Pedia Patient with Fever Flashcards
most common reason for a sick child visit
fever
most common cause of fever in newborn
infection (neonatal sepsis) and overclothing
normal body temperature
36.6-37.9
t/f body temp is highest in the morning and lowest in evening
false, lowest morning highest evening, variation of 0.5C
fever is defined as ___
rectal temp >/=38 C
hyperpyrexia is __
> 40 C
most accurate method to measure temp
rectal temp
___ temp is higher than actual temp, while ___ temp is lower than the actual temp
rectal higher, axillary lower
mechanisms that regulate body temp
- hypothalamus responses to changes in blood temp
- skin and muscles have cold and warm receptors
endogenous pyrogens
il1b, il6, tnf-a, ifna and gamma
exogenous pyrogens
pamp pathogens, damp, toxins
infectious pathogens: microbes, toxins, and other microbial products (most common)
drugs
activation of cells leads to secretion of ___
il1 alpha -> pge2 (best mediator of pyrogens)
the body increases its core temp by activating ___
sympathetic nervous system -> inhibits sweating and shivering
heat production due to volatile inhalational anesthetic agents and muscle relaxants (succinylcholine)
malignant hyperthermia
heat production due to aspirin intake leading to development of reye’s syndrome
salicylate toxicity
examples of defective heat loss
ectodermal dysplasia
victims of severe heat exposure
t/f you give antibiotics if fever has been persistent for 6 days
false
most common cause of acute fever
infectious etiology (rarely goes above potentially lethal levels)
misc causes for fever
drugs (vancomycin), blood products, self-induced
beneficial effects of fever
- impair reproduction and inhibit bacterial and viral replication
- strengthens immune response to pathogens
harmful effects of fever
- increased o2 consumption
- co2 production
- increased fluid and caloric reqs
- can precipitate febrile seizures
pattern of fever: exaggerated circadian rhythm that includes period of normal temp on most days
intermittent fever (there should be a day/time the pt is fever-free)
pattern of fever: extremely wide fluctuations in temp but always with a fever
septic/hectic fever
pattern of fever: persistent and does not vary by >0.5C per day
sustained fever
pattern of fever: persistent and varies by >0.5C per day
remittent fever
pattern of fever: single illness with 2 distinct periods
biphasic fever (poliomyelitis, enterovirus, lepto, dengue, yellow fever)
pattern of fever: narrowly describes fever syndromes with a regular periodicity
periodic fever (cyclic neutropenia, pfapa)
pattern of fever: characterized by febrile periods that are separated by intervals of normal temp
relapsing fever
what is tertian fever
fever on 1st and 3rd days (p vivax malaria)
what is quartan fever
fever on 1st and 4th days (p malariae malaria)
what is quotidian fever
fever that peaks once in 24 h, non-relapsing (p knowlesi malaria)
what is double quotidian fever
fever that peaks twice in 24 h (inflammatory arthritis)
pattern of fever: self induced, caused by intentional manipulation of thermometer or pyogenic material
factitious fever
hr rises ___ per 1 c rise in temp for children older than 2 months of age
10 bpm per 1 c
relative tachycardia vs bradycardia
tachy: non-infectious, toxin responsible
brady: typhoid fever, lepto, drug fever
if patient presents with fever less/= 7 days duration and no other complication you ___
treat as outpatient, provide patient education, reevaulate to ensure symptoms disappear
if patient presents with fever less/= 7 d with special situation (hpi or other family members with illness)
provide patient education, consider hospitalization + diagnostics + culture, iv antibiotics
if outpatients with fever >7 days
FUO: >3 w outpatient, >1 w inpatient
hospitalize, diagnostic testing and empirical treatment
t/f there is evidence to support that high fever can result in brain damage or other bodily harm
false, except of cases of febrile status epilepticus and heat stroke
t/f treating fever in self-limiting diseases to bring body back to regulat remp is not necessary in otherwise healthy child
true, fever is an adaptive response. treatment only for selected cases. especially is no history of febrile seizures
t/f fever with temps <39C in healthy children does not require treatment
true
t/f antipyretic therapy changes the course of infectious diseases and provides symptomatic relief
false
t/f there is likely an association between high fever during pregnancy and teratogenic effects
true, esp in first trimester
indications to treat fever in child
- child is uncomfortable
- caregiver is concerned
- child is in a high risk group
children between ____ are more prone to simple febrile seizures and may need treatment
6 mos-5 yo
t/f only give one type of medication for fever
true
administration of paracetamol
10-15 mg/kg/dose q 4h, effective in 30-60 min
rectal: for vomiting or impaired consiousness
iv: rapid entry into cns
administration for ibuprofen
5-10 mg/kg/dose q 8h, effect in 3-4 h
can cause gastritis, gastric ulcer, and nephrotoxicity
t/f tepid sponge baths are effective
false
