Program Keperawatan (D-3)

Sekolah Tinggi Ilmu Kesehatan Jenderal Achmad Yani Cimahi

EFFECTIVENESS OF TEPID SPONGE COMPRESSES AND PLASTER COMPRESSES

ON CHILDREN'S FEVER TEMPERATURE TYPHOID

RESTI PERMATASARI

Department of Medical Technology, School of Health Sciences Jenderal Achmad Yani

Cimahi – Indonesia
([email protected])

ABSTRACT

Typhoid is infectious disease which is still encountered widely in various developing countries, especially
those located in the tropic and subtropics. Fever is a clinincal manifestation that is often the main complaint
of the sufferer. Action can be done to lower body temperature that is tepid sponge compress and plaster
compress. The purpose of this study is to determine the comparison of the effectiviness of tepid sponge
compress and plaster compress of changes body temperature in school age children with typhoid fever in
cibabat hospital in year 2017.
The method used is quasy experiment research method with the approach of pre test and post test two
design group. As many as 24 samples were taken at the patient ward of hospital Cibabat. Respondents
divided into two groups namely tepid sponge compress and plaster compress by way concecutive sampling.
This study was conducted for 20 minutes at each intervenstion. Data analysis used Wilcoxon test, dependen t
test, and Mann-Withney. Average body temperature before and after given tepid sponge compress are
38,75oC and 38,08oC with temperature different is 0,67oC. While average body temperature before and after
given palster compress are 38,80oC and 38,57oC with temperature different is 0,23oC.
Mann-Withney test result show that the p value = 0,000 < α = 0,05 which means bottom tepid sponge
compress is more effective in lowering body temperature in scholl age children compared with plaster
compress. Based on the result of the study, it can recommend tepid sponge compress in the implementation
of nursing care to lower body temperature in typhoid fever patients.

Key word: Fever, Plaster compress, Tepid sponge

INTRODUCTION Nursing actions

Typhoid fever is an infectious infectious
disease that can occur in children and adults.
Children are the most susceptible to typhoid fever,
although the symptoms experienced by children
are lighter than adults. Almost in all endemic areas,
the incidence of typhoid fever occurs mostly in
children aged 5-19 years (Nugroho and Susilo,
2011). The World Health Organization (WHO)
estimates that the number of cases of fever
worldwide reaches 16- 33 million with 500-600
thousand deaths each year. The 2014 Cimahi City
Health Profile Report, the number of cases of
typhoid and paratyphoid treated by hospitals with
the age range 0- 1 year was 283 cases, aged 1-4
years were 778 cases, age 5-14 years were 974
cases, and ages 15-44 years were 2,256 cases.
Clinical manifestations of patients with
typhoid fever in general are fever, fever that is
often encountered usually fever more than a week
(Nani, 2014). Fever in children with rectal
temperatures above 38oC is at risk of seizures.
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 Program Keperawatan (D-3)
Sekolah Tinggi Ilmu Kesehatan Jenderal Achmad Yani Cimahi

during a fever episode one of them as care giver

where the intervention nursing for patients who
have a fever is intended to support the body's
normal physiological processes, provide comfort,
and prevent complications. The action that can be
taken to reduce fever is by compressing tepid
sponge and plaster compress (Kolcaba, 2007 in
Bartolomeus, Haryani, dan Arif, 2012; Darwis,
2010 dalam Syltami, 2014).
Non-pharmacological efforts that can be
done to reduce fever are wearing thin clothes,
drinking more often, taking lots of rest, bathing
with warm water, giving hot compresses (Aden,
2010 in Fatkularini, Mardi, and Solechan, 2014).
Some compresses that can be done are warm wet
compresses, warm dry compresses using warm
jars, cold wet compresses with a solution of anti-
septic drugs, cold wet compresses with plain
water, dry cold compresses with ice kirbat
(eskap), compress tepid sponges, and plaster
compresses (Asmadi, 2008 in Fatkularini, Mardi,
and Solechan, 2014; Kolcaba, 2007 in
Bartolomeus, Haryani and Arif,

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 Effectiveness Of Tepid Sponge Compresses
And Plaster Compresses on Children's Fever Temperature Typhoid

