CHAPTER I

PRELIMINARY

1.1 Background

In the stage of growth and development, toddlers often experience pain. Various

diseases attack, especially diseases caused by infections that are almost always

accompanied by fever. Fever is one of the causes that often make parents bring

their children to seek treatment. Fever is not a disease but rather a symptom of a

disease as a body reaction to fight off infections or diseases that can be caused by

viruses or bacteria. When the body is fighting disease or infections that enter, the

body will release a certain amount of heat to the skin of the body resulting in an

increase in body temperature (Suririnah, 2010).

According to Walsh in the Australian Journal of Pharmacy (2008), fever is

defined as an increase in body temperature above normal. Normal body

temperature is influenced by many factors including environment, age, gender,

physical activity, and air temperature. The temperature of the human body is

governed by the thermostat system in the brain to keep the body temperature

constant between 36.50C-37.50C. Normal body temperatures of toddlers also

vary within a day, during the move or at night the body temperature will be

higher and usually will be lower in the morning. Toddlers expressed fever when

body temperature taken through the armpit above 37.50C (Suririnah, 2010).

Meanwhile, according to Avner (2009) in Acute Fever Pediatric in Review, fever

is also a clinical sign of a disease that occurs in infants. If the increase in body

temperature that occurs in infants is not immediately addressed properly then it

can cause serious effects in infants that can cause dehydration and seizures.

Fever is a manifestation that is commonly found in infectious diseases such as

DHF, Malaria, Measles, Diarrhea and other diseases. One of the major symptoms

of fever is typhoid fever. Typhoid fever or typhoid fever is a systemic syndrome

mainly caused by Salmonella typhi. Typhoid fever is the most common type of

Salmonellosis. Other types of enteric fever are paratyphoid fever caused by

Salmonella paratyphi A, Salmonella schottmuelleri (originally Salmonella

paratyphi B), and Salmonella hirschfeldii (originally Salmonella paratyphi C)

(Keliobas, 2015).

Typhoid fever (typhus abdominalis, enteric fever) is a systemic infection caused

by Salmonella enteric bacteria, especially variants derivatives, namely

Salmonella typhi, Paratyphi A, Paratyphi B, and Paratyphi C. These germs attack

the digestive tract, especially in the intestine. Typhoid fever itself is an acute

infectious disease that is always found in society (endemic) Indonesia. Patients

also vary, ranging from toddlers, children and adults (Ardiansyah, 2012).

Typhoid fever is one of the diseases of the gastrointestinal tract and is

characterized by a fever or rise in body temperature, the disease is mostly

attacking toddlers and children. Typhoid fever is currently the highest case in the

world (Keliobas, 2015).

According to Keliobas (2015), WHO (World Health Organization) estimates at

least 12.5 million cases occur annually worldwide. The incidence of typhoid

fever in the United States is reported per year <0.2 cases / 100,000 populations,

similar to those in Western Europe. Since the beginning of the 20th century, the

incidence of typhoid fever has decreased in the USA and Europe. This is due to

the availability of clean water and good disposal systems, and this is not yet

shared by most developing countries. High incidence of typhoid fever occurs in

Central Asia, South Asia, Southeast Asia, and possibly South Africa (Incidence>

100 cases per 100,000 population per year). The incidence of typhoid fever is

relatively moderate (10-100 cases per 100,000 population per year) located in

Africa, Latin America and Oceania (except Australia and New Zealand) and

which is low (<10 cases per 100,000 pupolations per year) in the world (Widodo,

2014).

In Indonesia, the incidence of typhoid fever is common in populations aged 3-19

years. The incidence of typhoid fever according to the Directorate General of

Public Health Development of the Ministry of Health of the Republic of

Indonesia in 2010, reported typhoid fever ranks 3 of 10 most diseases in

Indonesia. The incidence of typhoid fever in Indonesia is 1000 / 100,000

population per year. Among the typhoid recovered clinical fever, in 20% of them

are still found Salmonella typhi bacteria after 2 months and 10% still found in the

3rd month and 3% still found after one year (Widodo, 2014). Indonesia currently
for the case of typhoid fever amounted to 55,098 people, with death rate 2.06%

of the number of patients (Keliobas, 2015).

Based on data from the Health Office of Batam City noted that the fever is

included in the 10 largest diseases of patient visits at the health center throughout

Batam City in 2015 ranks 5th with the number of 10,822 patients. In 2016 ranks

7th with the number of 56,990 patients.While in 2017 ranks 8th with the number

of 6,233 patients. And based on data from the Health Office Batam Typhoid

Fever disease in 2017 amounted to 1605 patients. Based on the data, the highest

incidence of Typhoid Fever in SeiLangkai Health Center, Sagulung was found.

Based on the preliminary survey at the PuskesmasSeiLangkai, Sagulung, Batam

City obtained data on the incidence of typhoid fever in 2018 in January to April

amounted to 377 patients of various ages. In children 1-5 years of age amounted

to 168 patients.

According to Thomas in the journal Comparative Effectiveness of Tepid Water

Sponging and Antypiretic Drug Versus Only Antipyretic Drug In The

Management of Fever Among Children (2009), treatment of fever in infants is

often not based on research and inconsistent in practice. Several methods have

been recommended for fever in infants which include nonpharmacology therapy

and pharmacological therapy. Nonpharmacology therapy that includes the

provision of tepid water sponging, using a fan, compress alcohol while

pharmacological therapy is by the administration of antipyretic drugs.

Meanwhile, according to Alves (2008) in Sao Paulo Medical Journal of Tepid

Sponging Plus Dipyrone Versus Children, 2008) nonfarmakologi recommended

therapy to reduce fever that is by using tepid water sponging, using thin clothes,

bathing, compress cold water, warm water compress, using a fan, cooling the

room and using antipyretic drugs. The tepid water sponging compress is a warm

compress technique that combines the technique of block compresses in the

supervisorial blood vessels with wiping technique on the whole body.

