20

Journal of Nursing Karya Bhakti Volume 4,

Number 2, July 2018 Page 20-29

APPLICATION Tepid WATER SPONGE ( WTS) TO OVERCOME

An abdominal typhoidal FEVER IN. Z
Puji Astuti 1, Wahyu Tri Astuti 2 Lis Nurhayati 3

Department of Child Nursing, Nursing Academy Karya Bhakti Nusantara

Magelang, (0293) 3149517, 085292885982
E-mail: puji22659@gmail.com

ABSTRACT

Background : Abdominal typhoidal is an infectious disease that is transmitted through contaminated food and drink
germs Salmonella typhoid, abdominal typhoidal disease usually attacks the gastrointestinal tract with symptoms of
fever over a week. WTS is a combination block technique with a wipe. This technique is used to compress the
block is not just in one place, but directly in some place that has large blood vessels. Purpose : An application
describes the WTS on. Z fever in the abdominal typhoidal. Method : This research uses the case study method, the
participants are the first children who suffer from abdominal typhoidal. Results: Measures will be undertaken for
2x20 minutes, cooperative child, but the temperature has not dropped then do compress the temperature dropped
to 37'6 o C.

Conclusion: WTS compress effectively reduce fever in patients with abdominal typhoidal of 39 o C becomes 37'6 o C. There
was a decrease of 1'4 o C.

Keywords: hyperthermia, compresses, abdominal typhoidal, WTS

ABSTRACT

background: Abdominal Typoid is an infectious disease that is transmitted through food and drink Contaminated
withgerms Salmonella typhoid, typoid abdominal disease usually attacks the digestive tract, with symptoms of fever for
more than a week. WTS is a combination of block and wipe techniques. This technique uses compressed blocks not only
in one place, but directly in several places that have large blood vessels. Objective: describe the application of WTS to An.
Z who has a fever in typoid abdominal. Methods: this study used a case study method, of participants were one child who
suffered from abdominal typoid. results: Measures taken for 2x20 minutes, the child was cooperative, but the temperature
had not dropped the compress was then re-done the temperature dropped to 37'6 C. Conclusion: WTS compress
o

Effectively reduced fever in abdominal typoid Patients from 39 C to 37'6 C. A Decrease of 1'4 C.
o o o

Keywords: hyperthermia, compress, abdominal typoid, WTS

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preliminary shows that pravelensi typhoidal

Fever is a situation where abdominalis in Central Java at 1.61%

body temperature is higher than usual, and who are scattered throughout the district with

a symptom of a disease pravelensi different in every place.

(Maryuani, 2010). Hipertermi / fever is The data obtained from the Department of Health

a condition where the body temperature exceeds Magelang in 2017 the number of

fixed point ( set point), more than 37 o C typhoidal patients with abdominal number 50

usually caused by the condition of the body or patients.

External create more Common symptoms that often occur in

heat than can be issued by the typhoidal abdominalisyaitu, fever with temperature

body (Wong, 2008). body up and down, especially in the afternoon

abdominal typhoidal is a and at night, headache, especially in

disease transmitted infections front, muscle aches, fatigue, appetite

food and drink contaminated meal decreased, and the symptoms of the channel

germ salmonella typhoid. disease typhoidal digestion usually occurs nausea and vomiting,

Abdominal usually affects channel constipation, diarrhea, bloody bowel movements

digestion with symptoms of fever over (Munadhiroh, 2014).

week, digestive disorders, and can Some techniques reduce fever

also accompanied by disturbances of consciousness. among others, warm compresses and Water

Patients experiencing abdominal typhoidal Tepid Sponge ( WTS). based on research

the temperature rise in the first week, Memed (2014) concerning the effectiveness of decline

decreases in the morning and rise again body temperature between warm compresses and

in the afternoon and evening (Sodikin, 2011). WTSpada children aged 6 months-3 years with