2012; Darwis, 2010 in Syltami, 2014). Cold sponge therapy was 0.97 ºC in 60 minutes. In the
compresses according to IDAI (2014) are not implementation tepid sponge must prepare water
recommend because it can increase the center of warm when the child has a fever and water that
the temperature setting (set point) in the widens various parts of the body of the child can
hypothalamus, causing the body to shiver and the cause discomfort. Giving this action looks less
blood vessels to shrink (vasoconstriction) resulting practical for mothers but is very economical.
in increased body temperature. However, there are still many parents who have not
According to Alves and Almeida (2008, in done this tepid sponge technique.
Hamid 2011) of several compress actions In this modern era, a new innovation is
performed, tepid sponge is a warm compress emerging to reduce heat when a child has a fever.
technique alternative that is widely researched in The innovation is a compress plaster that is ready
developed countries and in other developing to use, considered practical, and is sold freely at
countries. The main objective of this compress the pharmacy. Likewise with a warm compress,
technique is to reduce fever body temperature. this compress plaster is effective in lowering body
Developed and researched in developed countries temperature. when experiencing a fever. Just put a
like America and England. Until recently this compress plaster that is ready to get into the child's
technique continued to be researched and expanded body, and periodically monitor the child's body
in other countries such as Brazil, Singapore, and (Darwis and Hardiningsih, 2010). Making plaster
India. In the results of the study showed there was compresses using hydrogel on polyacrylate-base.
a decrease in temperature of fever clients who This Hydrogel has become the basic ingredient in
received antipyretic therapy and tepid sponge making compress plaster that is widely used in
compared to clients who only received antipyretic Indonesia. Research by Syltami (2014) says that
therapy. the average temperature change of children who
Tepid sponge technique is a combination of have a fever before and after being given compress
block techniques with wiping. This technique uses plaster is 0.6 ºC within 20 minute. This study was
block compresses not only in one place, but supported by research Fatkularini, Mardi, and
directly in several places that have large blood Solechan (2014) saying that the average decrease
vessels. In addition there is still additional in body temperature after being given compress
treatment that is by giving some in some areas of plaster was 0.4ºC for 30 minutes.
the body so that the treatment applied to the client In addition to the advantages it has, the use of
in this technique will be more complex and plaster compressors also has several disadvantages,
complicated compared to other techniques. including the plaster compresses can not be
Providing block compresses directly in various attached to the skin properly, so that the process of
places will facilitate the delivery of signals to the absorption of body heat is not optimal. Therefore,
hypothalamus more intensively. Wounding will it must be corrected in terms of stickiness. Plaster
also accelerate the widening of peripheral blood of this compress are white not transparent (Darwis
vessels that facilitate heat transfer from the and Hardiningsih, 2010). Basically, the action of
surrounding body's environment so that it compressing has been done by nurses in the
accelerates the decrease in body temperature management of fever patients. However, warm
(Alves and Almeida, 2008 in Hamid, 2011). compresses are usually done by nurses in the room
The research by Hamid (2011) used a that is only compresses on the forehead and
Randomized Control Trial approach with the aim underarm areas. In addition to providing warm
to determine the effectiveness of compressed compresses, there are parents of patients who use
sponges carried out by the mother in reducing compress plaster to reduce fever with the reason
fever in children. The design of this study used 30 that it is easier to do than compressing using warm
random simple sampling techniques. Decreased water. Never research has been conducted
body temperature in the tepid sponge group began regarding the effectiveness of these two actions.
to occur at 6 minutes and continued to decrease The purpose of this study was to determine the
sharply until at minute 90 reached 1 ºC. The effectiveness of tepid sponge compresses and
decrease in body temperature in each group compress plaster on changes in body temperature
occurred after the treatment arrived at minute 90. in school-age children with typhoid fever in
Research by Setiawati (2008, in Bartolomeus, Cibabat Hospital in 2017.
Haryani and Arif, 2012) stated that the average
decrease in body temperature when receiving tepid

Third International Seminar on Global Health (3rd ISGH)

