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MANAGEMENT OF
FEVER
Penny McDougall, Senior sister, Paediatric Unit,Queen Alexandra
Hospital, Portsmouth.
Maureen Harrison, Senior lecturer, Faculty ofHealth Sciences,
Uniersity of Southampton.
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!"#$%&'($S !F &H$ S&UD)
Understand the feer process in children.
Descri*e the sympathetic andparasympathetic nerous systems+
response
to feer in children. 'dentify serious illness in children ith
feer.
!utline di-erent ays of managing childrenith feer in hospital
and at home.
Discuss the importance of proiding adiceto parents and carers of
children ith feer.
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!/MA0 "!D) &$MP$/A&U/$ AD
S0$$P
&he suprachiasmatic nucleus locatedin the anterior
hypothalamus of the*rain, is the main control for
circadian rhythms 12eaer 34456. 'tis found close to the optic
chiasmand is 7non to respond to light and
dar7. %ore *ody temperature is controlled
*y the thermoregulatory centre in
the pre8optic anterior hypothalamus.
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/$0A&'! "$&2$$ circadian *odytemperature and circadian
sleep8a7e cycle
'ncrease inperipheral *odytemp
(asodialation
2arms the s7in
'nduce sleepiness
Decrease inperipheral *ody temp
(asoconstriction
%ore *ody temp rise
/$M increase
Alert and aa7e
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FEVER
'%$ 19:3;6 de
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PATHOPHYSIOLOGY
Attac7
%ome in contact ith theimmune cells
/elease of cyto7ines1'08
3*eta, '08B, &F8alpha,'F8alpha6
Stimulates production of
%/P and serum amyloidprotein from lier
&rigger neuroendocrineresponse
prostaglandin $91PC$96 from the*rea7don
of arachidonic acidandcyclooxygenase89.
PC$9actiates thethermoregulatory
centre *y increasingthe normal circadiantemperature
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Sympathetic nerous system
/elease adrenalin and noradrenaline
'ncrease in pulse and respiratory rate andperipheral
asoconstriction
%onseres heat
Decreases the actiity of digestie tract
%urls up, shiers, sleepy, pale mottled s7in,reluctant to eat and
drin7
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%linical assessment of feer
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A!/$'A, P!!/ F$$D'C AD
H)D/A&'!
/esponse of sympathetic nerous system
'nhi*ited gastric emptying
'mpaired intestinal a*sorption
Anorexia , omiting
0imits the aaila*ility of Fe, En, Mn topathogens
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Sleep and rest
'nammatory response
%oncentration of cyto7ines increase1'083 *eta, &F alpha6
Modulate /$M and promote non /$M
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MAAC$M$& !F F$($/ ' %H'0D/$
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Safety adice for parents and carers
&o detect the child is unell
!-er the child regular uids
$ncourage the child to drin7 more Do not undress or oerrap the
child
Use antipyretics appropriately
0oo7 for signs of non *lanching rash %hec7 the child during
night
Geep the child aay from school
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PA/$&S SH!U0D S$$GAD('%$ 'F
&he child has a
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Main recommendation for use ofantipyretics in children
%hildren ith feer ho appeardistressed
2hen using paracetamol ori*uprofen in children ith feer
o %ontinue only as long as the child isdistressed
o %onsider changing to other agents ifnot releied
o Do not gie the drugs simultaneously
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THANK YOU
