Week 1- Fever Flashcards
Normal axillae body temp:
97.5 with range of 94.5-99.1
Normal oral body temp:
97.9 with range of 95.9-99.5
Normal rectal temp:
98.6 with a range of 97.9-100.2
Normal infrared tympanic temp:
97.9 with a range of 96.3-99.5
Lowest temp is between what hours?
4am and 8 am
When does body temp peak?
Between 4-6 pm
What individual and environmental factors affect body temp?
Age (slightly higher in young infants) Sex Physical activity Ambient air temp An atomic site
Where is core body temp most accurately measured?
Pulmonary artery
Other deep tissue locations (lower esophagus, nasopharynx)
Definition of fever?
Rectal greater than 100.4
Oral greater than 100.0
When does cellular damage occur with fever?
Doesn’t occur until 105.8-107.6
What beneficial effects does fever play in fighting infection?
Retards growth and reproduction of bacteria and viruses.
Enhances neutrophil production and T-lymphocyte proliferation.
Aids in the body’s acute phase reaction.
Does the degree of fever always correlate with severity of illness?
No it does not
Primary goal with fever?
Improve the child’s overall comfort rather than focus on the normalization of body temperature.
What controls the temperature the body tries to maintain?
Hypothalamic set point
What is the physiology of a fever?
Induces macrophages to release cytokines that function as endogenous pyrogens -> circulate to anterior hypothalamus -> increase local levels of prostaglandin E2 -> induce an increase in setpoint.
The human body generates heat by:
Metabolic processes
Heat conservation is maintained by:
Vasoconstriction and heat preference behaviors
Heat loss occurs by:
Sweating, evaporation, conduction, radiation, convection, vasodilation, cold preference behaviors
Negative effects of fever:
Increased metabolic rate - increased fluid loss - increased oxygen consumption - increased caloric needs - can precipitate seizures Associated symptoms - HA - Malaise - Anorexia - Irritability Respiratory status - tachypnea -tachycardia
Petechiae or purpuric rashes are associated with?
Bacteremia
Purpura associated more often with what?
Meningicoccemia
Reliable method for determining degree of illness:
Yale observation scale
6 variables in Yale observation scale?
Quality of cry Reaction of parent stimulation State variation Color Hydration Response
What score on the Yale observation scale indicates a serious bacterial infection?
16 or more
Clinical red flags for serious infection in children older than 1 month?
Parental concerns Physician instinct Changes in crying pattern. Drowsiness Inconsolable Moaning Crackles Cyanosis Decreased BS Poor peripheral circulation SOB Decreased skin elasticity Hypotension Meningeal irritation Petechiae rash Seizures
Normal WBC?
5000-15000
Bands should be less than 1500
Elevated procalcitonin is better or worse predictive value of infection than WBC?
Better- marker of inflammation and bacterial infection.
When is chest X-ray indicates?
Infants over 1 month with respiratory symptoms- tachypnea, refractions, O2 sats <95%
Fever >102.2
WBC >20000
Lab findings consistent of serious bacterial infections:
UA unspun- more than 10WBC/HPF WBC: more than 15000 ANC- more than 10000 CRP- more than 40 Procalcitonin level- more than 0.5
Tylenol dosing
10-15 mg/kg/dose q4-8 hrs
Motrin dosing
6 months and up
Fever <102.5 5mg/kg/dose
Fever > 102.5 10mg/kg/dose
Do not exceed 40mg/kg/day
Asthmatics May be sensitive to:
NSAIDS
What is a prolonged fever?
Rectal temp >101 or oral temp greater than 100 for 2-3 weeks or more and no known etiology
