Exam 1 - Fever of unknown origin (FUO) Flashcards
What are the two definitions of FUO?
- Core body temp >/= 38.1 C (100.5 F) measured at least once daily for 14+ consecutive days and diagnosis not apparent after careful history, physical exam, and relatively simple, noninvasive tests
- Temp >38 C (101 F) or greater on several occasions of more than 3 weeks duration, and with failure to reach a diagnosis, despite one week of intense investigation
__% of FUO self resolve and thought to be due to ___ processes
25% of FUO self resolve and thought to be due to viral processes
When evaluating a patient with fever of unknown origin, what specialist should the FNP work closely with?
Infectious disease specialist
Components of HPI that should be collected during interview
Same as fever without source in addition to the following:
- History of fever pattern
- Family history of autoimmune disease or hereditary fever syndromes
- Family pets or exposure to animals
- Eating habits
- History of pica and travel
- Insects
Lab tests and diagnostics that should be ordered when evaluating FUO
- CBC w/ diff
- Blood culture
- BMP
- LIFT
- ESR
- CRP
- UA and urine culture
- Chest x-ray (if indicated)
When evaluating for FUO and labs return as normal, what are the FNPs next steps?
- Further workup required with infectious disease specialist
- Specific lab testing and imaging
- Ultrasound
- CT scant
- MRI
Is empiric treatment with antibiotics recommended in managing fever of unknown origin?
No - will delay diagnosis and mask symptoms
What is the drug of choice in managing fever in pediatrics - acetaminophen or ibuprofen?
Acetaminophen
What is the usual dosage of acetaminophen that can be given to children for fever management?
10-15 mg/kg q4-6h
- Should not exceed five doses in 24 hours
Does acetaminophen or ibuprofen have a longer duration of action?
Ibuprofen
Ibuprofen should be used for infants and children of what ages?
6 months to 12 years old
What is the usual dose of ibuprofen given to children with a temp <102.5 F?
5 mg/kg q6-8h
What is the usual dose of ibuprofen given to children with a temp >102.5 F?
10 mg/kg q6-8h
What is the maximum daily dose of ibuprofen?
40 mg/kg
Antipyretic education
- Adequate hydration
- Do not bundle (will raise temp)
- Tepid bath water only is temp >104 F
- No ASA d/t Reyes syndrome