Meanwhile, according to Zahroh (2017) in JurnalNersLentera understanding

Tepid water sponging or tepid sponge bath is a compress method that aims to

lower body temperature by using warm water by wiping the whole body using

washlap or sponge.

Based on the results of research Keliobas (2015) suggests that tepid water

sponging is more effective than warm compresses against decreased body

temperature in children with typhoid fever. This is evidenced by the results of

research indicating that the average body temperature before given tepid water

sponging is 38.6110C and the average body temperature after the given tepid

water sponging to 36.8890C. From the results of this study obtained the average

value of body temperature difference before and after given tepid water sponging

is 1.7220C. While the average body temperature before given a warm compress

is 38.5000C and the average body temperature after a warm compress to

37.3790C. And from the results of this study also got the average value of body

temperature difference before and after given warm compress is 1.1210C.

The result of Aguspairi (2011) research in Journal of Batanghari University of

Jambi said that giving of tepid water sponging is more effective than cold

compress. This is also evidenced by the results of research showing that the

average value of body temperature before the cold compress is given 38.20C and

the average body temperature after being given cold compress to 37.60C. The

average body temperature difference before and after the cold compress is given

0.60C. While the average value of body temperature before given tepid water

sponging is 38.70C and the average body temperature value after given tepid

water sponging is 37.40C. From the results of this study found the data decrease

in body temperature before and after given tepid water sponging is 1.30C. Based

on the results of research that has been stated above can be concluded that

compress tepid water sponge given to fever experienced toddlers proven

effective to lower body temperature than using the method of warm water

compress and cold water compress.

Based on the presurvey in May 2018 at SeiLangkai Health Center by conducting

interviews to parents of children under five who suffer from typhoid fever and

fever obtained data that from 11 people interviewed said that so far if the child

has a fever the patient's parents only give fever-lowering drugs and 7 parents of

11 interviewed parents said using cold water compress or warm water

compresses as a technique to reduce fever and combined with fever-lowering

drugs. Based on interviews with nurses at PuskesmasSeiLangkai during this time

only provide warm water compress technique in patients with fever, while tepid
 water sponging compresses have not been done. Therefore the researcher tries to

make the water sponging tepid better known by the society in everyday life and

can be done at SeiLangkai Health Center as an effective method in reducing

fever. Based on the above description of the background, the authors raised the

title of research on the effect of giving tepid water sponging to body temperature

in toddlers with typhoid fever in SeiLangkai Health Center Batam 2018.

1.2 Problem Formulation

Based on the results of the background description of the problem above, then

the formulation of the problem in this study "Is there any effect of tepid water

sponging on body temperature on toddlers with typhoid fever in SeiLangkai

Health Center Batam 2018?".

1.3 Research Objectives

1.3.1 General Purpose To know the effect of giving tepid water sponging to body

temperature on toddler with typhoid fever in SeiLangkai Health Center

Batam 2018.

1.3.2 Specific Objectives

a. To know the body temperature before done compresses tepid water

sponging in toddlers with typhoid fever in SeiLangkai Health Center

Batam 2018.
 b. To find out the body temperature after done compress tepid water

sponging in toddlers with typhoid fever in SeiLangkai Health Center

Batam 2018.

c. To know the effect of giving tepid water sponging to the temperature

on the body of the toddler with typhoid fever in SeiLangkai Health

Center Batam 2018.

1.4 Research Benefits

1.4.1 Benefit for Education Institution of University of Batam

Can provide benefits and add insight for the readers especially students

of Nursing Science Study Program of the University of Batam

regarding the handling of fever with non-pharmacological therapy by

giving the method of tepid water sponging to lower body temperature

in toddlers with typhoid fever.

1.4.2 For Nursing Professions

The result of this research can develop the science of nursing

profession, so that it can be more optimal in giving handling of

decrease of body temperature specially non pharmacology method that

is by using tepid water sponging to decrease body temperature in

toddler which is typhoid fever.

1.4.3 For Puskesmas Sei Langkai

The results of this study are expected to provide information and

inputs in improving services, especially nurses in order to perform

independent actions nursing on toddlers with typhoid fever using tepid

water sponging motode.

1.4.4 For Parents

The results of this study can add insight and knowledge of parents

about providing care for infants who experience increased body

temperature by non-pharmacological therapy that is by using tepid

water sponging.

1.4.5 For Patients

The results of this study can increase knowledge about non-

pharmacological therapy that is tepid water sponging in decreasing

body temperature in toddlers who have typhoid fever

 CHAPTER II

LITERATURE REVIEW

2.1 Typhoid Fever

2.1.1 Definition of Typhoid Fever

Fever or heat is one of the most common causes of underfives. Fever is not

a disease but a reaction to the body's defense mechanism from the presence

of infection or entry of foreign substances into the body. At the time of the

fever occurs the body is fighting against viruses, bacteria, or foreign

objects that cause disease (Sudarmoko, 2011).

According to Avner in the journal Acute Fever Pediatric in Review (2009),

the effects that can be caused by fever can be excessive evaporation of

body fluids resulting in lack of fluids and seizures. Many parents who

consider the fever is dangerous for the health of children under five

because it can cause seizures and brain damage.

Typhoid fever or typhoid fever is a systemic syndrome mainly caused by

Salmonella typhi. Typhoid fever is the most common type of

Salmonellosis. Other types of enteric fever are paratyphoid fever caused by

Salmonella paratyphi A, Salmonella schottmuelleri (originally Salmonella

paratyphi B), and Salmonella hirschfeldii (originally Salmonella paratyphi

C). Typhoid fever is also an acute infectious disease that is always found in

society (endemic) Indonesia. Patients also vary, ranging from toddlers,

children and adults. Typhoid fever is one of the diseases of the

 gastrointestinal tract and is characterized by a fever or rise in body

temperature, the disease is mostly attacking toddlers and children. Typhoid

fever is currently the highest case in the world (Keliobas, 2015).