Vol 1 | No. 1 | October 2019 | Page 2 of
RESEARCH METHODS either tepid sponge compress or compress plaster,
The design of this study was quasi- the second temperature (posttest) was measured to
experimental with the design of pre and post test determine the effectiveness of tepid sponge
two design groups (using two treatment groups). compresses and compress plaster.
The research design was quasi-experimental with After the pretest is performed by measuring
pre and post test with two design groups. Both the minimum body temperature above 38 ºC-39 ºC.
groups measured body temperature before and Twelve of the first patients were given tepid
after the intervention. The first group received sponge compresses. This procedure used washcloth
intervention by compressing tepid sponges and the to wipe the face, neck, body, hands and feet,
second group received intervention with compress followed by the back (back, buttocks, hands, thighs
plaster. and legs) for 20 minutes and twelve second
The population in this study were children patients given compress tape. This tape will be
aged 6-12 years according to the inclusion criteria. applied to the frontal, axillary, and inguinal areas
Children with typhoid fever with body temperature for 20 minutes. At the time of posttest,
above 38 ºC-39 ºC. Sampling method with measurements of body temperature in the axillary
consecutive sampling technique. From the results area were used with a digital thermometer. This
of the sample calculation for each group 12 was done to determine the effectiveness of each
children. The total sample from both groups treatment and see a comparison between antarapre
compress tepid sponge and compress tape as many and post. temperature measurements were carried
as 24 children. Instruments used with observation out, the results were immediately recorded on an
sheets, water thermometers to measure water observation sheet. After 30 minutes of
temperature when it will compress tepid sponges, intervention, the respondent was given antipyretics
digital thermometers to measure body temperature, according to the dose.
and the Standard Operating Procedure (SOP). The Data were tested for normality by saphiro-
SOP is used to compress the mirror according to wilk test. Tepid sponge compressed pre-test group
Marni 2016, and the plaster is compressed was
according to PT. Hisamitsu. Pharma Indonesia, 0.023 (data is not normal) and the results of the
2016; Syltami, 2014. The measuring instrument post- test of tepid sponge compress were 0.013
uses data from variables that can be measured (data not normal). pre test and post test in tepid
through observation. When there is a typhoid fever sponge group is still not normal, so for bivariate
patient who complains of fever with a temperature analysis using Wilcoxon test, the results of
above 38 ºC normality test data in compress test plaster group is
– 39 ºC will be done the measurement of body 0.058 (normal data) and compress test plaster post
temperature (pretest) to determine the child's body test is 0.135 (normal data) so using dependent t
temperature by using a digital thermometer. After test, to find out whether there was a significant
the researcher conducted informed concent to difference between tepid sponge compresses and
parents the researchers took measures to give tepid compress plaster to decrease body temperature in
sponge compress or plaster compress to his child. typhoid fever patients using the Man Whitney test.
The action of compressing tepid sponge and plaster
compresses aims to reduce the temperature of RESEARCH RESULT
children who have a fever with a temperature In the process of collecting samples in the
above 38 ºC - 39 ºC. After the temperature tepid sponge compress group it took 11 days from
measurement and the patient is said to have a fever May 8- 18, 2017, while the sample collection
with a temperature above 38 ºC – 39 ºC, the patient process in the compress tape group took 12 days
will be given an intervention with a tepid sponge from May 20 to 31 2017.
compress from patients 1 - 12 and administration
of compress tape from patients 13-24. For patients Table 1. Comparison of Body Temperature
who were given an intervention compress tepid Before and After Done Compressing Tepid
sponge, the temperature of the water was prepared Sponge
first before compressing that is 30-35 ºC which
was measured using a water thermometer. While in
patients who were given compressed plaster, the
amount of compress tape was prepared according
to the client's needs. After the patient was given
intervention,
Compressing N Mean SD p-value
tepid sponge
Pre test 12 38,75 0,21 0,002
Post test 12 38,08 0,19
 Based on table 1. shows that the results of the DISCUSSION
analysis of the average body temperature before The results of the study on 12 children who
applying a sponge compress is 38.75 ºC, with a experienced typhoid fever showed an average body
standard deviation of 0.21. after being given a temperature before being given a tepid sponge
compressed tepid sponge of 38.08 ºC, with a compress that was 38.75 ºC after being given a
standard deviation of 0.19. There are differences in sponge compress at 38.08 ºC. All respondents who