The current surveillance data memperkiraan fever in Puskesmas Kartasura Sukoharjo

in Indonesia there are 600.000-1,3juta case typhoidal concluded that more effectively compress

Abdominal each year by more than WTS in lowering the body temperature of children

20,000 deaths. On average in Indonesia, fever, compared to the method

persons aged 3-19 years providing warm compresses. Warm compresses experience

figure of 91% of the cases typhoidal drop in temperatures ranging from 0.1 o C - 0.3 o C and

abdominal (WHO, 2012). In the research report for WTS drop in temperatures ranging

national basic health 2007 0.3 o C - 0.6 o C.

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WTS is a combination block technique there is a decrease in the average value of the body temperature

with a swab. This technique uses at 1'4 0 C after being given the WTS.

compress the block is not just in one place, Based on the preliminary study

but directly in some places held on June 7, 2018 in room

have large blood vessels. other than that FlamboyanRS Tk. II.04.05.01 dr. Soedjono

there is additional treatment with Magelang, management of fever in children

giving wipe in some areas of the body with therapy pharmacology and non-

so that the treatment applied to the pharmacology. Therapy pharmacological

client on this technique will be more complex administration of antipyretic or fever

and complicated compared with other techniques whereas non-pharmacological therapy with

but to compress the block directly do a warm compress. An. Z

This will facilitate the various places treated since the date of June 6, 2018 with

delivery of a signal to the hypothalamus to medical diagnosis that abdominal typhoidal

more aggressively. Besides giving will wipe have a fever, fever perceived continue

accelerate the dilation of blood vessels sustained and increased in the afternoon and evening

Peripheral facilitate heat transfer from day and the fever down in the morning. Purpose

body kelingkungan around so that from scientific journals is to know

accelerate the decrease in body temperature (Reiga, the effect of WTS compress against

2010). decrease in body temperature in pediatric patients

Research Setiawati (2008) Average with abdominal typhoidal in room

a decrease in body temperature in children hyperthermia Flamboyan RS Tk. II.04.05.01 dr.

who get antipyretic therapy plus Soedjono Magelang.

WTS at 0'53 0 C within 30 minutes,

Method
while receiving therapy alone WTS
Data collected through
an average reduction of body temperature
structured and unstructured interviews
0'97 0 C within 60 minutes. Maling, et al
the subject or his family, observation,
(2012) reported an average body temperature
measurements and tests carried out
before being given the WTS at 38'5 0 C
on the subject, the study documentation.
with a standard deviation 0'4 0 C, the average value
1. Contracting with the patient and
after being given the WTS at 37'1 0 C
family. An. Z and families willing
standard deviation 0'5 0 C so unknown
used as respondents in
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research. An. Z and the family agree SOP compress WTS according to the Government

for action compresses WTS Central Java Provincial Health Office.

to reduce fever. SOP is attached

2. Conducting studies on An. Z and 5. The last act is doing

family. An assessment on. Z and evaluation and documentation action

family obtained from: nursing given to An. Z.

a. medical records

Based on the medical records of An. Z result

An obtained data about identity. Z, In this chapter outlines the exposure

main complaint, medical history case was obtained according to the research focus

now and first, history conducted at room Flamboyan RS

development child, result Tk.II.04.05.01 dr. Soedjono Magelang, in

laboratories and doctors therapy. dated June 7, 2018. The results of this study

b. Physical examination obtained using methods

A physical examination is done alloanamnesa or analyzes with a view

in An. Z suffering typhoidal based on data in the medical records of clients,

Abdominal with fever, observation, and physical examination and

ie perform temperature measurements The assessment was conducted by

body An. Z uses autoanamnesa or assessments that

mercury thermometer. by interview live

3. Having obtained the assessment data to clients. The principle of this writing

then analyzed the data and with regard to theory process

enforcement of nursing diagnoses. nursing consist from Step

4. planning nursing assessment, The nursing diagnoses

Given care plan priorities, planning, implementation,

in An. Z with hyperthermia diagnosis and evaluation of nursing actions for

related to the disease process that 'priorities.

