At

first, the patient will be chilled by this; allow several minutes for his body to adjust to the

temperature of the water.

Bathing goes on as follows: Sponge each of the patient's limbs for five minutes.

Keeping the lower half of the patient covered, begin sponging his arms and chest. Work

your way to the legs, keeping the patient covered with a towel in the areas you are not

bathing. Sponge the back and buttocks for ten minutes. This time is essential to lowering the

temperature effectively. Continue to monitor the patient's temperature at intervals

throughout the bath procedure. Replace the tepid water if chilled. If at any time the patient

becomes chilled and begins shivering, stop the bath. Discontinue the bath once the

temperature has reached a normal level. Cover the patient with the bath sheet.6

According to North Glasgow University Hospitals NHS Division Clinical Procedure

Manual 5

Febrile Response Management has certain objectives such as: Prepare the patient for the

procedure, Collect and prepare the equipment; Carry out tepid sponging.

Indications for tepid sponging include: Tepid sponging is the application of water to the

patient’s skin surface to promote dispersal of body heat when the body temperature is

39.5°C and over. The procedure is based on the principles of evaporation and conduction.

A patient may be pyrexial when there is: Invasion by pathogenic micro organisms;

Disease of the nervous system; Metabolic disorder; Malignant/neo-plastic disease.

The Equipment required are: Basin of tepid water (29°C – 32°C), Bed linen, Hospital towels,

Disposable face cloth, Gown, Trolley, Bed linen trolley, Receptacle for soiled disposables

Procedure is: Perform hand hygiene; Collect and prepare the equipment; Ensure patient

understands and consents to procedure; Ensure the patient’s privacy; Measure, record and

document patient’s temperature; Sponge the patient’s body using tepid water; Do not dry

patient – leave water to evaporate; Perform hand hygiene; Change bed linen and patient’s

gown; Administer 1 g of paracetamol, following Administration of Medicines procedure;

Measure and record patient’s temperature twenty minutes after the tepid sponge;

Document the procedure, monitor for after-effects and report abnormal findings

immediately. 5

A quasi-randomised controlled trials was done to determine whether the best

available evidence supports the types and timing of the various nursing interventions that

are commonly used to reduce fever in non-critically-ill children, and to what extent the

outcomes are influenced by these nursing actions. This involved non-critically-ill children

with a fever aged between 3 months and 16 years. The methodological quality of the study

was assessed by two independent reviewers using a piloted critical appraisal checklist. The

result was concluded that the combination of antipyretics and tepid sponging showed

effective in treatment of fever.19

A randomized control trial among children with fever was conducted in hongkong in

1997. 20 children aged 5 to 68 months were selected with fever of 38.9 degree C. children

were randomly assigned to acetaminophen plus a 15 minute tepid sponge bath. Results

showed that sponge bathed subjects cooled faster during the first hour and proved tepid

sponging with antipyretic to be effective in reducing the fever in the children14

A controlled clinical study compared the effectiveness of sponging with tepid water,

ice water, and equal parts of 70 per cent isopropyl alcohol and water in addition to orally

administered acetaminophen to reduce fever in children. Sample size was 12o children.

More rapid reduction of fever was demonstrated when sponging was combined with the

oral antipyretic drug. however, sponging with tepid water afforded significantly better

comfort during the sponging procedure.12

A randomized clinical trial was undertaken at Instituto Materno-Infantil,Pernambuco

Italy, to compare the effects of Tepid sponging plus dipyrone versus dipyrone alone for

reducing body temperature in febrile children. Children from six months to five years old

with axillary temperature greater than 38 degree C in the emergency ward between January

and July 2006 were studied. One hundred and twenty children were randomly assigned to

receive oral dipyrone (20 mg/kg) or oral dipyrone and tepid sponging for 15 minutes. The

primary outcome was mean temperature reduction after 15, 30, 60, 90 and 120 minutes.

Secondary outcomes were crying and irritability. Results were 106 children finished the

study. After the first 15 minutes, the fall in axillary temperature was significantly greater in

the sponged group than in the control group (p < 0.001). From 30 to 120 minutes, better

fever control was observed in the control group. Therefore the study concluded as Tepid

sponging plus dipyrone cooled faster during the first 15 minutes, and dipyrone alone

presented better fever control over the two-hour period.18

STATEMENT OF THE PROBLEM:

A study on the effectiveness of tepid sponging with antipyretic drug versus only

antipyretic drug in the management of fever among children in selected hospital, Bangalore

6.3: OBJECTIVES OF THE STUDY

1. To determine the axillary body temperature among febrile children prior to the

intervention.

