| Course | NUR-4220 Nursing Care of Infants, Children, and Adolescents |
|---|---|
| Module | Module 2 |
| Paper type | Pediatric nursing paper: the febrile young infant |
| Length | About 1,043 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 4220 Module 2
38.4 at Five Weeks: Sorting Low Risk From High Risk in a Febrile Infant
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-4220: Nursing Care of Infants, Children, and Adolescents
Mentor Name
Month Day, Year
38.4 at Five Weeks: Sorting Low Risk From High Risk in a Febrile Infant
The Patient
Baby Mateo is invented for this paper. He is 5 weeks old, born at 39 weeks after a healthy pregnancy. His mother noticed he felt warm and took his temperature rectally at home: 38.4. In the emergency department he was alert, feeding well, pink and well perfused, with a normal heart rate for his temperature and no obvious source of fever. His parents were frightened; they had read that fever in young babies can be dangerous.
Why Young Infants Are Different
Infants in the first two months have immature immune systems and may have serious bacterial infections, such as urinary tract infection, bloodstream infection or meningitis, with few signs beyond fever. Most febrile infants have viral illnesses, but a minority have bacterial infections, and the rate is higher in the youngest. Clinicians must balance the risk of missing a dangerous infection against the harms of testing and treating every infant, including painful procedures, antibiotic exposure and hospital stays.
The 2021 Guideline
Pantell et al. (2021) published the American Academy of Pediatrics guideline on evaluating infants who look well, are between 8 and 60 days old and have a temperature of 38.0 Celsius or higher. It separates infants into three age groups, days 8 through 21, days 22 through 28 and days 29 through 60, since the risk of serious infection declines as infants grow. For all groups it recommends a urinalysis and blood culture. Inflammatory markers, such as procalcitonin, absolute neutrophil count and C-reactive protein, guide decisions about lumbar puncture, antibiotics and admission in the older groups. Infants 8 to 21 days are generally evaluated more fully and admitted. Infants 29 to 60 days with normal inflammatory markers and urinalysis can often be managed without a lumbar puncture and observed at home with close follow-up, if families can return reliably.
Validated Risk Rules
Kuppermann et al. (2019) derived and validated a prediction rule in the Pediatric Emergency Care Applied Research Network for infants 60 days and younger. Infants were classified as low risk for serious bacterial infection if they had three results together: a clean urinalysis and blood neutrophil and procalcitonin values below the rule's cut points. In validation, the rule identified nearly all infants with serious bacterial infections and missed very few.
Gomez et al. (2016) validated the European Step-by-Step approach in more than 2,000 febrile infants 90 days and younger. The approach evaluates general appearance first, then age, then urinalysis, then procalcitonin, then C-reactive protein and neutrophil count. It identified a low-risk group in which invasive bacterial infection was rare and performed better than older criteria.
| Source | Key point | Nursing application |
|---|---|---|
| Pantell et al. (2021) | Evaluation by age group; urinalysis and blood culture for all | Know which tests each age group needs |
| Kuppermann et al. (2019) | Low risk if urinalysis negative and neutrophils and procalcitonin under thresholds | Obtain specimens accurately and promptly |
| Gomez et al. (2016) | Step-by-step evaluation identifies low-risk infants | Appearance first; report any change |
Nursing Diagnoses
The student identified risk for infection-related deterioration, acute pain related to procedures and anxiety in the parents related to uncertainty about the cause of fever.
Nursing Care
The student confirmed the fever with a rectal temperature, the most accurate method in young infants, and recorded vital signs and appearance at regular intervals, since a change from well-appearing to ill-appearing would move Mateo into a higher-risk category. A urine sample was collected by catheter, which gives a reliable result in infants, rather than by bag, which is easily contaminated. Blood was drawn for a culture, complete blood count and procalcitonin.
To reduce pain, the student offered sucrose solution on a pacifier and encouraged his mother to hold him skin to skin or breastfeed during and after procedures where possible. Swaddling and facilitated tucking helped him settle.
Results and Decision
Mateo's urinalysis was negative, his absolute neutrophil count was 3,200 and his procalcitonin was 0.2. By the guideline and the PECARN rule, he was at low risk. The physician discussed options with his parents: observation at home with a recheck in 24 to 36 hours and blood culture monitoring, or admission. Because they lived ten minutes away, had a car and a phone and were comfortable with the plan, they chose home observation.
Talking With Worried Parents
Mateo's parents had read online that fever in a newborn means meningitis. The student explained the steps in plain language before each test, what each result would mean and why the team might not need a lumbar puncture if his results were reassuring. Giving them a role, holding and feeding him, eased their fear and helped him settle. The student also explained that a fever-reducing medicine would not be given before the evaluation, since it could hide how he was doing.
What If He Had Looked Ill
The plan would have been very different if Mateo had appeared ill, with poor color, lethargy or poor feeding. Ill-appearing infants of any age need a full evaluation, including a lumbar puncture, and prompt antibiotics. The student learned that the nurse's repeated description of appearance is one of the most important pieces of information the team uses.
Discharge Teaching
The student taught the parents to measure his temperature rectally, to watch for warning signs such as poor feeding, fewer wet diapers, unusual sleepiness, irritability, breathing problems or color change and to return immediately if any appeared. The student confirmed their phone number for culture results and the time of the follow-up visit.
