Fever in hospitalised patients

Question 1

what is the range for a normal body temperature ?

Answer 1

range : 35.6-38.2

Question 2

what is the mean for th enormal body temperature ?

Answer 2

mean : 36.8(+/- 0.4)

Question 3

How many people have a normal body temperature of 37 ?

Answer 3

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

Question 4

explain the circadian rhythm for temperature

Answer 4

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

Question 5

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

Answer 5

it is at its lowers ( not >37.2)

Question 6

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

Answer 6

highest (not usually more than 37.8)

Question 7

inn which sites is the temperature higher ?

Answer 7

centrally such as the right atrium .

Question 8

what is Fever ?

Answer 8

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

Question 9

what are the causes of a fever

Answer 9

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

Question 10

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

Answer 10

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 )

Question 11

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

Answer 11

IRIS

Question 12

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

Answer 12

1. Drip site infection
2. Surgical site infection
3. Infected bedsore

Question 13

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

Answer 13

• IV catheter
• post -op
• immobility

Question 14

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

Answer 14

local cellulitis
test : Blood culture

Question 15

what are the respiratory associated infectious causes of Fever ?

Answer 15

Pneumonia

Question 16

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

Answer 16

1. Dyspnoea
2. cough
3. Risk of aspiration

Question 17

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

Answer 17

Tachpnoea
crackles
Test/investigation : Chest X ray

Question 18

what are the GIT associated infectious causes of Fever ?

Answer 18

C.difficile diarrhoea

Question 19

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

Answer 19

• Diarrhoea
• antibiotic use

Question 20

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

Answer 20

Abdominal tenderness
test : Antigen /toxin PCR

Question 21

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

Answer 21

Post- laparotomy collections

Question 22

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

Answer 22

recent laparotomy

Question 23

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

Answer 23

Abdominal tenderness
test /investigation : Abdominal imaging

Question 24

what are the urinary tract associated infectious causes of Fever ?

Answer 24

catheter-associated UTI

Question 25

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

Answer 25

often non specific

Question 26

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

Answer 26

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

Question 27

what are the CNS associated infectious causes of Fever?

Answer 27

Menigitis (post-op)

Question 28

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

Answer 28

confusion/drowsy

Question 29

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

Answer 29

Neck stiffness test : CSF exam

Question 30

what are the vascular associated infectious causes of Fever ?

Answer 30

Endocarditis

Question 31

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

Answer 31

IV catheter

Question 32

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

Answer 32

murmur tests : blood culture and Echo

Question 33

what are the 3 indications for urinary catheters ?

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What are the important components of catheterinsertion?

Answer 35

* hand hygiene * sterile technique * use smallest catheter possible * secure properly

Question 36

How can a catheter UTI be prevented ?

Answer 36

* 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 .

Question 37

What things not to do in management of urinary catheters ?

Answer 37

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 )

Question 38

What are the indications for peripheral IV lines ?

Answer 38

* 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

Question 39

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

Answer 39

* hand hygiene * sterile technique,clean the skin with chlorhexidine * use smallest catheter possible * secure properly

Question 40

How can a drip site sepsis be prevented ?

Answer 40

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 .