Fever Flashcards
Fever
An elevation in the set point of the body’s temperature.
What is temperature homeostasis controlled by?
anterior portion of the hypothalamus, which acts as a thermostat that sets the body’s target temperature
Definition Ineffective Thermoregulation
Temperature fluctuation between hypothermia and hyperthermia
Defining Characteristics Ineffective Thermoregulation
cool skin, cyanotic nail beds, fluctuations of body temp above or below normal, flushed skin, seizures, piloerection, shivering, increased RR and HR
Why would antibiotics be prescribed for fever?
Used for the bacterial cause of a fever.
Peak Level
measures highest concentration of medication in the plasma, drawn 30-60 minutes after dose administered, done after several doses
Trough Level
Measures the lowest concentration of the medication in plasma, drawn immediately prior to next dose
Antipyretics
Inhibit synthesis of prostaglandins, lowers the set point, and reduces discomfort
Peak & Trough levels
provides information to the healthcare team about the effectiveness and toxicity of a drug in the plasma. it monitors for therapeutic and toxic levels
TNIs Fever
monitor VS, assess skin color and skin T, monitor WBC, HCT, and other pertinent values for indications of infection, dehydration, remove excess blankets when client warm and provide extra warmth when client chilled, provide adequate nutrition and fluids to meet increase metabolic needs and prevent dehydration, measure I & O, administer order antipyretics, provide tepid sponge bath and oral hygiene, reduce physical activity to limit heat production
Septicemia
Presence of pathogenic microorganisms in the blood
Reye Syndrome
acute encephalopathy of unknown cause in children under the age of 15 after a viral illness. Thought to be associated with the use of aspirin during a viral illness
Cooling Blanket
Commercially available cooling device used to reduce body temperature
Fever of Unknown Origin (FUO)
Fever exceeding 101F on several occasions with unknown cause
TNI cooling blanket
place blanket on bed and cover with sheet or lightweight blanket, frequent temperature monitoring is necessary to avoid excessive cooling of the body, assess patient comfort
Nursing Responsibilities for Peak and Trough levels
obtain blood sample, check sample results, notify MD and administer medication on a timely manner
Hyperthermia
body temperature exceeding the set point, which usually results from the body or external conditions creating more heat than the body can eliminate, such as in heat stroke, aspirin toxicity, seizures, or hyperthryroidism
What therapeutic effects does fever have?
increased white blood cell activity, interferon production and effectiveness, and antibody production and enhancement of some antibiotic effects
Over Three Temperature reading
pinna up and back
Under Three Temperature reading
pinna down and back
Cel. and Fahr. Converting Formula
C=(Fahrenheit Temp-32)X5/9
Heat Exhaustion
not a true fever. excessive heat and dehydration (paleness, dizziness, N, V, fainting, increased T)
Heat Stroke
Not a true fever. Exercising in hot weather (warm, flushed skin, and do not sweat, unconscious, seizures, T =106+)
Hypothermia
Core body T lower than the lower limit of normal. R/T - impaired hypothalamic thermoregulation, inadequate heat production, excessive heat loss
Core Temperature
T of deep tissues of the body, remains constant
Surface Temperature
T of the skin, SC tissue, and fat. Rises and falls in response to the environment
What effects heat production?
basal metabolic rate (decreases with age), muscle activity (shivering, increase rate), epinephrine/norepinephrine/sympathetic stimulation/stress response (immediate increase in rate), fever (increase cellular metabolic rate)
Heat Loss
radiation, conduction, convection, evaportation
Radiation
Transfer of heat from surface to surface. “to radiate”
Conduction
One molecule transfers heat to a molecule of a lower T. Molecules must have contact. T difference of molecules determines the amount of heat loss.
Convection
Dispersion of heat through air currents
Evaportion
Vaporization of moisture from R tract and mucosa of the mouth and from skin (insensible water loss/heat loss)
Temperature Control
Sensors in the periphery and in the core, Integrator in the hypothalamus, Effector system that adjusts the production and loss of heat.
Hyperpyrexia
Very high fever
Other words for fever
pyrexia, hyperthermia, febrile
Intermittent Fever
T b/w periods of fever and periods of normal or subnormal
Remittent Fever
wide range of T fluctuations occurs over a 24hr period, all higher than normal
Relapsing Fever
short febrile periods of a few days with periods of 1-2 days normal T
Constant Fever
Fluctuates minimally, above normal
Fever Spike
T that rises rapidly and then returns to normal within a few days
Phases of Fever
Prodromal, Chill, Flush, Defervescence
Prodromal Phase
non-specific complaints, “don’t feel good,” headache and muscle ache, fatigue
Chill Phase
Increase HR and RR, vasoconstriction, c/o chills, cool skin, piloerection
Flush Phase
vasodilation, warm, flushed skin, c/o feeling warm, diaphoresis, increase thirst, concentrated urine, postural hypotension
Piloerection
goose bumps
Defervescence Phase
diaphoresis, fever resolves
Fever and Comfort Needs
administer antipyretics as prescribed, provide extra warmth or remove blankets depending on fever phase, ensure gown and bed linens are dry
Fever General TNIs
monitor T and VS, monitor mental status, promote comfort, monitor nutrition status, accurately measure I & O/ fluid status, monitor ordered labs (WBC)
Fever Oxygenation TNIs
monitor O2 sat, administer supplemental O2 prn, prevent shivering, provide rest
Fever Fluid TNIs
monitor I & O carefully, force fluids as ordered (po and IV), provide frequent oral care, estimate insensible loss
Fever Nutrition TNIs
offer foods that are easily digested, increase carbohydrates and protein, increase calories as ordered
Fever Safety and Security TNIs
side rails up, assistance when OOB, call bell within reach, seizure precautions as appropriate
Antibiotics
Used for the bacterial cause of a fever
TNIs Antibiotics
may obtain C & S prior to treatment, assess for allergies, cross sensitivities with with PCN, effectiveness, assess IV site freq, side effects = GI, CNS, rash, anemia, assess for allergic reaction
Cefazolin (ancef, kefzol)
1st generation cephalosporin - bactericidal
Cefazolin Use
surgical prophylaxis, R infections, UTI, Bone/joint and skin infections
Gentamicin (Garamycin)
Aminoglycoside. Bactericidal, effective against aerobic gram-negative infections
Gentamicin
systemic infections, bowel prep prior to surgery (sterilize), effective against aerobic gram-negative infections, assess for allergic reaction, IV preferred route, monitor peak and trough levels
TNIs Antipyretics
cautious use with other medications, do not use aspirin with children, acetaminophen, NSAIDS commonly used
What are most fevers caused by in children?
virus
What is the preferred antipyretic drug for children?
acetaminophen
What NSAID is approved for fever reduction in children as young as 6 months of age?
ibuprofen
What cooling methods can RNs teach parents to use safely with febrile children?
wear minimal clothing, expose skin to air, reduce room temperature, increase air circulation, apply moist compress to forehead