2.1.2 Causes of Typhoid Fever

According to Ardiansyah (2012) the cause of this disease is Salmonella

typhi, Salmonella paratyphi A, Salmonella paratyphi B. Its form is gram

negative bacillus, moves with shakes hair, does not have berspora and has

three kinds of antigen (antigen O, H, and VI). In the serum of the patient,

there is a substance (aglutinin) to the three kinds of antigen. Germs grow in

an aerobic and facultative anaerobic atmosphere at a temperature of 150C-

410C (optimum 370C) and pH growth of 6-8.

2.1.3 Signs and Symptoms of Typhoid Fever

According Ardiansyah (2012) clinical symptoms of typhoid fever in

toddlers and children are usually lighter than adults. The average shoot

period is 10-20 days. The shortest shoot is four days, if the infection occurs

through food. Meanwhile, the longest buds lasted 30 days, if the infection

through the drink. During the incubation period, there may be prodomal

symptoms, ie feeling unwell, lethargy, headache, dizziness, and lack of

excitement, which is then followed by the following clinical symptoms:

 a. Fever

Fever lasts for three weeks, is febrile remittance, and with a not-so-high

body temperature. During the first week, temperatures gradually

increase, usually down in the morning and increase again in the

afternoon and evening. In the second week, the patient continues to have

a fever and in the third week the patient fever is gradually normal.

b. Disturbance of the gastrointestinal tract

Breath smelling, dry and cracked lips, coated tongue, reddish tips and

edges, flatulence, liver and spleen enlarged, accompanied by pain on

palpation.

c. Disturbance of consciousness

Awareness decreases, although not too degenerate, ie apathy to

somnolence (desire to sleep and continue to sleep). In addition to these

symptoms, in the back and limbs are also found roseola, the reddish

spots due to basil embolism in the skin capillaries.

2.1.4 Pathophysiology of Typhoid Fever

The pathophysiology of typhoid fever according to Ardiansyah (2012) is:

1. Germs enter into the mouth through food or drink contaminated by

Salmonella (usually more than 10,000 bacterial bacilli). Some germs

can be destroyed by gastric acid HCL and partly into the small
 intestine. If the humoral immune response of the intestinal mucosa

(IgA) is poor, Salmonella bacilli will penetrate epithelial cells (M cells)

and then to lamina propia and multiply in the lymphoid tissue of the

transferee plaque in the distal ileum and mesenteric lymph nodes.

2. Lymphoid tissue of the plaque and mesenteric lymph nodes undergo

hyperplasia. The bacilli enter the bloodstream (bakterimia) through the

thoracius duct and spread throughout the body's reticuloendotalial

organs, especially the liver, bone marrow, and lymph through the portar

circulation of the intestine.

3. Enlarged liver (hepatomegaly) with infiltration of lymphocytes, plasma

substances, and mononuclear cells. There is also focal necrosis and

lymph enlargement (splenomegaly). In this organ bacteria Salmonella

typhi breed and enter the blood circulation again, resulting in a second

bacteremia with signs and symptoms of systemic infection (fever,

malaise, myalgia, headache, abdominal pain, vascular instability, and

coagulation mental disorders).

4. Gastrointestinal bleeding occurs due to erosion of blood vessels around

the plaque of the necrotizing sufferers and hyperplasia.

 2.1.5 Prevention of Typhoid Fever

According to Suririnah (2010) Prevention of typhoid fever is as follows:

a. Eat-cleaned food. Uncooled snacks are often sources of contagion

b. Drink water properly cooked

c. Keeping hands clean. The habit of washing hands and keeping the

environment clean is the main thing

d. Provide Typhoid immunization after 2-year-old child and restart every 3

years.

2.1.6 Management of Typhoid Fever

Management of typhoid fever is as follows:

1. Treatment

According Ardiansyah (2012) treatment in patients with typhoid fever is

as follows:

a. Bed rest up to a minimum of 7 days free of fever or less for 14 days.

b. The position of the body should be changed once every 2 hours to

prevent decubitus (skin injuries from too long emphasis lying in bed

on one side of the body).

c. Mobilization according to conditions

 2. Diet

According to Ardiansyah (2012) diet for people with typhoid fever is as

follows:

a. Food is given gradually according to the condition of the disease

(initially water, then soft food, and then ordinary food)

b. Food contains enough fluids, TKTP

c. Food must contain enough fluids, calories, and high protein, should

not contain lots of fiber, neither stimulate nor cause gas.

3. Pharmacological Therapy

According Ardiansyah (2012) pharmacological therapy in patients with

typhoid fever is as follows:

a. Giving antibiotics

b. Provision of anti-inflammatory drugs (anti-inflammatory)

c. Provision of antipyretic drugs

d. Provision of antiemetic drugs

4. Nonpharmacology Therapy

Nonpharmacology therapy in patients with typhoid fever is as follows:

a. Warm water compresses

1) Understanding warm water compress

According to Dewi (2016) in Nursing Journal of Muhammadiyah on

Differences of Body Temperature Determination Among Provision

 of Warm Water Compress with Tepid Sponge In Children Fever,

understanding compress is one of the physical method to lower body

temperature when the child has fever. There are several kinds of

compresses that can be given to lower body temperature compress of

warm water and tepid sponge bath. Compress is a method of

maintaining body temperature by using a liquid or a tool that can

cause warm or cold temperatures on the body (Asmadi, 2012).