do the authors is to give 1. assessment focus

WTS compress, rationale for a. Biography

reduce fever in An. Z. Biodata patient named An. Z-old

instrument used writer is 3 years 10 days, was born on the 26th

 24

May 2018, female gender, An. Z recommended for the patient in

preschool, Muslim, room for process

residence at Connect, Jetis, healing. An. Z entrance hall

Magelang. An undertaking. Z Flamboyant with medical diagnosis

is Mr. A who is the father typhoidal abdominal.

of An. Z residence in Connect, 2) Past medical history

Jetis, Magelang, age 30, An family of data obtained. Z

Muslim, military occupation. said An. Z yet

b. Main complaint been hospitalized, if

An family. Z says pain is usually taken to the doctor

An. Z fever since 5 days before practice or midwife.

hospitalized. d. Assessment of functional patterns

c. Medical history 1) Anthropometric nutritional patterns BB: 10kg

1) Current health history Height: 70cm, LILA: 18cm, LD: 50cm,

An family. Z says An. Z LK: 46cm, black hair, diet porridge

fever since 5 days prior to admission given 3kali a day, exhausted

hospital, perceived fever continues half portion.

increasing numbers time 2) CHAPTER elimination pattern 1kali day

late in the afternoon and evening, soft yellow color consistency,

has been taken to a doctor but BAK 4-6 times a day yellow

there has been no change, then clear.

dated June 6 at 16:00 pm e. Physical examination

admission to the hospital emergency department Tk. The results of physical examination found

II.04.05.01 dr. Soedjono Magelang, Data awareness compos mentis,

An. Z got Ringer infusion therapy weak general condition, temperature: 39 o C

Lactate (RL) 12 drops per minute pulse: 80 beats per minute, respiratory rate:

macro, Sanmol infusion of 150 mg and 29 times per minute, dry lips mucosa,

Cefotaxime injection 2x500mg and dirty tongue, redness,

done examination skin feels warm.

widal testing laboratory. After

examination by a physician,
 25

f. Results of investigations nursing During 2x20 minutes

Examination support that An expected heat. Z down with

held on June 6, 2018 outcomes: body temperature within limits

An widal test results obtained. Z is normal, stable body temperature 36'5 o 37'2 C- o C,

: Typhi O: Typhi H 1/180 and 1/320. pulse within normal limits.

g. medical therapy 4. Nursing actions

IV medication given to An. Z Nursing actions performed

namely infusion of Ringer Lactate (RL) 12 drops to address the related hyperthermia

per minute macro, Sanmol infusion of 150mg with infection Samonella Thyposa, on

3x1 2x500mg Cefotaxime injection, and dated June 7, 2018 at 09:00 GMT

Oral medications: Nyndia drops 3x1cc. to compress WTS. responses

2. Analysis of the data and nursing diagnoses An. Z cooperative, so that the compress WTS

The assessment results on June 7 can be done well, responses

2018 08:30 GMT data obtained the patient's body temperature dropped from 39 o C became

subjective: the family says An. Z 38'5 o C.

fever since 5 days before entering the house Implementation of the application of repeated WTS

fever continued and increased back at 12:15 pm do

late in the afternoon and evening. Data back packs nursing actions

objective: warm clammy skin, the skin looks WTS, cooperative patient response and temperature

redness, body temperature 39 o C, membranes body temperature decreased from 38 o C became

dry mucosa, tongue dirty, can be taken 37'6 o C.

problem nursing hipertermi 5. evaluation of nursing

associated with the process infection An action on the results of the evaluation. Z

Samonella Thyposa. with nursing problems hipertermi

3. Care plan (intervention) associated with the process infection

Nursing action plan Samonella Thyposa, conducted in

will be done to overcome hipertermi dated June 7, 2018 9:20 pm hour in

associated with the process infection get the data S: mother An. Z says

Salmonella Thyposa that is with An. Z still feverish, O: skin looks

compress WTS. Purpose redness, skin feels warm, body temperature

actions after action 38'5 o C, A: the problem of hyperthermia yet

 26

resolved, P: WTS compress intervention back pain or if any member

next. Another family that is misbehaving

Results of the evaluation on June 7 hyperthermia.