Evaluation
At the 24-hour recheck, Mateo's fever had resolved, his blood culture showed no growth and he was feeding well. His symptoms fit a viral illness.
Limits
Prediction rules perform best when applied as validated; procalcitonin may not be available everywhere. The guideline applies to well-appearing infants. A student assists with specimens and teaching but does not decide disposition. Mateo is invented.
Conclusion
Fever in a young infant calls for structured evaluation. The 2021 guideline set the steps by age, and the PECARN rule and Step-by-Step approach showed how laboratory markers identify infants at low risk. Accurate temperatures and specimens, comfort during procedures, close watching for any change in appearance and clear teaching for parents made a safe plan for home observation possible.
References
Gomez, B., Mintegi, S., Bressan, S., Da Dalt, L., Gervaix, A., & Lacroix, L. (2016). Validation of the "Step-by-Step" approach in the management of young febrile infants. Pediatrics, 138(2), Article e20154381. https://doi.org/10.1542/peds.2015-4381
Kuppermann, N., Dayan, P. S., Levine, D. A., Vitale, M., Tzimenatos, L., Tunik, M. G., Saunders, M., Ruddy, R. M., Roosevelt, G., Rogers, A. J., Powell, E. C., Nigrovic, L. E., Muenzer, J., Linakis, J. G., Grisanti, K., Jaffe, D. M., Hoyle, J. D., Greenberg, R., Gattu, R., . . . Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network. (2019). A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections. JAMA Pediatrics, 173(4), 342-351. https://doi.org/10.1001/jamapediatrics.2018.5501
Pantell, R. H., Roberts, K. B., Adams, W. G., Dreyer, B. P., Kuppermann, N., O'Leary, S. T., Okechukwu, K., Woods, C. R., Byington, C. L., Lavelle, J. M., Lye, P. S., Macy, M. L., Munoz, F. M., Nelson, C. E., Pearson, S. J., Powell, K. R., & Teichman, J. S. (2021). Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics, 148(2), Article e2021052228. https://doi.org/10.1542/peds.2021-052228
NUR 4220 Module 2 instructions, in plain terms
Age-appropriate assessment and acute illness in infants both appear in TESU's NUR-4220 catalog paragraph, and since no syllabus is posted publicly, module two is planned as a paper on the febrile young infant. Describe the infant's age, temperature, appearance and history, explain why young infants are evaluated differently and set out the national guideline by age group. Report at least one validated risk rule, write nursing diagnoses and describe accurate temperature measurement, specimen collection, pain relief during procedures and close observation. Then explain the shared decision about disposition, including the family's ability to return, and the discharge teaching. Some sections assign fever in older children instead. Check whether your instructor wants the risk rule thresholds listed in full. Describe what the plan would have been if the infant had looked ill.
How the NUR 4220 Module 2 example is put together
A fictional 5-week-old with a rectal temperature of 38.4 looks well in a Morristown emergency department while his parents worry. The paper explains why young infants are evaluated differently, then summarizes Pantell and colleagues' guideline, the PECARN rule and the Step-by-Step approach with the nursing step each one requires, in a table. Diagnoses, a confirmed rectal temperature, a catheter urine sample, blood tests, sucrose and skin-to-skin contact for pain, results that place him at low risk, a shared decision for home observation based on the family's access, discharge teaching, evaluation at 24 hours, limits and a conclusion follow. Sections on talking with worried parents and on what would change for an ill-appearing infant are included.
Reading the NUR 4220 Module 2 grading rubric
Febrile infant papers stand out when they explain why age matters, report the guideline's age groups accurately and describe a validated risk rule with its laboratory thresholds. Readers look for nursing accuracy that feeds these rules, such as rectal temperatures and catheter urine samples, and for repeated assessment of appearance. Comfort measures during procedures, including sucrose and skin-to-skin contact, show family-centered care. Attention to whether a family can return, and clear warning signs at discharge, show awareness of the social factors behind a safe plan. Leaving disposition to the physician shows a sound sense of scope. Explaining why fever reducers are held before evaluation shows careful thinking.
Common NUR 4220 Module 2 mistakes, and how to avoid them
Papers on febrile infants often list tests without explaining why the youngest infants need more; start with age and appearance. Another frequent gap is ignoring how specimens are collected, even though a contaminated bag urine can mislead the whole evaluation. Describe temperature measurement, catheter urine and blood tests, pain relief and repeated checks of appearance. Explain the risk rule's results and the shared decision, including the family's ability to return. Teach warning signs clearly. Your case and the module prompt are enough for us to prepare a free first draft. Explain each test before it happens and give parents a role.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4220 Module 2 questions, answered
Where can I find a free NUR 4220 Module 2 sample paper?
The febrile infant paper about a fictional 5-week-old in a Morristown emergency department is reproduced in full here.
Which infants does the 2021 AAP febrile infant guideline cover?
Infants between 8 and 60 days of age who look well and have a temperature of at least 38.0 Celsius.
What makes an infant low risk under the PECARN rule?
A clean urinalysis together with neutrophil and procalcitonin results under the rule's set cut points.
Why collect infant urine by catheter?
Bag samples are easily contaminated, while catheter samples give reliable results for diagnosing urinary infection.
How can nurses reduce pain during infant procedures?
Sucrose on a pacifier, skin-to-skin contact or breastfeeding, swaddling and facilitated tucking.