Warm water compress is a given action with the aim to lower body

temperature by compressing on the forehead, axillae, and groin to

give vasodilation effect on the blood vessels thus accelerating body

evaporation (Ardiansyah, 2012).

2) Purpose of warm water compress

According to Asmadi (2012), there are several purposes of giving

method of warm water compress is as follows:

a) Lower body temperature

b) Streamlining the blood circulation

c) Reduce the pain

d) Provide a sense of warmth, comfort, and calm in the patient

e) Streamlining exudate spending

f) Stimulates intestinal peristalsis

 g) Reduced local bleeding

h) Reduce the pain in an area

i) Prevent widespread inflammation

3) Physiology of warm water compresses

Provision of warm water compresses in the body area can provide

stimulation or signal to the hypothalamus through the spinal cord.

When heat-sensitive receptors in the hypothalamus are stimulated,

the effector system emits signals through sweating and peripheral

vasodilation. Changes in blood vessels are regulated by the

vasometer center on the medulla oblongata of the brain stem, under

the hypothalamic effects of the anterior part resulting in vasodilation.

The occurrence of this vasodilation leads to the disposal or loss of

heat energy through increased skin (which is characterized by

sweating bodies), then body temperature may be decreased or normal

(Potter and Perry, 2010).

b. Compress cold water

1) Understanding cold water compress

According to Aguspairi (2011) in Scientific Journal of Batanghari

University of Jambi on the Effectiveness of Tepid Sponge Method

and Cold Compress in Lowering Body Temperature of Children

 Fever understanding of cold water compress is one way to remove

heat from the body through the conduction process.

According to Avner in the journal Acute Fever Pediatric in Review

(2009) the cold compress technique should not be used today because

it causes vasoconstriction rather than vasolidation required for heat

dissipation and will cause seizures in infants.

According to Suririnah (2010) to reduce high body temperature in

toddlers do not use ice / cold water, or alcohol because hypothalamus

in the brain that serves as a central body temperature regulator will

receive temperature signals outside the body cold so it will increase

the body temperature that makes blood vessels increasingly

narrowed. As a result the body can not release heat, and even

increase its temperature. Conversely, when compressed with warm

water, the temperature center will receive a signal that the

surrounding temperature is warm and will soon be lowered as the

expected effect. Efforts to lower body temperature is necessary to

prevent seizures.

2) Purpose of cold water compress

According to Aguspairi (2011) in Scientific Journal of Batanghari

University of Jambi on the Effectiveness of Sponge Tepid Method

 and Cold Compress in Lowering Body Temperature, Fever Children

say that cold compress application is aimed at high body temperature

can be down to normal.

3) Physiology of cold water compress

According to Aguspairi (2011) in the Journal of Scientific University

of Batanghari Jambi said that the application of cold compress will

cause heat to move following the thermal gradient decrease from

hotter to cooler objects because it is transferred from molecule to

molecule. During this process, the initially hot molecule will lose

some of its thermal when the molecule slows down and becomes

colder.

c. Compress alcohol

1) Understanding of alcohol compress

According to Jayanti (2013) in the journal on the Differences of

Effectiveness of Warm Compress and Alcohol Compresses, the

alcohol compresses provide a temporary cold stimulation, this effect is

achieved by evaporation of an alcohol solution aimed at lowering body

temperature, controlling bleeding, overcoming local infections,

swelling or inflammation as well reduce pain.

 According to Avner in the journal Acute Fever Pediatric in Review

(2009), compress techniques using alcohol as a therapy should not be

used today because it can cause vasoconstriction rather than

vasolidation required for heat dissipation and may cause seizures in

infants. Alcohol administration by the compress method will also be

absorbed through the skin and lead to toxicity.

2) The purpose of the alcohol compress

According to Jayanti, et al (2013) in the journal about the Differences

of Effectiveness of Warm Compress and Alcohol Compresses, the

purpose of alcohol compresses is to lower body temperature, control

bleeding, overcome local infections, swelling or inflammation and

reduce pain.

e. Wear thin clothes

According Setiawati (2009) other interventions to reduce fever in infants

is by not wearing thick clothes. The best way to decrease the temperature

of a toddler with a fever is to wear a thin dress, do not cover with a thick

blanket, give a thin blanket when toddlers feel cold (Suririnah, 2010).
 f. Cool the room

According Setiawati (2009) other interventions to reduce fever in children

is to set the appropriate room temperature (26,50C). Place a toddler in an

AC room or keep the room temperature cool for the toddler to feel

comfortable (Suririnah, 2010).

g. Gives plenty of fluids

According Setiawati (2009) nonfarmakologis handling in addition to

compress is to maintain adequate fluid intake. Fluid intake in children

with fever is increased by at least 30-50 ml of fluid per hour. Give fever

toddlers drink plenty of water and fluids to prevent dehydration because

fever can cause the body to lose more fluids (Suririnah, 2010).

2.3 Tepid Water Sponging

2.3.1 Understanding Tepid Water Sponging

According to Alves (2008) in the journal Tepid Sponging Plus Dipyrone

Versus Diponone Alone In Reducing Body Temperature In Febrile

Children, understanding of tepid water sponging compress is a warm

compress technique that combines the technique of block compresses in

supervisial blood vessels by technique seka. Compression tepid sponge

bath is one way of physical methods to reduce fever that is

nonfarmakoterapi. This technique is done by doing a warm compress

throughout the child's body (Setiawati, 2009). Meanwhile, according to

Zahroh (2017) in JurnalNersLentera Tepid water sponging or tepid sponge

bath is a compress method that aims to lower body temperature by using

warm water by wiping the whole body using washlap or sponge.