body temperature before and after being given were given intervention in compressing the sponge
tepid sponge compresses (p value = 0.002 <α = experienced a decrease in temperature with an
0.05). average value of 0.67 ºC. Compress tepid sponges
using washcloth to wipe the face, neck, body,
Table 2. Comparison of Body Temperature hands and feet, continue with the back (back,
Before and After Provision of Compress Plaster buttocks, hands, thighs and legs) for 20 minutes.
Plaster kompres n Mean SD p-value The advantages of tepid sponge technique by
Pre test 12 38,80 0,19 0,004 wiping the body of the patient is the wider body
Post test 12 38,57 0,22 surface that is in contact with the compressing
medium (washcloth) so that it will be very
Based on table 2. In the compressed plaster effective in reducing fever quickly. Due to other
group it was seen that the average body factors, one of which is room temperature, where
temperature before being given compress plaster the temperature shift between humans and the
was 38.80 ºC, with a standard deviation of 0.19; environment or room temperature occurs mostly
after being given a compressive plaster of 38.57 through the skin (Tamsuri, 2012 in Mahdiyah,
ºC, with a standard deviation of 0.22. There are Rahman, and Lestari, 2015).
differences in body temperature before and after The results of this study used the Wilcoxon
being given a compress plaster (p value = 0.004 <α test and the results obtained p value = 0.002 with
= 0.05) α=
0.05 showed there was a difference in body
temperature after being given tepid sponge
Table 3. Differences in the Effectiveness of compresses with a difference in the average
Compressing Tepid Sponge and Compress decrease in body temperature of 0.67ºC. This is in
Plaster line with the research conducted by Setiawati
p- (2009) on "The effect of tepid sponge on
Variabel Groups n Mean SD decreasing body temperature and comfort in
value
Post children who have a fever in the nursery of
test Muhammadiyah Bandung Hospital" which states
12 38,08 0,19 that there are differences in temperature before and
tepid
Body 0,001 after the intervention of giving tepid sponge which
sponge
temperature compress was measured in the first 10 minutes after finishing
Post test the tepid sponge and the second measurement (30
compress 12 38,57 0,22 minutes after the first measurement) with p value =
plaster 0,000 <α = 0.05.
Body temperature displacement according to
Based on table 3. the average decrease in Asmadi (2008) is classified into 4, namely
body temperature in the tepid sponge compress radiation, conduction, convection, and evaporation.
group was At compress the tepid sponge release of heat
38.08 ºC with a standard deviation of 0.19, while occurs through evaporation from the skin
the average decrease in body temperature in the (Djuwariyah, 2011). Giving warm tepid sponge
compressed plaster group was 38.57 ºC with a compresses to the body will give a signal to the
standard deviation of 0.22. There were significant hypothalamus through the spinal cord. When
differences in the average decrease in body receptors that are sensitive to heat in the
temperature between tepid sponge compresses and hypothalamus are stimulated, the effector system
compress plaster in children with typhoid fever (p secretes signals that start sweating and peripheral
value = 0.004 <α = 0.05) vasodilation. Changes in the size of blood vessels
are regulated by the vasomotor center of the
medulla oblongata of the brain stem, under the
influence of the anterior hypothalamic causing
vasodilation. The occurrence of vasodilation will
cause heat dissipation through increased skin are difficult to dissolve in water. The presence of a
(sweating), it is expected that there will be a large water content in the hydrogel structure can be
decrease in body temperature so that it reaches a used to reduce fever through absorption of heat
normal state again. If body temperature rises, the (energy) from parts of the body that fever and
center of temperature regulation tries to reduce it, evaporate it (Darwis et al, 2010 in Mardiyah,
and vice versa (Nurwahyuni 2009, in Mohammad, Rahman, and Lestari, 2015).
2011 in Mahdiyah, Rahman, and Lestari, 2015). The results of the analysis of the average
The results of the study on 12 children who decrease in body temperature after the tepid
experienced typhoid fever obtained an average sponge compress was 38.08ºC while the average
body temperature before being given compress decrease in body temperature after the application
plaster was 38.80ºC after being given a compress of compress plaster was 38.57ºC obtained p value
plaster was 38.57ºC. All respondents given the =
intervention of compress plaster experience a 0.001 <α = 0.05, there was a difference in the
decrease in temperature with an average value of effectiveness of temperature reduction body on
0.23ºC. This is in accordance with Potter and tepid sponge compresses and compress plaster.
Perry's theory (2010, in Syltami 2014) saying that Effectiveness between tepid sponge compresses
fever occurs due to changes in setting points in the and compress plaster can be seen in the difference
