Week 2: Fever Flashcards
A ___ is a body temperature higher than the normal core temperature. It is mostly self-limiting and non-threatening.
It is maintained by the hypothalamus in response to a pyrogen.
fever
Normal oral temperature is about ____.
98.6 ℉ or 37 ℃
Rectal and tympanic temperatures are about ___ higher than oral and axillary temperatures.
1 ℉
What are the 9 symptoms of fever?
- elevated body temperature
- sweating (body is trying to mining homeostasis)
- chills (body is trying to generate heat)
- headache
- Generalized malaise
- Tachycardia (fast heart rate)
- Delirium
- Disorientation
- Irritability
What are the 4 complications of fever?
- dehydration
- seizures
- change in mental status
- irreversible neurological damage (temperatures > 106 ℉)
The etiology of a fever can be ____ induced.
- microbe (viruses, bacteria)
- pathology (malignancies, gout, hyperthyroidism, heart attack)
- drug (discontinue the drug ASAP, ranges from 98.9-109 ℉)
When talking about the pathophysiology of a fever, the _____ is the anterior hypothalamus. There are thermosensitive neurons in the skin and CNS.
thermoregulatory center
What are 2 physiologic responses to fever?
- heat dissipation
sweating, vasodilation, and hyperventilation - heat production
shivering, goose bumps, and vasoconstriction
3 important factors to consider when measuring temperature are?
- patients age (fever is less in elderly than young)
- anatomic site
- time of the day (higher in the evening compared to morning)
The Gold standard for detection of fever is a ___.
They are considered a medical device and regulated by the FDA.
Thermometer
The rectal thermometer recommended for children that are ____ old.
Less than 6 mo
For detection of fever, the ____ is NOT reliable.
axillary method
There is no reliable conversion factor for axillary vs. rectal temperature so you must ____.
use the same site with each measurement
The preferred site of temperature for a child ≤ 3 months is ____.
rectal
avoid oral, tympanic, axillary
The preferred site of temperature for children 3 months to 3 years is ____.
rectal
it is OK to use tympanic and axillary. note: axillary is not reliable
The recommended sites of temperature for children 4-5 years are ____.
rectal, oral, tympanic, and axillary.
note: axillary is not as reliable
The preferred site of temperature for children 5 years and older is ____.
oral
rectal, tympanic, and axillary is OK to use. note: rectal is not as reliable
What are the Specific Guidelines for RECTAL Temperature Measurement?
- APPLY a water-soluble LUBRICANT to tip of thermometer
- For infants or young children, PLACE CHILD FACE DOWN OVER YOUR LAP
- For adults, have the patient lie on ONE SIDE with the LEG FLEXED to about a 45° ANGLE from the abdomen.
What are the Specific Guidelines for ORAL Temperature Measurement?
- Wait 20-30 minutes after drinking or eating
* Place tip of thermometer under tongue
What are the Specific Guidelines for TYMPANIC Temperature Measurement?
- Pull ear backward and up to straighten ear canal
* Place ear probe into canal and aim the tip of the probe toward patient’s eye
Normal body temperature ranges based on ____.
site of measurement
Fever that persist ____ with or without treatment are EXCLUDED for self-treatment.
> 3 days
When talking about the pathophysiology of a fever, the _____ is the anterior hypothalamus. There are thermosensitive neurons in the skin and CNS.
thermoregulatory center
When talking about the pathophysiology of a fever, the fever is a hallmark of ____. Heat gets generated internally. Fevers maintain a balance between the production and dissipation of heat.
immune system activation
What are 2 physiologic responses to fever?
- heat dissipation
sweating, vasodilation, and hyperventilation - heat production
shivering, goose bumps, and vasoconstriction
3 important factors to consider when measuring temperature are?
- patients age (fever is less in elderly than young)
- anatomic site
- time of the day (higher in the evening compared to morning)
The Gold standard for detection of fever is a ___.
They are considered a medical device and regulated by the FDA.
Thermometer
The rectal thermometer is recommended for children that are ____ old.
less than 6 months
For detection of fever, the ____ is NOT reliable.
axillary method
There is no reliable conversion factor for axillary vs. rectal temperature so you must ____.
use the same site with each measurement
The preferred site of temperature for a child ≤ 3 months is ____.
rectal
avoid oral, tympanic, axillary
The preferred site of temperature for children 3 months to 3 years is ____.
rectal
it is OK to use tympanic and axillary. note: axillary is not reliable
The recommended sites of temperature for children 4-5 years are ____.
rectal, oral, tympanic, and axillary.
note: axillary is not as reliable
The preferred site of temperature for children 5 years and older is ____.
oral
rectal, tympanic, and axillary is OK to use. note: rectal is not as reliable
What are the Specific Guidelines for RECTAL Temperature Measurement?
- APPLY a water-soluble LUBRICANT to tip of thermometer
- For infants or young children, PLACE CHILD FACE DOWN OVER YOUR LAP
- For adults, have the patient lie on ONE SIDE with the LEG FLEXED to about a 45° ANGLE from the abdomen.
What are the Specific Guidelines for ORAL Temperature Measurement?
- Wait 20-30 minutes after drinking or eating
* Place tip of thermometer under tongue
What are the Specific Guidelines for AXILLARY Temperature Measurement?
- Place tip of thermometer under armpit
- Ensure that armpit is clean and dry
- Thermometer must be touching skin, not clothes
What are the Specific Guidelines for TYMPANIC Temperature Measurement?
- Pull ear backward and up to straighten ear canal
* Place ear probe into canal and aim the tip of the probe toward patient’s eye
Patients who are older than 6 months of age with rectal temperatures of ____ are EXCLUDED for self-treatment.
≥ 100.4℉
Children who are younger than 6 months of age with rectal temperatures of ____ are EXCLUDED for self-treatment.
≥ 101 ℉
Children with history of _____ are EXCLUDED for self-treatment.
febrile seizures or seizures
Fever that persist ____ with or without treatment are EXCLUDED for self-treatment.
> 3 days
One of the non-pharmacologic managements of fever is to prevent ___.
dehydration
One of the non-pharmacologic managements of fever is to body sponge with ___.
tepid water
NOT alcohol or ice water
One of the non-pharmacologic managements of fever is to maintain room temperature at ___.
68 ℉
A pharmacologic management of fever include ____ antipyretics for at least 24 hours and NON-pharmacologic measures. The same dose, frequency, and max dose/day apply.
around the clock (ATC)
A pharmacologic management of fever include ____ for those who are above 6 months of age. Dosing should be based on body weight.
acetaminophen and ibuprofen
avoid ibuprofen in children less than 6 months
A pharmacologic management of fever include ____ for those who are above 12 years old.
naproxen
You should generally AVOID ____ as pharmacologic management of fever.
aspirin
Alternation of antipyretics is alternating acetaminophen and ibuprofen at staggered dosage intervals. It is commonly used as a technique to lower fever without exceeding the max of drugs. How would you counsel patients on alternation of antipyretics?
Do not recommend. There is NO evidence that this method lowers fever faster than either agent alone.
Why? Can be very confusing to patients and risk of OD and medication errors