The independent role of nurses in overcoming fever can be done by

compressing. The results of research conducted by Alves (2008) in the

journal Tepid Sponging Plus Dipyrone Versus Diponone Alone In

Reducing Body Temperature In Febrile Children, explains that after 15

minutes done tepid sponge bath combined with antipyretic axillary body

temperature in infants aged 6 months to 5 years experienced a significant

decrease in body temperature. While in the control group showed that after

2 hours of antipirteik alone, the fever will fall.

According to Kusnanto (2008)in Media Journal Ners on the Effectiveness

of Tepid Sponge Bath Temperature 320C and 370C in Lowering Body

Temperature Fever said that the warm compresses different from the

provision of tepid sponge bath. Provision of warm compresses done in

certain places in the body, which is located large blood vessels. While

giving tepid sponge bath is done by wiping the whole body of the client

with warm water. Administration of the sponge bath soaked thoroughly

throughout the body is expected more and more peripheral blood vessels in

the skin undergoing vasodilation. The temperature of water used in tepid

 sponge bath is warm water with temperature (34-370C) close to core body

temperature (37,10C) and expected to decrease body temperature of fever

2.3.2 Objectives and Benefits of Tepid Water Sponging

The purpose and benefits of doing tepid water sponging is to lower the

body temperature that has increased. The temperature drop occurs with the

body heat mechanism used to evaporate water on the compressed cloth.

Because warm water will help the peripheral blood dilated, so that the

pores become open which will further facilitate the release of heat from the

body. With temperatures outside the warmer, the body will assume the

temperature outside is quite hot which makes the body react to lower the

temperature (Potter and Perry, 2010).

2.3.3Pathophysiology of Tepid Water Sponging

The application of tepid water sponging compress is a compress performed

on all parts of the patient's body. This is what distinguishes with warm

compresses in large areas of blood vessels as areas with large blood

vessels. Tepid water sponging is an effort to provide stimulation in the area

of supervisial blood vessels with wet technique to lower body temperature.

Warm signals given thoroughly on all parts of the body will be carried by

the blood to the hypothalamus and will stimulate the supervisial area which

will result in signal release by the effector system. This signal will cause

the expulsion of body heat through the mechanism of peripheral

 vasolidation of blood vessels and sweating. Then heat is delivered from

deeper organs and tissues to the skin, where heat dissipates into the air and

surrounds. Therefore, the rate of heat loss is determined by the factor of

how quickly and effectively heat can be conduction and can then be

transmitted from the surrounding skin (Isnaeni, 2014).

According to Alves (2008) in the journal Tepid Sponging Plus Dipyrone

Versus Diponone Alone In Reducing Body Temperature In Febrile

Children, heat stimuli arising from the supervisial area will result in a

vasodilation process or dilated blood vessels and conduction that will

signal the hypothalamus so that the heat will be excreted through sweat and

lost to the surrounding air.

According to Alves (2008) in the journal Tepid Sponging Plus Dipyrone

Versus Diponone Alone In Reducing Body Temperature In Febrile

Children, heat stimuli arising from the supervisial area will result in a

vasodilation process or dilated blood vessels and conduction that will

signal the hypothalamus so that the heat will be excreted through sweat and

lost to the surrounding air.

2.4 Theoretical Framework

Based on the literature review described by Alves (2008), Potter and Perry

(2010), Thomas (2009), Suririnah (2010), Jayjit (2011), the following

research theoretical framework is developed:

 Typhoid fever

Pharmacological therapy Non Pharmacological therapy

1. Administration of antibiotik 1. Warm water compresses

2. Administration of anti 2. Cold water compresses

infamantory drugs
3. Alcohol compresses
3. Administration of antipretic
4. Tepid Water Sponging
drugs
5. Wear thin clothes
4. Administration of antimietic
drugs 6. Cool the room

7. Provide plenty of fluids

Tepid Water Sponging

Do it for 15 minutes in face area without touching the eyes, then to

the neck, upper extremities to the tip of the fingers of the lower
extremities to the tip of the toes, back and abdomen

Stimulate the supervisial area

The occurance of vasodilation and conduction processes

Information:
Decreased body temperature
Researched

Not Researched Skema 2.1 KerangkaTeori

2.5 Typhoid Fever

2.5.1 Definition of Typhoid Fever

Fever or heat is one of the most common causes of underfives. Fever is not

a disease but a reaction to the body's defense mechanism from the presence

of infection or entry of foreign substances into the body. At the time of the

fever occurs the body is fighting against viruses, bacteria, or foreign

objects that cause disease (Sudarmoko, 2011).

According to Avner in the journal Acute Fever Pediatric in Review (2009),

the effects that can be caused by fever can be excessive evaporation of

body fluids resulting in lack of fluids and seizures. Many parents who

consider the fever is dangerous for the health of children under five

because it can cause seizures and brain damage.

Typhoid fever or typhoid fever is a systemic syndrome mainly caused by

Salmonella typhi. Typhoid fever is the most common type of

Salmonellosis. Other types of enteric fever are paratyphoid fever caused by

Salmonella paratyphi A, Salmonella schottmuelleri (originally Salmonella

paratyphi B), and Salmonella hirschfeldii (originally Salmonella paratyphi

C). Typhoid fever is also an acute infectious disease that is always found in

society (endemic) Indonesia. Patients also vary, ranging from toddlers,

children and adults. Typhoid fever is one of the diseases of the

gastrointestinal tract and is characterized by a fever or rise in body

 temperature, the disease is mostly attacking toddlers and children. Typhoid

fever is currently the highest case in the world (Keliobas, 2015).

2.5.2 Causes of Typhoid Fever

According to Ardiansyah (2012) the cause of this disease is Salmonella

typhi, Salmonella paratyphi A, Salmonella paratyphi B. Its form is gram

negative bacillus, moves with shakes hair, does not have berspora and has

three kinds of antigen (antigen O, H, and VI). In the serum of the patient,

there is a substance (aglutinin) to the three kinds of antigen. Germs grow in

an aerobic and facultative anaerobic atmosphere at a temperature of 150C-

410C (optimum 370C) and pH growth of 6-8.

