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WARD CARE > Fever in hospitalised patients > Flashcards

Fever in hospitalised patients Flashcards

info from the seminar

1
Q

what is the range for a normal body temperature ?

A

range : 35.6-38.2

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2
Q

what is the mean for th enormal body temperature ?

A

mean : 36.8(+/- 0.4)

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3
Q

How many people have a normal body temperature of 37 ?

A

the standard “normal “ temperature is 37degrees C in only 8%

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4
Q

explain the circadian rhythm for temperature

A

the body temperature becomes highest in pm ( not usually >37.8) and lowest in the am ( not usually >37.2)

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5
Q

what is the change in body temperature in the morning (am)?

A

it is at its lowers ( not >37.2)

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6
Q

what happens to the body temperature in the afternoon (pm)?

A

highest (not usually more than 37.8)

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7
Q

inn which sites is the temperature higher ?

A

centrally such as the right atrium .

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8
Q

what is Fever ?

A

body temperature > or = to 38 degrees C, usually measure in the oral cavity or the axilla

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9
Q

what are the causes of a fever

A

anything that can trigger systemic inflammatory response, can be non-infectious or infectious .

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10
Q

list non-infectious causes of fever that you need to look out for ?

A
  1. Thromboembolic disease
  2. Bedsores ( even non infective bedsores , this is because there is tissue death )
  3. Infarction (Stroke,MI,PVD)
  4. IRIS (Immune reconstitution inflammatory syndrome)->associated with HIV
  5. Drug fever (diagnosis of exclusion )
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11
Q

what is the important causes of fever in our South African context inn the hospitals ?

A

IRIS

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12
Q

what are the skin and soft tissue associated infectious causes of Fever ?

A
  1. Drip site infection
  2. Surgical site infection
  3. Infected bedsore
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13
Q

what are the important indicators on history taking for skin and soft tissue associated infectious causes of Fever ?

A
  • IV catheter
  • post -op
  • immobility
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14
Q

what are the important features during examination for skin and soft tissue associated infectious causes of Fever ? which test to do ?

A

local cellulitis
test : Blood culture

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15
Q

what are the respiratory associated infectious causes of Fever ?

A

Pneumonia

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16
Q

what are the important indicators on history taking for respiratory associated infectious causes of Fever ?

A
  1. Dyspnoea
  2. cough
  3. Risk of aspiration
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17
Q

what are the important features on examination that are inkeeping with respiratory associated infectious causes of Fever ? name the appropriate test (most important )

A

Tachpnoea
crackles
Test/investigation : Chest X ray

18
Q

what are the GIT associated infectious causes of Fever ?

A

C.difficile diarrhoea

19
Q

what are the important indicators on history for GIT associated infectious causes of Fever ?

A
  • Diarrhoea
  • antibiotic use
20
Q

what are the important indicators during examination for GIT associated infectious causes of Fever ? name the appropriate test (most important )

A

Abdominal tenderness
test : Antigen /toxin PCR

21
Q

what are the intra-abdominal associated infectious causes of Fever ?

A

Post- laparotomy collections

22
Q

what are the important indicators during history taking for intra-abdominal associated infectious causes of Fever ?

A

recent laparotomy

23
Q

what are the important indicators during examination for intra-abdominal associated infectious causes of Fever ? name the appropriate test (most important )

A

Abdominal tenderness
test /investigation : Abdominal imaging

24
Q

what are the urinary tract associated infectious causes of Fever ?

A

catheter-associated UTI

25
Q

what are the important indicators during history taking for urinary tract associated infectious causes of Fever ?

A

often non specific

26
Q

what are the important indicators during examination for urinary tract associated infectious causes of Fever ? name the appropriate test (most important )

A

ofeten non specific renal angle tenderness
test : urine/blood culture

27
Q

what are the CNS associated infectious causes of Fever?

A

Menigitis (post-op)

28
Q

what are the important indicators during history taking for CNS associated infectious causes of Fever ?

A

confusion/drowsy

29
Q

what are the important indicators during examination for CNS associated infectious causes of Fever ? name the appropriate test (most important )

A

Neck stiffness
test : CSF exam

30
Q

what are the vascular associated infectious causes of Fever ?

A

Endocarditis

31
Q

what are the important indicators during history taking for vascular associated infectious causes of Fever ?

A

IV catheter

32
Q

what are the important indicators during examination for vascular associated infectious causes of Fever ? name the appropriate test (most important )

A

murmur
tests : blood culture and Echo

33
Q

what are the 3 indications for urinary catheters ?

A
  • Acutely ill patient requiring monitoring of the urine output
  • Urinary retenntion ( obstruction or neuropathy )
  • Local wounds requiring intensive wound care
34
Q

Name to condions /situations that are where insertion of an urinary catheter is not indicated

A

low level of consciousness and urinary incontinance .
These patients can be nursed and putting a catheter puts them at risk of infection .

35
Q

What are the important components of catheterinsertion?

A
  • hand hygiene
  • sterile technique
  • use smallest catheter possible
  • secure properly
36
Q

How can a catheter UTI be prevented ?

A
  • collecting fresh urine from the sampling port using a sterile needle and syringe after cleaning the port with disinfectant -> to prevent contamination
  • empty collecting bag regularly
  • Keep colleacting bag below level of the bladder and suspend off the floor .
37
Q

What things not to do in management of urinary catheters ?

A

do not :
1. clean the meatal area with antiseptic , this does not help
2. screen for asymptomatic bacteria - don’t sent urine culture for patients that are well , this will cause over treatment
3. treat asymptomatic bacteria
4. use systemic antibiotic as prophylaxis
5. Change catheter rountely ( do it if required )
6. Irrigate the catheter routinely (if requred )

( every day you must assess the indication for the need for urinary catheter )

38
Q

What are the indications for peripheral IV lines ?

A
  • if the patient require IV antibiotics , such as in infections like meningitis ,endocarditis ,osteomylitis and blood stream infections .
  • Requires IV fluids or nutrition and water
  • When oral administration is not possible or effective ( when a pt is too ill to swallow, poor absorption,intubated)
  • Patient with haemodynamic instability ( IV line needed during resus)
  • For ininitial therapy for severe infections ( but can consider oral agents with good bioavailability )
  • if there are no appropriate oral antibiotic savailable
39
Q

What are the important components when putting in a peripheral IV line ?

A
  • hand hygiene
  • sterile technique,clean the skin with chlorhexidine
  • use smallest catheter possible
  • secure properly
40
Q

How can a drip site sepsis be prevented ?

A
  1. Examine daily for signs of inflammation /sepsis
  2. Remove IV lines if any sign of drip site inflammation ( don’t change it routinely , just when they are signs )
  3. Always remove when the drip ‘tissues’ (fluid coming out of the drip) and discard and replace with you set and new fluid .
  4. Everyday evaluate the indication for the need for IV line .

WARD CARE (3 decks)

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