2. To assess the effectiveness of tepid sponging with antipyretic drug among febrile

children.

3. To assess the effectiveness of only antipyretic drug among febrile children.

4. To compare the effectiveness of tepid sponging with antipyretic drug versus only

antipyretic drug among febrile children.

6.4: ASSUMPTIONS

Fever will be reduced faster when different methods are administered to reduce

temperature in febrile children like tepid sponging, removing clothes, keeping the

environment cold etc.

6.5: HYPOTHESES

1. H1: the mean post interventional temperature will be significantly lower than the

pre interventional temperature

2. H2: the mean post interventional temperature of children receiving tepid sponging

with antipyretic drug will be significantly lower than the children receiving only

antipyretic drug.

6.6: OPERATIONAL DEFINITIONS

• Effectiveness: in this study, it refers to the change in body temperature after

providing tepid sponging with antipyretic drug versus only antipyretic drug.

• Tepid sponging: it refers to providing sponging with tap water to the children for

15mins to reduce increased body temperature.

• Antipyretic drug: it refers to reducing the body temperature by taking drugs like

Tab.paracetamol or Tab.dolo that gets absorbed in GI system and through

circulation acts on the body.

• Fever: in this study it is defined as increase in body temperature of children more

than 101 degree fahrenheit.

• Children: in this study, it refers to children under the age group of 6months to

5yrs .

6.7: DELIMITATION :

• The study is limited to children within the age group of 6months to 5yrs

• Period of data collection is only 6 weeks

• The study is limited to selected hospital in Bangalore.

ANNEXURE II

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Data will be collected from 6 months to 5yrs aged children having fever above 101

degree fahrenheit in a selected hospital.

7.2 RESEARCH METHODOLOGY

7.2.1 RESEARCH APPROACH: A quantitative research approach

7.2.2 RESEARCH DESIGN: A quasi experimental design

7.2.3 SAMPLE: 60 children under the age group of 6 months to 5yrs in selected hospital ,

Bangalore

7.2.4 SAMPLING TECHNIQUE: Random sampling technique.

7.2.5 SAMPLING CRITERIA:

INCLUSION CRITERIA:

1. Parents who are giving consent for children to participate in the study.

2. Axillary Temperature of above 101 degree fahrenheit

3. Parents who can speak english, kannada, hindi, and tamil.

EXCLUSION CRITERIA:

1. Children of above 5yrs of age

2. If any contra indications in providing tepid sponging (physician refuses)

7.2.6 VARIABLES:

• Independent variable: effectiveness of tepid sponging with antipyretic drug versus

only antipyretic drug.

• Dependent variable: fever

7.2.7 SETTING:

The present study is conducted in a pediatric ward in selected hospital, Bangalore

7.2.8 DATA COLLECTION TECHNIQUE

DESCRIPTION OF TOOL:

• Section A: Baseline data – Age, gender, temperature.

• Section B: thermometer, tool consisting of temperature, pulse and respiration

starting with zero hour after 30mins, 45mins, 60mins, 90mins

INTERVENTION PROTOCOL: Tepid sponge bath is considered as one of the best cooling treatments. This method is recommended for

febrile individuals, especially those with fever ranging from 102.2 F or higher. It is effective in relieving fever

by reducing high temperature and also helpful in alleviating pain or discomfort.6

Articles required :

Basin - 1 

Pitcher filled with cold water - 1

Small towels - 2

Bath towel - 1

Rubber sheet - 1

Thermometer ( place it in a thermometer tray) - 1

Gloves 1 pair

 

Step 1 Check the temperature of the child and if it is >101 degree F, Provide antipyretic

prescribed by the physician.

Step 2 Explain the procedure to the parents of the child.

Step 3 Set all equipments on the area near the bed.

Step 4 Wash hands thoroughly before starting the procedure.

Step 5 Close the door or the partition sheets to provide privacy.

Step 6 Adjust the patient's bed on a certain height that is accessible for working.

Step 7 Place the bed protector or rubber sheet on patient's bed to protect bed linens.

Step 8 Wear the gloves. This prevents transmission of infection.

Step 9 Carefully remove child's clothing and place the bath blanket on top of the child to ensure privacy.

Step 10 Fill in the basin with tap water. Appropriate temperature is 20 to 25 degrees C.

Step 11 Immerse or dip small towels in the water. Squeeze it to avoid dripping, and gently apply on the

forehead, the axilla or armpits and the groin area. Do this for about 15 minutes and repeat if necessary. Heat

transfer is much more effective when compresses are applied on areas with large superficial blood vessels

such as the axillary and groin areas.