2.5.3 Signs and Symptoms of Typhoid Fever

According Ardiansyah (2012) clinical symptoms of typhoid fever in

toddlers and children are usually lighter than adults. The average shoot

period is 10-20 days. The shortest shoot is four days, if the infection occurs

through food. Meanwhile, the longest buds lasted 30 days, if the infection

through the drink. During the incubation period, there may be prodomal

symptoms, ie feeling unwell, lethargy, headache, dizziness, and lack of

excitement, which is then followed by the following clinical symptoms:

a. Fever

Fever lasts for three weeks, is febrile remittance, and with a not-so-high

body temperature. During the first week, temperatures gradually

 increase, usually down in the morning and increase again in the

afternoon and evening. In the second week, the patient continues to have

a fever and in the third week the patient fever is gradually normal.

b. Disturbance of the gastrointestinal tract

Breath smelling, dry and cracked lips, coated tongue, reddish tips and

edges, flatulence, liver and spleen enlarged, accompanied by pain on

palpation.

c. Disturbance of consciousness

Awareness decreases, although not too degenerate, ie apathy to

somnolence (desire to sleep and continue to sleep). In addition to these

symptoms, in the back and limbs are also found roseola, the reddish

spots due to basil embolism in the skin capillaries.

2.5.4 Pathophysiology of Typhoid Fever

The pathophysiology of typhoid fever according to Ardiansyah (2012) is:

1. Germs enter into the mouth through food or drink contaminated by

Salmonella (usually more than 10,000 bacterial bacilli). Some germs can

be destroyed by gastric acid HCL and partly into the small intestine. If

the humoral immune response of the intestinal mucosa (IgA) is poor,

Salmonella bacilli will penetrate epithelial cells (M cells) and then to

lamina propia and multiply in the lymphoid tissue of the transferee

plaque in the distal ileum and mesenteric lymph nodes.

 2. Lymphoid tissue of the plaque and mesenteric lymph nodes undergo

hyperplasia. The bacilli enter the bloodstream (bakterimia) through the

thoracius duct and spread throughout the body's

reticuloendotalialorgans, especially the liver, bone marrow, and lymph

through the portar circulation of the intestine.

3. Enlarged liver (hepatomegaly) with infiltration of lymphocytes, plasma

substances, and mononuclear cells. There is also focal necrosis and

lymph enlargement (splenomegaly). In this organ bacteria Salmonella

typhi breed and enter the blood circulation again, resulting in a second

bacteremia with signs and symptoms of systemic infection (fever,

malaise, myalgia, headache, abdominal pain, vascular instability, and

coagulation mental disorders).

4. Gastrointestinal bleeding occurs due to erosion of blood vessels around

the plaque of the necrotizing sufferers and hyperplasia.

2.5.5 Prevention of Typhoid Fever

According to Suririnah (2010) Prevention of typhoid fever is as follows:

a. Eat-cleaned food. Uncooled snacks are often sources of contagion

b. Drink water properly cooked

c. Keeping hands clean. The habit of washing hands and keeping the

environment clean is the main thing

d. Provide Typhoid immunization after 2-year-old child and restart every 3

years.
2.5.6 Management of Typhoid Fever

Management of typhoid fever is as follows:

1. Treatment

According Ardiansyah (2012) treatment in patients with typhoid fever is

as follows:

a. Bed rest up to a minimum of 7 days free of fever or less for 14 days.

b. The position of the body should be changed once every 2 hours to

prevent decubitus (skin injuries from too long emphasis lying in bed

on one side of the body).

c. Mobilization according to conditions

2. Diet

According to Ardiansyah (2012) diet for people with typhoid fever is as

follows:

a. Food is given gradually according to the condition of the disease

(initially water, then soft food, and then ordinary food)

b. Food contains enough fluids, TKTP

c. Food must contain enough fluids, calories, and high protein, should

not contain lots of fiber, neither stimulate nor cause gas.

 3. Pharmacological Therapy

According Ardiansyah (2012) pharmacological therapy in patients with

typhoid fever is as follows:

e. Giving antibiotics

f. Provision of anti-inflammatory drugs (anti-inflammatory)

g. Provision of antipyretic drugs

h. Provision of antiemetic drugs

4. Nonpharmacology Therapy

Nonpharmacology therapy in patients with typhoid fever is as follows:

a. Warm water compresses

1) Understanding warm water compress

According to Dewi (2016) in Nursing Journal of Muhammadiyah on

Differences of Body Temperature Determination Among Provision

of Warm Water Compress with Tepid Sponge In Children Fever,

understanding compress is one of the physical method to lower body

temperature when the child has fever. There are several kinds of

compresses that can be given to lower body temperature compress of

warm water and tepid sponge bath. Compress is a method of

maintaining body temperature by using a liquid or a tool that can

cause warm or cold temperatures on the body (Asmadi, 2012).

 Warm water compress is a given action with the aim to lower body

temperature by compressing on the forehead, axillae, and groin to

give vasodilation effect on the blood vessels thus accelerating body

evaporation (Ardiansyah, 2012).

2) Purpose of warm water compress

According to Asmadi (2012), there are several purposes of giving

method of warm water compress is as follows:

a) Lower body temperature

b) Streamlining the blood circulation

c) Reduce the pain

d) Provide a sense of warmth, comfort, and calm in the patient

e) Streamlining exudate spending

f) Stimulates intestinal peristalsis

g) Reduced local bleeding

h) Reduce the pain in an area

i) Prevent widespread inflammation

3) Physiology of warm water compresses

Provision of warm water compresses in the body area can provide

stimulation or signal to the hypothalamus through the spinal cord.

