Chapter 6 - Fever Flashcards
1
Q
Fever
A
- 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
2
Q
Hyperthermia
A
- Malfunctioning of normal thermoregulatory process
- Due to excessive heat exposure or production
3
Q
Hyperprexia
A
- Body temperature exceeding 106 degrees Fahrenheit
- Causes mental and physical damage
- Can stem from fever or hyperthermia
4
Q
Fever Pathophysiology
A
- 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
5
Q
Fever Clinical Presentation
A
- 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
6
Q
Fever Detection
A
- 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
7
Q
Thermometer Types + Fever Temperatures
A
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
8
Q
Fever Complications
A
- 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
9
Q
Fever Treatment
A
- 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
10
Q
Fever Treatment Goal
A
Alleviate Discomfort
11
Q
Treatment Approach
A
- Antipyretics
- Good for self-care, but good to get a medical evaluation first to identify cause of fever
12
Q
Fever Nonpharmacologic Treatment
A
- 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)
13
Q
Fever Pharmacologic Treatment
A
- 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
14
Q
APAP - Fever
A
- 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
15
Q
Ibuprofen - Fever
A
- 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
