Exam 3 - Fever Flashcards
What is the leading cause of ED visits for those under 15
Fever
Where is body temperature regulated
Hypothalamus
Why do we get fevers
The body’s defense against infection - a sign your body is fighting
What is hyperpyrexia
When body temp is over 106
What is hyperthermia
Malfunctioning of normal hypothalamus level from excess heat exposure
NOT the same treatment as fever
What are pyrogens
Any substance that increases the body temperature and activates the body’s host defense
What symptoms are associated w/ hyperpyrexia
Mental and physical symptoms
What can cause hyperpyrexia
Fever or hyperthermia
What is an oral temperature over 100 caused by
Pyrogen
What is the range for a normal body temp
97.5 - 98.9
What is the principal reason to treat a fever w/ an OTC
Alleviate discomfort
DO NOT use to treat a specific temp
What population has the highest response to pyrogens
Children
Temperatures under ____ is unlikely to be a concern in young adults
103
What is a common sign of fever
Chills
What causes chills w/ a fever
Vasoconstriction and muscle rigidity
(Vasoconstriction reduces blood flow, making you cold. Muscle rigidity makes you cold because muscles are warmer when they are being moved)
What is a subjective way to detect a fever
Feel the forehead or cheek
*not accurate
Thermometers are considered ____
Medical devices
When should you NOT use an oral thermometer to check a patient’s temp
Recent oral surgery
Mouth breathing
Hyperventilation
Not fully alert
Uncooperative/confused
Children under 3
What is the gold standard for taking temp
Rectal
What is considered a normal temperature when measured rectally
97.9 - 100.4
When monitoring temperature, it is important to use…
The same thermometer and the same spot of measurement
What is considered a normal temperature when measured orally
95.9 - 99.5
What is considered a fever when measured rectally
> 100.4
What is considered a fever when measured orally
> 99.5
What is considered a normal temperature when measured via axillary route
94.5 - 99
What is considered a fever when measured via axillary route
> 99
What is considered a normal temperature when measured via tympanic route
96.3 - 100.4
What is considered a fever when measured via tympanic route
> 100.4
What is considered a fever when measured via temporal route (age groups)
0-2 months: > 100.7
3-47 months: 100.3
Older than 4 years: > 100.1
(47 months = almost 4 years)
What is considered a normal temperature when measured via temporal route
97.9 - 100.1
List all normal temperature and fever ranges for all routes of temperature measurement
Rectal:
- normal = 97.9 - 100.4
- fever = > 100.4
Oral:
- normal = 95.9 - 99.5
- fever = > 99.5
Axillary:
- normal = 94.5 - 99
- fever = > 99
Tympanic:
- normal = 96.3 - 100.3
- fever = > 100.4
Temporal:
- normal = 97.9 - 100.1
- fevers:
— 0-2 months = > 100.7
— 3-47 months = > 100.3
— above 4 years = > 100.1
Where is an electronic probe used
Oral
Rectal
Axillary
How long does it take to get a reading from an electronic probe
10 - 60 seconds
When can you start using tympanic thermometers
At 6 months of age
Why should we avoid axillary temperature readings if possible
They are not reliable and have large variations
At what rectal temperature should you take an infant younger than 4 months old to the ER
> 100.4
What causes febrile seizures
No defined cause
At what axillary temperature should you take an infant younger than 4 months old to the ER
> 99
At what oral temperature should you take an infant younger than 4 months old to the ER
> 99.5
What % of children from ages 6 months to 5 years old have a febrile seizure
2-5%
When do the chances for having a febrile seizure peak
18-24 months
What increases the risk of febrile seizures
How fast the fever comes and how high the fever is
What raises the risk of reoccurrence of a febrile seizure
If younger than 1 year when first seizure occurs and a family history of epilepsy
After one seizure, what happens to the risk of developing epilepsy, impaired movement, and other neurologic disorders
Unlikely that risk will change
What does the American Academy of Pediatrics NOT recommend use for prophylactic treatment of febrile seizures
Anti-epileptics
Antipyretics
What is recommended for comfort when there is a risk of febrile seizures
Antipyretics
When can febrile seizures return
If the child has another fever
What OTC can prevent febrile seizures
NONE
Antipyretics can reduct fever, but will not prevent seizure
When should we suspect a pt may have a drug fever
In patients that don’t have an obvious source of fever
What is drug fever
Febrile response to admin of medication
If hyperthermia is due to a drug, when should the fever decrease
24-72 hrs within stopping agent
How can we detect that a fever is caused by a drug
Note the relationship between the fever and admin of medication
Note the temp elevation despite clinical improvement
What two OTC drugs can cause fever
Cimetidine
Salicylates
Should we reduce fever before vaccines
Currently not recommended to use antipyretics before or after vaccination
However, symptomatic fevers after vaccination should be treated
What are serious complications of fever
- Seizures
- Coma
- Irreversible neurologic/muscle damage
- Dehydration
- Delirium
(SCIDD)
Who is most at risk for serious complications from fever
Infants
Elderly
What causes infants and elderly to be most at risk for serious complications from a fever
- Dehydration
- Decreased sweating capacity
- Fever increases oxygen demand, elderly tend to have COPD or CHF
General treatment rules for fevers over 101
Use both non-drug and oral antipyretics
General treatment rules for fevers under 101
Treat if pt is uncomfortable/elderly
Goals for treating fever
- find and remove cause
- decrease discomfort caused by the fever
- use treatment when benefits outweigh risk
What are the exclusions to self treatment of fever in adults
Vomiting
Hyperthermia risk/fever for > 3 days
Stiff neck
Diarrhea
Severe headache
CNS damage
Rash
Immunocompromised
Sore throat
Pt on steroids
Impaired oxygen (COPD, CHF)
Ear pain
Rectal fever over 104
(Very Hot Snacks Do Seem CRISPIER)
What are the exclusions to self care treatment of fever in children
Very sleepy
Hard to wake up
Fever over 104
Irritable
Looks very ill, drowsy, fussy
Overheated/had seizure previously
Less than 6 mo w/ rectal temp >104
Vomiting/diarrhea
Fever > 24 hrs in child under 2
Spots/rash
Fever > 3 days in child 2+ yrs
Refuses to drink
(Very High Fevers In Little Ones Look Very Fucking Scary, For Real)
What rectal temperature excludes children under 6 months from self care
> 100.4
What are some non-pharm options for fever treatment
Lightweight clothing
Decrease room temp
Fluid intake increase
When can sponging be considered for a fever
When oral temp is > 104 and 1 hr after a dose of oral med
Why should you not bathe someone w/ a fever in water or alcohol
Can increase body temp because of shivering
Uncomfortable and can be dangerous
Does not reduce the body’s temp set point
How much should fluid be increased for adults w/ fever
60-120 mL per hour
How much should fluids be increased in children w/ fever
30-60 mL/hr
What are some good fluid choices for someone w/ fever
Sports drinks
Fruit juice
Balanced electrolyte
Water
