Fever Flashcards
fevers are more commonly reported in
children than adults
populations with greater risk for fever
children, elderly, immunocompromised
principle reason to treat a fever
to relieve discomfort
risk in treating a fever
may have benefit on the host defense mechanism; treating fever may delay identification of underlying pathology
benefit in treating fever
improved patient comfort
normal body temperature
between 97.5-98.9
core body temp is regulate by
the hypothalamus
core body temp =
temp of blood that surrounds the hypothalamus and is NOT subject to much variation
core body temp rising:
information is transmitted between
the anterior hypothalamus and thermo-sensitive neurons in the skin and CNS
physiologic and behavioral mechanism will regulate
body temp to the normal range
skin temp may fluctuate greatly due to
environmental conditions
fever occurs when
there is a regulated rise in the core body thermoregulatory set point
fever occurs in response to
circulating pyrogens that active that host defenses
prostaglandins
elevate the core temp
during the upward temp readjustment
the person experiences chills cause by peripheral vasoconstriction and muscle rigidity to maintain homeostasis
fever is a body temp higher than
100 degrees
most febrile episodes are caused by
microbial infections
hyperthermia
malfunction of the hypothalamus that leads to a lack of control of the thermoregulatory set point
malignant hyperthermia consists of
temp greater than 104, muscle rigidity, metabolic acidosis
hyperpyrexia
temp > 106; leads to harmful and mental consequences
hyperpyrexia typically occurs in patients with
underlying medical conditions that prevent the body from regulating the core temp
non-specific symptoms of fever
chills, diaphoresis, tachycardia, headache, malaise, arthralgia, irritability and anorexia
rectal
- normal range
- fever
1) 97.9-100.4
2) greater than or equal to 100.4
oral
- normal
- fever
1) 95.9-99.5
2) greater than or equal to 99.5
temporal
- normal
- fever for 0-2 months
- fever for 3-47 months
- fever for greater than 4 years
1) 92.9-100.1
2) greater or equal to 100.7
3) greater or equal to 100.3
4) greater or equal to 100.1
accuracy of temp measurement
rectal > oral/temporal/tympanic > axillary
converting oral to rectal
add one degree
converting axillary to rectal
add 2 degrees
converting temporal/tympanic to rectal
same
electronic probe
- readings provided in 10-60 seconds
oral electronic probe
- wait 20/30 min after eating or drinking
- not appropriate for under 3
how long for pacifier shaped thermometer
2-6 min
preferred method in less than 3 months
rectal
risks of rectal measurement
retention of thermometer, rectal or intestinal perforation, peritonitis
infrared readings
- provided in 5 secs or less
- do not use in less than 6 months
infrared for children younger than one year
pull ear backwards
infrared for children older than one year
pull ear up and back
complications of fever
dehydrations, mental status changes, and seizures
complications of fever typically occur in
infants, elderly or patients with brain tumors/hemorrhage, CNS infections, pre-existing neurologic damage, and neuropathy
febrile seizure
seizure accompanied by fever in infants and children due to rapidly rising temp
signs and symptoms of dehydration
- feeling thirsty
- urinating less often, dark yellow or brown urine
- dry mouth or cracked lips
- decrease skin turgor
- no tears when child cries
- feeling tired or confused
- eyes that look sunken
- feeling dizzy or light headed
- babies than have “sunken fontanel”
exclusions for self treatment
- pts > 3 mos w rectal temp > 100.4
- pts < 3 mos w rectal temp > 100.1
- severe symptoms of infection
- risk of hyperthermia
- impaired oxygen utilization
- impaired immune function
- CNS damage
- children w history of febrile seizures or seizures
- child w spot or rash
- child who wont drink fluids
- child who is sleepy, irritable or hard to wake up
- child who is vomiting and cant keep fluids down
- child w repeated diarrhea
- child w stiff neck
- pts > 2 with fevers > 3 days
- pts <2 with fever > 24 hrs
- fever repeated rising > 104
non pharm treatment
- increase fluid intake
- wear lightweight clothing, remove blankets, and maintain room temps of 68
- body sponging w tepid water ( not recommended for fever < 104 )
antipyretics moa
inhibit prostaglandin E2 which decreases feedback between thermoregulatory neurons and hypothalamus which reduces hypothalamic set point
APAP ped dose
10-15 mg/kg q4-6hr max 5 dose in 24 hrs
APAP adult dose
325-1000 mg q4-6hr max 4000mg/day and elderly 3000mg.day
ibuprofen ped dose
ONLY IF OLDER THAN 6 mos
5-10mg/kg q6-8hrs max 40mg/kg/day
ibuprofen adult dose
200-400mg q4-6hr max 1200mg/day
naproxen ped dose
not for children < 12
naproxen adult dose
220 mg q8-12hr max 660mg, elderly 440mg
aspirin ped dose
not for children
aspirin adult dose
325-650 mg q4-6hr
how long to treat w antipyretics
around the clock for at least 24 hrs
may take 6-24 hrs to bring fever down
antipyretics should not be used longer than
3 days
