Question 1

Fever

Accepted Answer

- Most common reason for visits to pediatrician office - Leading cause of visits to ER in children 15 y.o. and younger - Self-limited and nonthreatening but can cause great discomfort and can indicate serious underlying conditions - Defined by body temperature exceeding 100 degree Fahrenheit - Body temperature is regulated by the hypothalamus and increases in response to pyrogens

Question 2

Hyperthermia

Accepted Answer

- Malfunctioning of normal thermoregulatory process - Due to excessive heat exposure or production

Question 3

Hyperprexia

Accepted Answer

- Body temperature exceeding 106 degrees Fahrenheit - Causes mental and physical damage - Can stem from fever or hyperthermia

Question 4

Fever Pathophysiology

Accepted Answer

- Skin temperature can vary widely but the core temperature should be within a narrow range - Pyrogens - fever producing substances that activate host defenses and increase set point - Can be exogenous (toxins or foreign invaders) or endogenous (from damaged tissue) - Need endogenous to reset temperature, exogenous can't do it alone - PGE2 reacts to circulating pyrogens and interacts with hypothalamus to raise the core temperature - Can be from infection, drugs, vigorous activity, or idiopathic, and much more - Fever isn't as pronounced in the elderly and children

Question 5

Fever Clinical Presentation

Accepted Answer

- Symptoms are nonspecific making it hard to determine symptomatically - Accurate temperature measurement is PARAMOUNT - Investigation into cause of fever is also important and needs to be treated over the fever alone - Discomfort, headache, malaise, chills, tachycardia, myalgia, irritability, anorexia can all accompany fever - If children are still alter and play normally, the fever isn't much of a concern

Question 6

Fever Detection

Accepted Answer

- Subjective - feeling part of the body for warmth - Thermometer - most accurate method to detect a rise in core temperature - Various types: rectal, axillary, oral, temporal, and tympanic - Rectal is considered gold standard but isn't patient preferred - Don't use glass/mercury thermometers - High temperatures occur in the late afternoon and early evening - Infared (less evasive, tympanic & temporal), electronic (pen or pacifier), and color changing (less accurate) thermometers are also available in certain situations

Question 7

Thermometer Types + Fever Temperatures

Accepted Answer

``` Rectal: > 100.4 F Oral: > 99.7 F Axillary: > 99.3 F Tympanic: > 100.0 F Temporal: > 100.1 F ``` Oral + 1 = Rectal, Tempanic, and Temporal Oral - 1 = Axillary

Question 8

Fever Complications

Accepted Answer

- Risk factors are rare but may include acute complications like seizures, dehydration, muscle damage, and mental status change - Seizure can occur, but isn't a huge concern in children unless it is recurring - Serious detrimental effects are more common in hyperpyrexia - Those who can't dissipate heat well, like the elderly, are at a great risk of complications

Question 9

Fever Treatment

Accepted Answer

- Should focus on the cause rather than the fever itself - Most are short duration and can be host-defense benefits, so treating is mainly to increase the benefit:risk and decrease discomfort - Due to possible benefits, preferred to not treat when possible

Question 10

Fever Treatment Goal

Accepted Answer

Alleviate Discomfort

Question 11

Treatment Approach

Accepted Answer

- Antipyretics - Good for self-care, but good to get a medical evaluation first to identify cause of fever

Question 12

Fever Nonpharmacologic Treatment

Accepted Answer

- Fluid intake to prevent dehydration - Sponge bath and ice baths only for extreme temperatures about 104 F - Wear light weight clothing, maintain a comfortable room temperature, remove blankets - Increase fluids by 30-60 mL/hour in kids - Increase fluids by 60-120 mL/hour in adults - If diarrhea is present, avoid high sugar fluids (Gatorade)

Question 13

Fever Pharmacologic Treatment

Accepted Answer

- Antipyretics inhibit PGE2 synthesis by inhibiting COX enzyme - APAP and Ibuprofen are most commonly used - Don't use either for more than 3 days for fever - Can have duplicate therapy and inappropriate dosing easily

Question 14

APAP - Fever

Accepted Answer

- Achieved temperature reduction in 2 hours - Kid Dosing: 10-15 mg/kg q 4-6 h, max of 75 mg/kg/day - Adult Dosing: 325-1000 mg q 4-6 h, max of 4000 mg/day in adults - Loading dose is controversial - Available as a suppository as well but not reliable

Question 15

Ibuprofen - Fever

Accepted Answer

- Most common NSAID for fever - Max temperature reduction in 2 hours - Kid Dosing: 5-10 mg/kg q 6-8 h, max of 4 doses/day - Adult Dosing: 200-400 mg q 4-6 h max 1200 mg/day

Chapter 6 - Fever Flashcards