When heat-sensitive receptors in the hypothalamus are stimulated,

the effector system emits signals through sweating and peripheral

 vasodilation. Changes in blood vessels are regulated by the

vasometer center on the medulla oblongata of the brain stem, under

the hypothalamic effects of the anterior part resulting in vasodilation.

The occurrence of this vasodilation leads to the disposal or loss of

heat energy through increased skin (which is characterized by

sweating bodies), then body temperature may be decreased or normal

(Potter and Perry, 2010).

b. Compress cold water

1) Understanding cold water compress

According to Aguspairi (2011) in Scientific Journal of Batanghari

University of Jambi on the Effectiveness of Tepid Sponge Method and

Cold Compress in Lowering Body Temperature of Children Fever

understanding of cold water compress is one way to remove heat from

the body through the conduction process.

According to Avner in the journal Acute Fever Pediatric in Review

(2009) the cold compress technique should not be used today because it

causes vasoconstriction rather than vasolidation required for heat

dissipation and will cause seizures in infants.

 According to Suririnah (2010) to reduce high body temperature in

toddlers do not use ice / cold water, or alcohol because hypothalamus in

the brain that serves as a central body temperature regulator will receive

temperature signals outside the body cold so it will increase the body

temperature that makes blood vessels increasingly narrowed. As a result

the body can not release heat, and even increase its temperature.

Conversely, when compressed with warm water, the temperature center

will receive a signal that the surrounding temperature is warm and will

soon be lowered as the expected effect. Efforts to lower body

temperature is necessary to prevent seizures.

2) Purpose of cold water compress

According to Aguspairi (2011) in Scientific Journal of Batanghari

University of Jambi on the Effectiveness of Sponge Tepid Method and

Cold Compress in Lowering Body Temperature, Fever Children say that

cold compress application is aimed at high body temperature can be

down to normal.

3) Physiology of cold water compress

According to Aguspairi (2011) in the Journal of Scientific University of

Batanghari Jambi said that the application of cold compress will cause

heat to move following the thermal gradient decrease from hotter to

cooler objects because it is transferred from molecule to molecule.

 During this process, the initially hot molecule will lose some of its

thermal when the molecule slows down and becomes colder.

c. Compress alcohol

1) Understanding of alcohol compress

According to Jayanti (2013) in the journal on the Differences of

Effectiveness of Warm Compress and Alcohol Compresses, the alcohol

compresses provide a temporary cold stimulation, this effect is achieved

by evaporation of an alcohol solution aimed at lowering body

temperature, controlling bleeding, overcoming local infections, swelling

or inflammation as well reduce pain.

According to Avner in the journal Acute Fever Pediatric in Review

(2009), compress techniques using alcohol as a therapy should not be

used today because it can cause vasoconstriction rather than vasolidation

required for heat dissipation and may cause seizures in infants. Alcohol

administration by the compress method will also be absorbed through the

skin and lead to toxicity.

2) The purpose of the alcohol compress

According to Jayanti, et al (2013) in the journal about the Differences of

Effectiveness of Warm Compress and Alcohol Compresses, the purpose

 of alcohol compresses is to lower body temperature, control bleeding,

overcome local infections, swelling or inflammation and reduce pain.

e. Wear thin clothes

According Setiawati (2009) other interventions to reduce fever in infants

is by not wearing thick clothes. The best way to decrease the temperature

of a toddler with a fever is to wear a thin dress, do not cover with a thick

blanket, give a thin blanket when toddlers feel cold (Suririnah, 2010).

f. Cool the room

According Setiawati (2009) other interventions to reduce fever in children

is to set the appropriate room temperature (26,50C). Place a toddler in an

AC room or keep the room temperature cool for the toddler to feel

comfortable (Suririnah, 2010).

g. Gives plenty of fluids

According Setiawati (2009) nonfarmakologis handling in addition to

compress is to maintain adequate fluid intake. Fluid intake in children

with fever is increased by at least 30-50 ml of fluid per hour. Give fever

toddlers drink plenty of water and fluids to prevent dehydration because

fever can cause the body to lose more fluids (Suririnah, 2010).
 CHAPTER III

RESEARCH METHODOLOGY

3.1 Concept Research Framework

The framework of the concept of research is a description and visualization of the

relationship or relationship between one concept to another concept, or between

one variable with another variable of the problem to be studied (Notoadmodjo,

2010).

Independent Variable Dependent Variable

Giving Tepid Water Body Temperature

Sponging

Scheme 3.1 Research Concept Framework

3.2 Hypothesis

According to Rumengan (2010), the hypothesis is a temporary answer to the

problem formulation that is elaborated from the theoretical framework or the

study of theory and must be tested its truth, because it is temporary then it needs

to be done through empirical data from a scientific research. Hypothesis in this

research are:
3.2.1 The Null Hypothesis (H0)

The null hypothesis is a preposition or proposition that states a definite

relationship between two variables (Rumengan, 2010). The null hypothesis in

this study are as follows:

H0 : There is no effect of Tepid Water Sponging on Body Temperature on

Toddlers with Typhoid Fever

3.2.2 Alternative Hypothesis (Ha)

The alternative hypothesis is the opposite of the null hypothesis, is a statement

that states a relationship between two variables or states the differences

between two variables (Rumengan, 2010). The alternative hypothesis in this

research is as follows:

Ha : There is an effect of Tepid Water Sponging on Body Temperatures in

Toddlers with Typhoid Fever.

3.3 Research Variables

According to Notoadmodjo (2010) research variables contain the definition of

the size or characteristics possessed by members of a group different from that of

other groups.
3.3.1 Independent Variables

Independent Variables (free) is a variable that explains or affects other variables

(Rumengan, 2010). The independent variable in this research is giving of tepid

water sponging.

