Fever

Question 1

Average oral Temp

Answer 1

98.6 ∘ F (37 ∘ C)

Can range from 97.5 ∘ F to 98.9 ∘ F

Question 2

Oral temp is highest

Answer 2

in late afternoon/early evening

Question 3

Hypothalamus

Answer 3

Balance between heat generated from body’s metabolism and heat dissipated from skin & lungs

Question 4

Fever is defined as

Answer 4

oral temperature > 100.3 degrees F

Question 5

Body diverts blood away from extremities toward internal organs by _______ peripheral vessels, so the patient feels cold

Answer 5

vasocontricting

Question 6

Fever may be accompanied by

Answer 6

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

Question 7

Hyperthermia (heat stroke)

Answer 7

a pathologic condition where the hypothalamic set point does not change, but heat production exceeds the capacity of the body to dissipate it

Question 8

Symptoms of hyperthermia

Answer 8

Hot dry skin, CNS dysfunction, delirium, convulsions, coma

Serious damage occurs when temp > 105.8 F (41 C)

Question 9

Fever can be caused by

Answer 9

Infection

Medication: antibiotics, cardiovascular drugs, CNS agents, Chemotherapeutics

Question 10

Taking temp: Oral

Answer 10

Not recommended in children < 4 years old

Wait 15 minutes after eating or drinking to measure oral temperature

Question 11

Taking temp: Rectal

Answer 11

About 0.7-0.9°F higher than oral

Most accurate method in children younger than 4 years

Question 12

Taking Temp: Axillary

Answer 12

About 1° lower than other methods
May not be as accurate as other methods
If >99° then recheck with another method to confirm

Question 13

Taking Temp: Tympanic

Answer 13

About 1.4°F higher than oral

Ok for use in children > 6 months old

Question 14

Taking Temp: Temporal

Answer 14

Convenient

Must be used correctly for accuracy- follow instructions for the specific thermometer being used

Question 15

Goal of treating fever

Answer 15

Patient comfort

Question 16

Self care exclusions

Answer 16

Age < 6 months and rectal temperature (or equivalent) ≥ 101 ∘ F
Age >6 months and rectal temperature (or equivalent) ≥ 104 ∘ F
Signs/symptoms of hyperthermia
Signs/symptoms of severe infection
Comorbidities: COPD, heart failure, respiratory distress, cancer, HIV
CNS: head trauma, stroke, history of febrile seizures
Children with: rash, risk of dehydration, excessive drowsiness

Question 17

Non-pharm treatment of fever

Answer 17

Hydration: 1-2 children or 3-4 adults oz of fluid

lightweight clothing and comfortable room

Question 18

Acetaminophen brand names

Answer 18

Tylenol

Question 19

Acetaminophen MOA

Answer 19

antipyretic and analgesic

Question 20

Acetaminophen pediatric dosing

Answer 20

Formulation: 160mg/5ml oral suspension

Dose: 10-15mg/kg PO per dose every 4-6 hours PRN, max 5 doses/day

Question 21

Acetaminophen Adult dosing

Answer 21

650mg PO every 4-6 hours PRN max 3250mg/day

Question 22

Acetaminophen ADEs

Answer 22

Rare hepatotoxicity at antipyretic doses

Question 23

Ibuprofen brand names

Answer 23

Motrin, Advil

Question 24

Ibuprofen MOA

Answer 24

antipyretic, analgesic, anti-inflammatory

Question 25

Ibuprofen Pediatric dosing

Answer 25

Formulation: 100mg/5ml oral suspension
Dose: 10mg/kg PO per dose every 6-8 hours PRN, max 4 doses per day
Do not use in infants< 6 months

Question 26

ibuprofen Adult dosing

Answer 26

200-400mg PO Q6h PRN max 1200mg/day

Question 27

Ibuprofen ADEs

Answer 27

Ulcers/GI bleeding, fluid retention/edema, nephrotoxicity. Caution in pts with preexisting renal/cardiac disease or those who are dehydrated.

Question 28

Refer to PCP if fever with self-care treatment lasts

Answer 28

> 24 hours for children less than 2 years

> 3 days for ages 2+ years