Exam 3: Fever Flashcards
Thermoregulation: Avg oral temperature
98.6F (37C), can range from 97.5-98.9F
Highest late afternoon/early evening
Thermoregulation: Regulated by ____
Hypothalamus
Thermoregulation: Balance between heat generated from body’s ___ and heat dissipated from ____
body’s metabolism
dissipated from skin and lungs
T/F: Thermoregulation: Skin temp may change from external factors but core temp does not
True – skin temp may change from external factors like outside temp but core temp is regulated by hypothalamus
Fever def
Oral temp of >100.3F (before taking antipyretic meds)
Fever is the body’s response to _____
a pyrogen in which the set point of the hypothalamus is adjusted upwards (boosting immune system to kill off bacteria, etc.)
Fever: body diverts blood away from ___ toward ____ by vasoconstricting peripheral vessels.
away from extremities toward internal organs
pt feels cold – core temp rises but extremities are colder
Fever is often accompanied by:
chills, headache, sweating, flushed face, malaise, tachycardia, arthralgia, myalgia, irritability, anorexia
chills and malaise most common
Hyperthermia symptoms
hot dry skin, CNS dysfxn, delirium convulsions, coma
**fever is NOT hyperthermia
Diff between fever and hyperthermia
Hyperthermia - Pathologic condition where hypothalamic set pt does not change, but heat production exceeds capacity of body to dissipate it
Hyperthermia: serious damage can occur when temp > ___
> 41C (105.8F)
Causes of Fever
Infxn, medications abx: penicillin, macrolides, tetracycline CV: nifedipine, methyldopa, quinidine CNS: SSRIs, SNRIs, lithium, TCAs Chemo: daunorubicin, bleomycin
Temp assessment: Oral
Not recommended in children <4 yo
Wait 15 min after eating/drinking to measure oral temp
Temp assessment: Rectal
About 0.7-0.9F higher than oral
Most accurate method in children <4yo
Temp assessment: axillary (armpit)
About 1F lower than other methods (may not be as accurate)
If >99F then recheck with another method
Temp assessment: tympanic (ear)
About 1.4F higher than oral
Ok to use in children >6 months (<6 months not recommended due to diff ear shape??)
Temp assessment: temporal (forehead)
Convenient
Must be used correctly for accuracy
Can be affected by perspiration (if sweating, reading may not be accurate)
Treating Fevers
Usually not a problem
More to alleviate discomfort of pt (NOT # of temp)
Fever: Self-care exclusions
<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
Non-pharmacologic treatment of fevers
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)
Fever meds: Acetaminophen (Tylenol): MOA
Antipyretic and analgesic
Fever meds: Acetaminophen (Tylenol): Dosing: Children
Weight <60
160mg/5ml oral solutions
10-15mg/kg/dose PO q4-6h PRN
Max dose 5 doses/day
Fever meds: Acetaminophen (Tylenol): Adult dosing
650mg PO q4-6hrs PRN
Max: 3250mg/day
Fever meds: Acetaminophen (Tylenol): ADE
rare hepatotoxicity at antipyretic doses (>4g, max dose decreased to 3250mg to prevent hepatotoxicity)
Fever meds: Ibuprofen (Motrin, Advil): MOA
Antipyretic, analgesic, anti-inflammatory
Fever meds: Ibuprofen (Motrin, Advil): Pediatric Dosing
<12 yo (do NOT use in infants <6 months)
100mg/5ml oral suspension
10mg/kg/dose PO q6-8h PRN
Max 4 doses/day
Fever meds: Ibuprofen (Motrin, Advil): Adult dosing
200-400mg PO q6h PRN
Max 1200mg/day
Fever meds: Ibuprofen (Motrin, Advil): ADE
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)
T/F: You should wake up sleeping pt to take fever meds
False - if they are comfortable enough to sleep then let them sleep
T/F: You should alternate therapies between Tylenol and Motrin to decrease temp more
No – technically decreases temp more but can increase med errors and we are treating discomfort, not temp
T/F: You can use adult fever medications for children
DO NOT use adult medications for children
Refer to PCP if with self-care treatment fever lasts:
> 24h for children <2yo
3 days for children >2yo
**may indicate infxn/need for abx
