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Running head: Fever caused by lack of immunization 2

Chosen Pathophysiology Priority

Everyday there are caregivers visiting clinics and emergency rooms due to signs
and symptoms of fever in their infant. The infant with fever is a common presenting
problem in most emergency departments (EDs)(Slater M, 2015). The signs and
symptoms of fever in an infant are the infant is fussy, lethargic, vomiting, and stiff neck;
as well as a fever lasting for more than 48 hours. The case scenario presents a nanny who
is caring for an 11- month-old infant who has a fever of 38.0c and has a lack of
immunization records present. The nanny does not know what to do and does not know if
this is an emergency, she seeks information from the health care professional at the walk
in clinic. In this paper I will discuss the presence of a fever, as well, describe the nannys
role in the care of the infant, and how the fever can be managed.
Clinical Manifestation/ Complication
The clinical manifestations that can arise from an infant that lacks immunizations
are risk for infection, dehydration and the presence of a fever. Although all of the clinical
manifestations listed are influential, the most prevalent manifestation is presence of a
fever. Parents and caregivers are quick to worry when they detect a fever and often end
up at the emergency room looking a cause and a way to lower their fever. In the case
study, the anxious nanny brings the infant to a walk in to seek information on how to
handle the fever. Fever in infants can be detected by identifying specific signs and
symptoms. Common signs and symptoms of a fever in an infant are feeling hot to touch,
becoming fussy, excessive thirst, and appearing flushed or pale. If a fever goes
undetected or does not subside symptoms can potentially escalate. These symptoms are
identifiable when the infant seeming confused and delirious, has problems breathing,

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develops small purple spots, seizure, and difficulty waking up child (Sick Kids, 2014). A
method to detect a high temperature in infants is the use of a rectal thermometer. A fever
in infants can be defined as a rectal temperature of 38.0c (100.4f) or higher (Itzhak b,
2003). The rectal temperature is most accurate detection providing the most accurate
severity of the fever.
Nursing Interventions
One cause of a fever could be if the infant has acquired an infection. In the case
scenario the nanny feels that she cannot contact the parents unless the fever is an
emergency, though it is important, as there is important nutrients only a mother can
provide through breastfeeding. In infant development breast milk is important for the
infant as, breastfeeding transfers antibodies and other infection- fighting agents from
mother to child and enhances functioning of immune system (Laura E.B, 2010).
Nutrients are important in an infant who is ill as, Human milk protects against infections
in the breastfed offspring mainly via the secretory IgA antibodies (Hanson IGA, 2003).
The nanny should contact the parents to alert them of their infants high temperature so
the mother can implement breast-feeding into the feeding schedule as soon as she arrives.
Although these are all signs of a fever, it is important to know that a fever is a symptom,
not a disease (Sick Kids, 2014). Although you cannot give medication to decrease the
fever completely, there are many ways to ensure the infant be as comfortable as possible.
Interventions that the nanny can introduce to ensure the comfort of the infant are:
removing any excessing layers the infant has, obtaining infants Tylenol, dressing the
infant in cotton pajamas to promote ventilation (thus reducing sweating), placing the
baby in a lukewarm bath to bring down fever, and finally using a lukewarm damp towel

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to place on infants head to promote cool down of fever. Another reason as to why the
nanny should alert the parents is to understand which immunizations the infant has
received. All infants should receive their scheduled immunizations as, Vaccinating your
children is the best way to keep them safe from many serious and potentially deadly
diseases (Government of Canada, 2015). Vaccinating your infant allows the body to
recognize foreign pathogens and therefore have a higher immunity.
To respond to the case scenario appropriately, one would need to ensure that
health teaching is implemented during the walk in appointment. The anxious nanny is not
aware of how to care for an infant with a fever, and therefore could be putting the infant
at risk. Initially a subjective and objective assessment would be conducted including the
nanny to obtain as much information as possible. Once a baseline is obtained, the infant
can be treated with the appropriate measures depending on the severity of the symptoms
present. Communicating to the nanny what is going on while assessing the infant gives
the nanny reassurance therefore lowering her anxiety. Once the infant is stable, the health
care provider can educate the nanny on what a fever are, the signs and symptoms, and
what to implement with the infant to ensure comfort from the effects of the fever. The
health care provider should also demonstrate how to monitor the childs temperature,
what to use and how the to check the temperature, and what to do if the fever persists. All
these steps will ensure that the nanny is more confident in her skills, which reduces her
anxiety, and also ensures the infant will receive proper care if fever persists. Contacting
the parents to inform them of their infants high temperature should be encouraged as they
can provide further information about the infants heath history.

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