hypothalamus. or viruses that increase body in the average decrease in body temperature, in
temperature one of which is the bacterium groups using compressed sponges, the average
Salmonella typhi. Nitrogen acts as an antigen that temperature decreased by 0.67ºC, whereas in the
triggers the immune system response. The plaster group compress is 0.23ºC. This proves that
hypothalamus will increase the setting point and tepid sponge compresses are more effective in
the body will produce heat. To reach the new lowering body temperature in febrile patients
setting point, it takes several hours. The results of diagnosed with typhoid fever. This difference is
the t-test depend on the results, p value = 0.004 <α also caused by other factors, one of which is room
= 0.05, there is a difference in body temperature in temperature, where body temperature can
children who have fever in typhoid fever patients experience exchange with the room or
after applying compress plaster with a flat environment, meaning that body heat can be lost or
difference the decrease in body temperature is reduced due to room temperature or cooler
0.23ºC. environment, and vice versa (Tamsuri, 2012 in
The results of this study are in line with Mardiyah, Rahman, and Lestari, 2015).
research by Fatkularini, Mardi, and Solechan Providing complete compresses according to
(2014) which states that there are differences in Kozier in Suprapti, 2008 in Syltami 2014, heat has
temperature before and after the intervention of a different effect on the body, the effect also
giving compress plaster with p value = 0,000 <α = depends on the duration of heat. Heat
0.05. The implementation of fever using compress administration of 15-30 minutes has a vasodilating
plaster is by how to attach plaster on the forehead, effect on blood vessels resulting in an increase in
armpits and groin (Mardiyah, Rahman, and Lestari, blood flow. Increased blood flow will reduce blood
2015). In this study, compress plaster was applied viscosity and local metabolism because blood flow
to the forehead, armpit, and thigh folds with a carries oxygen to the tissues. Compress with
frequency of 1 time for 20 minutes. Plaster temperature maintenance methods using liquids or
compresses help the blood vessels in the skin to tools that cause warm temperatures aims to
widen so that the pores become open which further facilitate blood circulation and provide a sense of
facilitates the removal of heat from the body, so comfort (Asmadi, 2008 in Fatkularini, Mardi, and
the body can experience a large drop in Solechan, 2014).
temperature (Djuwariyah, 2011 in Mardiyah, The effectiveness of tepid sponge compresses
Rahman, and Lestari, 2015). The ready-made in this study was supported by a previous study by
compress plaster is now widely circulated in the Syltami (2014) on "Comparison of the
community with disposable packaging. This effectiveness of tepid sponging and compress
compress plaster is made from hydrogel on plaster in reducing body temperature in children
polyacrylate-base with the content of parabens and under five who experienced a fever in Puskesmas
menthol formulated so as to accelerate the process Salaman 1" with p value = 0,002 <α = 0,05, which
of transferring heat from the body to compress means there is a difference in the decrease in body
plaster. Parabens are white crystals that dissolve temperature in toddlers after doing tepid sponging
easily in methanol, ethanol and and compress plaster. This is in line with the
research that was also by Ernawati about
"Comparison of plaster
 Sampling: In Medical and Health Research 3rd
compresses with warm tepid sponge compresses to
decrease in body temperature in Toddler children
(1-3 years) who have a fever in Flamboyan C
RSUD Kanudjoso Djatiwibowo Balikpapan "with
p value
= 0,000 <α = 0,05, so it can be concluded that there
are differences between the two groups after being
given intervention compress plaster and compress
warm tepid sponge.

CONCLUSION
The results of the study on the differences in
the effectiveness of tepid sponge compresses and
compress plaster on changes in body temperature
in school-aged children with typhoid fever in
Cibabat Hospital showed that there were
differences in body temperature before and after
applying tepid sponge compresses (Wilcoxon p
test value = 0.002 <α = 0
05) and the difference in temperature decrease is
0.67ºC. There was a difference in body
temperature before and after the application of
compress plaster (dependent t test p value = 0.004
<α = 0.05) and a difference in temperature
reduction of 0.23ºC. The provision of tepid sponge
compresses was more effective in lowering body
temperature compared to compressed plaster
(Mann-withney test with p value
= 0.001 <α = 0.05).

RECOMMENDED
For hospitals, it is better to set a standard
operating procedure for compressing the sponge to
intervencie in nursing care for children who have a
fever, especially typhoid fever because it has been
shown to have an effect on reducing the child's
body temperature. For nurses recommended tepid
sponge compresses can be used as an
implementation of self-care nursing to reduce body
temperature in patients with typhoid fever.

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