3.3.2 Dependent Variables

Dependent variable (dependent) is variable which is explained or influenced by

independent variable (Rumengan, 2010). While the dependent variable in this

study is body temperature.

3.4 Design or Research Design

the design of this study used quasi experimental design, with one pretest-

posttest design where in this design there is no control group but at least the first

observation (pretest) has been done that allows the researcher to test the changes

that occurred after experiment (Notoatmodjo, 2010).

DilakukanTepid Water
Pretest Spongingselama 15 menit Posttest

Scheme 3.2 Desain One Group Pretest – Post test

3.6 Population and Sample

The population and sample in this study are as follows:

3.6.1 Population

Population is the whole object of research or object under study (Notoatmodjo,

2010). In this study, the population is all the toddlers with typhoid fever at the
 Health Center SeiLangkaiBatam. The total population in this study was 168

respondents.

3.6.2 Sample

The sample is a researched subject that is considered to represent the entire

population (Notoatmodjo, 2010). The sampling technique in this research is by

using total sampling technique. The saturated sample is a sample determination

technique when all members of the population are used as a sample (Sugiyono,

2015). The sample in this research is toddler who suffer from typhoid fever in

SeiLangkai Health Center of Batam City.

3.7 Location and Time of Research

3.7.1 Research Sites

The research will be conducted at PuskesmasSeiLangkai Kota Batam.

3.7.2 Research Time

This research will be conducted in May - June 2018.

3.8 Data Collection Tools and Techniques

3.8.1 Data Collection Tool

Stages performed in data collection using literature research and observation

sheet. Library research is the technique of collecting data done in writing by

citing the existing literature as the basis of research both library books and

journals. While the observation sheet is a way of collecting data with direct

observation and recording systematically to the object to be studied (Rumengan,

 2010). Data collection tool in this research is good variable of tepid water

sponging and variable of body temperature using observation sheet and axillary

digital thermometer.

3.8.2 Data Collection Techniques

Data collection techniques in this study is to use data collection procedures obtained

by doing:

a. Explain to parents of children under five at SeiLangkai Health Center about

research

b. Respondents' parents filled in informend consent

c. Measuring the body temperature of a toddler using a digital axillary

thermometer prior to the method of tepid water sponging

d. Using the Standard Operating Procedure (SOP) as a reference when providing

the method of tepid water sponging (Philippine Heart Center Nursing Service

Procedure Manual, 2016)

e. Provide treatment of tepid water sponging method on respondents

f. Measuring body temperature of a toddler using axillary digital thermometer

after tepid water sponging method

g. The measurement data is then entered into the observation sheet

3.9 Data Processing

According Notoatmodjo (2010), data processing techniques used are manually, then

the data is processed using the steps as follows:

3.9.1 Editing

This stage is done at the time of collecting data from the observation of

respondents. Re-examining the results of observations, whether there are

multiple observations.

3.9.2 Coding

Conducted encoding on the respondent's answer and observation sheet to

facilitate researchers in subsequent data processing. In this study the coding on

the variable of tepid water sponging is categorized based on 0 = Before the

action of tepid water sponging and 1 = After the action of tepid water sponging

for 15 minutes. While for body temperature variables categorized based on

normal body temperature that is 36,50C-37,50C and body temperature fever

that is body temperature more than 37,50C per axilla (Suririnah, 2010).

3.9.3 Scoring

This stage is done to give a score on each respondent's answer, this process can

be done computerized or manual.

3.9.4 Entering

Entering is the process of entering data that has been given code into the

computer like a computer program or manual.

3.10 Data Analysis

After all the data collected, then the next step is to analyze the data, so that the data

can be drawn a conclusion.

3.10.1 Univariate Analysis

 Univariate analysis is an analysis conducted on each variable in the results of

research in general. Univariate analysis aims to explain or describe the

characteristics of each research variable (Notoatmodjo, 2010). In this analysis

the researcher wanted to see the mean or the mean of the influence variable of

tepid water sponging to the body temperature on the toddler with typhoid

fever in SeiLangkai Health Center, Sagulung, Batam City, Riau Islands

Province 2018.

3.10.2 Bivariate Analysis

Bivariate analysis is a simultaneous analysis of two variables. This is usually

done to see if one variable is related to another variable related or correlated

(Notoatmodjo, 2010). Analysis of this research data using Kolmogorov

smirnov normality test. Kolmogorov smirvov is a test performed to ensure

data along the normal distributed diagonal line (Rumengan, 2010). Further

analyzed by using statistical test Paired t-test with degree of significance α

<0,05.
 CHAPTER IV

CONCLUSION

In the stage of growth and development, toddlers often experience pain. Various

diseases attack, especially diseases caused by infections that are almost always

accompanied by fever. Fever is one of the causes that often make parents bring their

children to seek treatment. Fever is not a disease but rather a symptom of a disease as

a body reaction to fight off infections or diseases that can be caused by viruses or

bacteria. When the body is fighting disease or infections that enter, the body will

release a certain amount of heat to the skin of the body resulting in an increase in

body temperature (Suririnah, 2010).

According to Alves (2008) in the journal Tepid Sponging Plus Dipyrone Versus

Diponone Alone In Reducing Body Temperature In Febrile Children, understanding

of tepid water sponging compress is a warm compress technique that combines the

technique of block compresses in supervisial blood vessels by technique seka.

Compression tepid sponge bath is one way of physical methods to reduce fever that is

nonfarmakoterapi. This technique is done by doing a warm compress throughout the

child's body (Setiawati, 2009). Meanwhile, according to Zahroh (2017) in

JurnalNersLentera Tepid water sponging or tepid sponge bath is a compress method

that aims to lower body temperature by using warm water by wiping the whole body

using washlap or sponge.