2018 at 12:35 pm in the data get S: Reasons for granting compress WTS

An mother. Z told fever decreases in An. Z is for An. Z experience

little, O: An. Z looked relaxed, typhoidal abdominal fever. Efendi

cooperative, 37'6 body temperature o C, A: the problem (2012) describe the administration wipe

hyperthermia has not been resolved, P: continue with warm water will accelerate

intervention with administration drug dilation of peripheral blood vessels

antipyretics. will facilitate heat transfer from

body to environment around and

Discussion accelerating drop in body temperature, temperature

1. Mechanical compress WTS the body will decrease gradually

WTS is a technique to compress up with the state of the body temperature

warm which combines technique back to normal, thus giving

compress the block in the blood vessels profit to patient for

superficial to wipe techniques. Compress adapt with temperature environment

WTS is almost identical to the around so that the patient's body temperature remains stable.

compress water warm ordinary, that is This is evidenced by measurement

compress in five points (neck, 2 body temperature prior to compress

armpits, groin 2) plus wiping WTS and after compress

abdomen and chest or throughout the body WTS can descend 1'1 o C.

with a cloth. Dampen the cloth when dry again 2. Results Award compress action WTS

(Alves, 2008). In An. Z after

Action compress WTS this WTS compress action for 2x 20

demonstrated to An. Z and minutes showed reduced fever

family, the family asked to look and of 39 o C becomes 37'6 o C. The temperature of 37'6 o C

help calm the patients to avoid could not reach the normal temperature for

cry, expected action compresses yet reached 37'2 o C, but treatment WTS

WTS can be done by families and This is already lowering the temperature as much as

apply it in if the patient's home 1.4 o C.

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This is supported by research Some factor that could

It's done in accordance with the affect the results of the implementation of the action

some research that already WTS compress on An. Z

dilakukanoleh Memed (2014) concerning experience hipertermi because typhoidal

the effectiveness of the drop in body temperature between Abdominal among others:

warm compresses and WTS in children aged 6 a. Supporting factors

3rd month years with fever Factors supporting the application

Public health center Kartasura Sukoharjo An action compresses the WTS. Z

concluded that more effectively compress An inter alia. Z therapy

WTS in lowering the body temperature of children other than the independent action of nurses

fever, compared with the method ie given antipyretics ie

compress warm. Compress warm paracetamol thus speeding

decreasing temperatures ranging from An healing process. Z, besides

0.1 o C-0.3 o C and for WTS decline An family. Z also cooperative in

temperatures ranging between 0.3 o C -0.6 o C. all nursing actions

Opinion Another, according to research given including being able to repeat

Setiawati (2008), the average drop in temperature WTS properly compress procedure.

a child's body hyperthermia that b. Obstacle factor

antipyretic therapy plus Factor resistor on

WTS at 0'53 0 C within 30 WTS application compresses action on

minute, while receiving therapy An. An Z, among others. Z when done

WTS just average drop in temperature WTS compress namely An. Z less

body of 0'97 0 C within 60 drink, environment is less

minute. Maling, et al (2012) stated comfortable.

the average body temperature before administration

WTS at 38'5 0 C with a standard knot

0'4 deviation 0 C, value average after 1. An circumstances. Z before

WTS given by 37'1 0 C WTS compresses are fever, skin

standard deviation 0'5 0 C so unknown redness and palpable warmth, body temperature

there is a decrease in the average value of the body temperature 39 o C.

at 1'4 0 C after being given the WTS.

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