Step 12 Carefully wipe the child's extremities for about five minutes. Then proceed with back area

and buttocks for another five minutes. Abdomen is included.

Step 13 Replace the patients' clothing and cover with a light sheet. Avoid wearing heavy clothing

Step 14 After care is done by doing the following : change bed linens and remove the equipments away

from the bed to prevent transmission of microorganisms, Remove gloves, and wash your hands thoroughly.

Step 15 Document the procedure done, along with the patient’s vital signs, response to treatment, and

complications if any

- Check the temperature after sponging from 15mins, 30 mins, 45 mins, 60 mins, 90 mins.

- Terminate the tepid sponging once the temperature returns to normal level that is 98.6 degree

fahrenheit.

- Administer antipyretic to group B as prescribed.

- Check the temperature of group B.

- Compare the temperature reading of group A and group B.

DATA COLLECTION PROCEDURE

• Formal consent will be taken from the hospital administrators and parents

• Select children who are having fever above 101 degree fahrenheit

• Divide the group into two by randomized sampling technique

• Group A will receive tepid sponging for 15 mins with antipyretic drug as prescribed

by the physician

• Group B will receive only antipyretic drug as prescribed by the physician.

• check the body temperature of the children of both the groups starting from the zero

hrs, 3omins, 45mins, 6omins, 9omins.

• Temperature reading of group A and group B are compared to know the

effectiveness of interventions.

•

7.2.9 DATA ANALYSIS TECHNIQUE

Data obtained will be analyzed in terms of objectives. Data analysis will be as follows:

• Descriptive statistics: Frequency, percentage

• Inferential: independent and paired‘t’ test, Anova.

7.3 Does the study required any investigation or intervention to be conducted on

patients or other humans or animals? If so describe briefly.

Yes, the study requires investigation among children suffering from fever with

temperature of about 101 degree fahrenheit in the form of assessing their temperature with a

thermometer by using a tool consisting of temperature, pulse and respiration. The study

requires intervention like tepid sponging and antipyretic drug to reduce the temperature

among children suffering from fever in selected hospital.

7.4 Has the ethical clearance been obtained from your institution?

Yes, ethical clearance has been obtained from the institution

8. REFERENCE

1. Edward Purssell, Physical treatment of fever, Arch Dis Child 2000; published by

group.bmj.com 82:238–239

2. Population Statistics. Health For Millions, India,December 2002

3. Patricia A. Potter, Anne Griffin Perry. Fundamentals of Nursing, 6th edition, India, Mosby

Company, 2005.

4. La Coose WI, Fever management, Department of Pediatrics, Chidren’s Hospital of Lowa,

2000

5. American Association Of Critical Care Nurses. Role of the critical care nurse. [On line].

2000,February 23 Available at: http://aacn.org/AACN/pubpolcy.nsf.

6. ANSI (The American National Standards Institute). tepid sponging procedure. 2002, march

17, Available at: http://eHow.com.

7. Anjali Jayjit Edbor, Amit Kishan Arora, Priyashree Shyamal Mukherjee, Early

Management of Fever: Benefits of Combination Therapy, Bombay Hospital Journal, Vol. 53,

No. 4, 2011

8. Watts R, Robertson J, Thomas G. Nursing management of fever in children a systematic

review. International Journal of Nursing Practice 2003; 9: 1-8.

9. Gildea JH.When fever becomes an enemy. Pediatric Nursing 1992; 18: 165-167.

10. Newman J. Evaluation of sponging to reduce temperature in febrile children. Canadian

Medical Association Journal 1985; 132: 641-642.

11. Sharber J. The efficacy of tepid sponge bathing to reduce fever in young children.

American Journal Emergency Medicine 1997; 15: 188-192.

12. Barton LL, Friedman AD. Efficacy of sponging vs. acetaminophen for reduction of fever.

Pediatriac Emergency Care 1990; 6: 255-257

13. Mahar AF, Allen SJ, Milligan P, Suthumnirund S, Chotpitayasunondh T, Sabchareon A,

et al. Tepid sponging to reduce temperature in febrile children in a tropical climate. Clinical

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9 Signature of the candidate :

1

0

Remarks of the guide : The study is feasible

1

1

11.1 Name and Designation of the Guide: Mrs. Sheela bernet

HOD of child health nursing.

Signature :

11.2 Co-Guide(if any)

Signature :

11.3 Head of Department: Mrs.Sheela Bernet,

HOD of Child Health Nursing,

Signature :

1

2

12.1 Remarks of the Chairman and Principal

Signature: