Exam 3: Fever

Question 1

Thermoregulation: Avg oral temperature

Answer 1

98.6F (37C), can range from 97.5-98.9F

Highest late afternoon/early evening

Question 2

Thermoregulation: Regulated by ____

Answer 2

Hypothalamus

Question 3

Thermoregulation: Balance between heat generated from body’s ___ and heat dissipated from ____

Answer 3

body’s metabolism

dissipated from skin and lungs

Question 4

T/F: Thermoregulation: Skin temp may change from external factors but core temp does not

Answer 4

True – skin temp may change from external factors like outside temp but core temp is regulated by hypothalamus

Question 5

Fever def

Answer 5

Oral temp of >100.3F (before taking antipyretic meds)

Question 6

Fever is the body’s response to _____

Answer 6

a pyrogen in which the set point of the hypothalamus is adjusted upwards (boosting immune system to kill off bacteria, etc.)

Question 7

Fever: body diverts blood away from ___ toward ____ by vasoconstricting peripheral vessels.

Answer 7

away from extremities toward internal organs

pt feels cold – core temp rises but extremities are colder

Question 8

Fever is often accompanied by:

Answer 8

chills, headache, sweating, flushed face, malaise, tachycardia, arthralgia, myalgia, irritability, anorexia

chills and malaise most common

Question 9

Hyperthermia symptoms

Answer 9

hot dry skin, CNS dysfxn, delirium convulsions, coma

**fever is NOT hyperthermia

Question 10

Diff between fever and hyperthermia

Answer 10

Hyperthermia - Pathologic condition where hypothalamic set pt does not change, but heat production exceeds capacity of body to dissipate it

Question 11

Hyperthermia: serious damage can occur when temp > ___

Answer 11

> 41C (105.8F)

Question 12

Causes of Fever

Answer 12

Infxn, medications 
abx: penicillin, macrolides, tetracycline
CV: nifedipine, methyldopa, quinidine
CNS: SSRIs, SNRIs, lithium, TCAs
Chemo: daunorubicin, bleomycin

Question 13

Temp assessment: Oral

Answer 13

Not recommended in children <4 yo

Wait 15 min after eating/drinking to measure oral temp

Question 14

Temp assessment: Rectal

Answer 14

About 0.7-0.9F higher than oral

Most accurate method in children <4yo

Question 15

Temp assessment: axillary (armpit)

Answer 15

About 1F lower than other methods (may not be as accurate)

If >99F then recheck with another method

Question 16

Temp assessment: tympanic (ear)

Answer 16

About 1.4F higher than oral

Ok to use in children >6 months (<6 months not recommended due to diff ear shape??)

Question 17

Temp assessment: temporal (forehead)

Answer 17

Convenient
Must be used correctly for accuracy
Can be affected by perspiration (if sweating, reading may not be accurate)

Question 18

Treating Fevers

Answer 18

Usually not a problem

More to alleviate discomfort of pt (NOT # of temp)

Question 19

Fever: Self-care exclusions

Answer 19

<6months with rectal temp ≥101F
>6months with rectal temp ≥104F
s/sx of hyperthermia
s/sx of severe infxn
Comorbidities: COPD, HF, respiratory distress, cancer, HIV
CNS: head trauma, stroke, hx of febrile seizures
Children with rash, risk of dehydration, excessive drowsiness

Question 20

Non-pharmacologic treatment of fevers

Answer 20

Hydration - aim for 1-2oz (children) or 3-4oz (adults) of non-caffeinated fluid/hr
Lightweight clothing and comfortable room temp
sponging not recommended at temp <104 (esp with alcoholic solutions - can cause alcohol poisoning in children and infants)

Question 21

Fever meds: Acetaminophen (Tylenol): MOA

Answer 21

Antipyretic and analgesic

Question 22

Fever meds: Acetaminophen (Tylenol): Dosing: Children

Answer 22

Weight <60
160mg/5ml oral solutions
10-15mg/kg/dose PO q4-6h PRN
Max dose 5 doses/day

Question 23

Fever meds: Acetaminophen (Tylenol): Adult dosing

Answer 23

650mg PO q4-6hrs PRN

Max: 3250mg/day

Question 24

Fever meds: Acetaminophen (Tylenol): ADE

Answer 24

rare hepatotoxicity at antipyretic doses (>4g, max dose decreased to 3250mg to prevent hepatotoxicity)

Question 25

Fever meds: Ibuprofen (Motrin, Advil): MOA

Answer 25

Antipyretic, analgesic, anti-inflammatory

Question 26

Fever meds: Ibuprofen (Motrin, Advil): Pediatric Dosing

Answer 26

<12 yo (do NOT use in infants <6 months)
100mg/5ml oral suspension
10mg/kg/dose PO q6-8h PRN
Max 4 doses/day

Question 27

Fever meds: Ibuprofen (Motrin, Advil): Adult dosing

Answer 27

200-400mg PO q6h PRN

Max 1200mg/day

Question 28

Fever meds: Ibuprofen (Motrin, Advil): ADE

Answer 28

Ulcers/GI bleeding, fluid retention/edema, nephrotoxicity

Caution in pts with preexisting renal/cardiac disease or those who are dehydrated (NSAID can worsen renal insufficiency)

Question 29

T/F: You should wake up sleeping pt to take fever meds

Answer 29

False - if they are comfortable enough to sleep then let them sleep

Question 30

T/F: You should alternate therapies between Tylenol and Motrin to decrease temp more

Answer 30

No – technically decreases temp more but can increase med errors and we are treating discomfort, not temp

Question 31

T/F: You can use adult fever medications for children

Answer 31

DO NOT use adult medications for children

Question 32

Refer to PCP if with self-care treatment fever lasts:

Answer 32

> 24h for children <2yo
3 days for children >2yo

**may indicate infxn/need for abx