Pages

Sunday, April 11, 2010

發燒處理原則:發冷期-保暖; 發熱期:散熱+補充水分; 退熱期: 補充水分與營養

發燒三階段處理原則:發冷期:保暖, 發熱期:散熱+補充水分, 退熱期: 補充水分與營養

當細菌或是病毒侵入人體時,免疫系統會加以對抗並引發發炎反應,這就是發燒的原因。適度的發燒可以增強抵抗力,但高達40度以上的高溫,也會帶來頭暈、酸痛等等的不適,因此會需要退燒。

發冷期:保暖為主。
體溫: 37℃至新設體溫之間
會有發抖、手腳冰冷的情況,應給予適當預防寒顫的措施如:增加被蓋(尤其是四肢的保暖)、或是用溫水袋、電毯等。
不可以用物理的方式像是躺冰枕、溫水擦澡、泡溫水澡等方式降溫。
當有不舒適情況,可以服用適當的藥物來減輕症狀。

發熱期:散熱+補充水分
體溫: 38℃以上即新設定的體溫
手腳發熱的階段,先依孩子舒適感受來調整衣著與被蓋,注意補充水分與增加營養、熱量的攝取,以防止脫水的可能。
‧ 適時給予退燒藥。
‧ 必要時才使用降溫措施(用溫水擦拭身體、躺冰枕、泡溫水澡等) 最好是在使用退燒藥後三十分鐘再進行較合宜。但如果孩子出現不舒服、煩躁不安等情形,則禁止使用。


退熱期:補充水分與營養
體溫: 體溫恢復
出現流汗與血管擴張等幫助散熱的現象,注意補充水分,增加營養及熱量的攝取,並且適當的保暖。
大量出汗可能造成脫水,使電解質不平衡,所以需適時的補充電解質水,並且注意心肺功能的變化。汗流浹背的孩子,需要勤擦汗與替換乾爽的衣物。


注意事項:
  • 在測量體溫時,有時會因為運動、長時間陽光照射、穿太多衣服等狀況,提高體溫,建議除去這些造成體溫上升的因素後,休息10-20分鐘後再測量體溫,會較為準確。
  • 發燒時食欲會降低。
  • 孩子的衣物應以棉質、寬鬆、吸汗、透氣的質料為宜。
  • 發燒時僅需密切監測孩子體溫變化,以及觀察舒適的程度就可以。如需使用降溫措施,最好在給予退燒藥三十分鐘後再嘗試,以避免干擾發燒型態。
  • 沒有依照階段幫孩子退燒,除了不能達到降溫的目的外,也會讓孩子更不舒服,同時會延長發燒的時間,造成抵抗力降低,變得更虛弱。
  • 孩子發燒時,在依階段經過適度的處理後,超過30分鐘依然沒有降溫,就需要儘快就醫,檢查是否為疾病引起的發燒。如有順利降溫,則不需要過度擔心,此現象應視為小孩暫時性的體溫調節不適,而不是發燒。
  • 室溫: 盡量維持在23℃至26℃之間,保持涼爽通暢。必要時可以將孩子安置在冷氣房中,或是用電扇繞轉著吹,但不要直接對著身體吹。這樣也可以幫助體溫散熱,也會使孩子感覺舒適些。如果發現孩子四肢冰涼又猛打寒顫,則表示需要溫熱,此時就要禁止使用冷氣或電扇,並趕緊加件毛毯覆蓋,直到孩子身體及手腳溫熱且全身出汗時,才可以再恢復使用冷氣或電扇來幫助散熱。
降溫措施
溫水拭浴:將孩子身上衣物解開,用約37℃左右的溫濕毛巾全身上下擦拭。使孩子皮膚的血管擴張將體熱散發出去,而且毛巾擦拭過後在身上留下的水氣,也會由身體表面蒸發,這樣也會吸收身體的熱氣,幫助熱氣快速散出。

冰枕: 冰枕是局部降溫的作用。就是將冰枕放在孩子頭枕部,把冰枕當枕頭用。冰枕是利用傳導原理,藉由較低的物體接觸體表後,將身體的熱氣傳到溫度較低的一方來降低溫度。

資料來源(References):

 1. 寶寶發燒怎麼辦?半數家長不知須分階段處理!書田診所小兒科 陳永綺主任


2.醫師媽媽的小兒發燒照護經, 陳永綺醫師著, 新手父母出版

Tuesday, February 23, 2010

Grade 1- Kids rewarding system -2

The 2nd semester started, we do some adjustments for John's star rewarding  system (SRS).  We start to deduct John's stars if John can't remain good disciples or don't want to take his responsibilities.
Disciplines:
1. When John drink yogurts, he usually drinks some then moves to doing other things.  In the end, he may forget to drink up yogurts and leave the cans on the table or any place convenient for him.
I set the first discipline for him. If he want to dink yogurts, he need drink up, wash up, and put it into cans recycle bin. If he didn't do it. I will take out 1 star from him.  The guideline already tell him for about a half year.  However, he can't follow it.
Maybe I should give him a star if he doing well on this discipline, I think.
Responsibilities:
In the past, John like to help hanging clothes and organize clothes.  We bought Wii FIT last weekend.  Thus, when I asked John if he want to help hanging clothes, he answered he want to play Wii. I know kids like to help doing households when they are not good at  them as they think they are fun.  However, when they know how to do it and there are other entertainment available, they may loose interest in helping doing households.
Therefore, I define help hanging clothes as one of his responsibilities.  If he help to hang cloth, he still can get 1 star.   However, if he don't want to help, he need to pay 5 stars as I need to do them all.  2010-2-23

Grade 1 - Kid's Rewarding System

In the 1st semester of grade 1, we develop star rewarding  system (SRS) for John.  It is aligned with rewarding system of school homeroom teacher.  The difference is that our rewarding system is also an allowance system.  A star is equal to one taiwan dollor.
John can use the money to buy some drinks or snacks whenever he want. 
In school, the homeroom teacher will give kids a circle whenever they behave weill in school.  When eack's circles reach 20, she will give them some stationaries such as pencils or pad as rewards.   However, if kids doesn't behave well, the teach will reduce their circles.
Our rewarding system focuses on encourging positive actions.  He will get rewards if he helps doing households, give good comments from school teachers or anyone, write  homework well, get good score in tests, or doing well on the things we want him to become habits.  The things we want him to become habits include turning on the lights when play piano or read books, put bowls into sinks when he finishes dinner.....
The SRS system work well in the 1st semeters.  John is eager to get stars from time to time.  We are also glad to offer stars whenever we see somehting good.  John remains his star level around 80 to 150 in the 1st semester.  He uses his stars 3 - 4 times and each time cost around 20 TWD.  2010-2-23