STUDY - Technical - New Dacian's Medicine
Fever
(pyrexia) (Classical / Allopathic Medicine)
Fever (pyrexia), a
common sign, can arise from any one of several disorders
affecting virtually any body system. As a result, fever in the
absence of other signs usually has little diagnostic
significance. A persistent high-grade fever, however,
represents an emergency.
Fever can be
classified as low-grade (oral reading of 99° to 100.4° F
[37.2° to 38° C]), moderate (100.5° to 104° F [38.1° to 40°
C]), or high-grade (above 104° F). Fever over 108° F (42.2°C)
causes unconsciousness and, if sustained, leads to permanent
brain damage and death.
Fever may also be
classified as remittent, intermittent, sustained, relapsing,
or undulant. Remittent fever, the most common type, is
characterized by daily temperature fluctuations above the
normal range. Intermittent fever is marked by a daily
temperature drop into the normal range and then a rise back to
above normal. An intermittent fever that fluctuates widely,
typically producing chills and sweating, is called hectic or
septic fever. Sustained fever involves persistent temperature
elevation with little fluctuation. Relapsing fever consists of
alternating feverish and afebrile periods. Undulant fever
refers to a gradual increase in temperature that stays high
for a few days and then decreases gradually.
Further
classification involves duration - either brief (less than 3
weeks) or prolonged. Prolonged fevers include those of unknown
origin, a classification used when careful examination fails
to detect an underlying cause.
ALERT:
If you detect a fever higher than 106.7° F (41.5° C):
- take the patient's other vital signs and determine his level of consciousness
- begin rapid cooling measures - for example, apply ice packs to the axillae and groin, give tepid sponge - baths, or apply a hypothermia blanket
- continually monitor the patient's rectal temperature, using a rectal probe
- administer an antipyretic, as ordered.
If the patient's fever is mild to moderate, perform a focused assessment.
If you detect a fever higher than 106.7° F (41.5° C):
- take the patient's other vital signs and determine his level of consciousness
- begin rapid cooling measures - for example, apply ice packs to the axillae and groin, give tepid sponge - baths, or apply a hypothermia blanket
- continually monitor the patient's rectal temperature, using a rectal probe
- administer an antipyretic, as ordered.
If the patient's fever is mild to moderate, perform a focused assessment.
HISTORY:
Ask the patient when the fever began and how high his temperature reached. Did the fever disappear, only to reappear later? Did he experience other symptoms, such as chills, fatigue, or pain?
Review the patient's medical history, noting especially immunosuppressive disorders, infection, trauma, surgery, and diagnostic testing.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Note especially immunosuppressant therapy and use of anesthesia. Also, ask the patient about alcohol intake.
Ask the patient about recent travel; certain diseases are endemic.
Ask the patient when the fever began and how high his temperature reached. Did the fever disappear, only to reappear later? Did he experience other symptoms, such as chills, fatigue, or pain?
Review the patient's medical history, noting especially immunosuppressive disorders, infection, trauma, surgery, and diagnostic testing.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Note especially immunosuppressant therapy and use of anesthesia. Also, ask the patient about alcohol intake.
Ask the patient about recent travel; certain diseases are endemic.
PHYSICAL
ASSESSMENT:
Let the historical findings direct your physical assessment. Because fever can accompany diverse disorders, the examination may range from a brief evaluation of one body system to a comprehensive review of all systems.
Let the historical findings direct your physical assessment. Because fever can accompany diverse disorders, the examination may range from a brief evaluation of one body system to a comprehensive review of all systems.
SPECIAL
CONSIDERATIONS:
Regularly monitor the patient's temperature. Provide increased fluid and nutritional intake. When administering a prescribed antipyretic, minimize resultant chills and diaphoresis by following a regular dosing schedule.
Regularly monitor the patient's temperature. Provide increased fluid and nutritional intake. When administering a prescribed antipyretic, minimize resultant chills and diaphoresis by following a regular dosing schedule.
PEDIATRIC
POINTERS:
Infants and young children experience higher and more prolonged fevers, more rapid temperature increases, and greater temperature fluctuations than older children and adults.
Keep in mind that seizures commonly accompany an extremely high fever, so take appropriate precautions.
Common pediatric causes of fever include varicella, croup syndrome, dehydration, meningitis, mumps, otitis media, pertussis, roseola infantum, rubella, rubeola, and tonsillitis.
Instruct parents not to give aspirin to a child with varicella or flu-like symptoms because of the risk of precipitating Reye's syndrome.
Fever can occur as a reaction to immunizations and antibiotic therapy.
Infants and young children experience higher and more prolonged fevers, more rapid temperature increases, and greater temperature fluctuations than older children and adults.
Keep in mind that seizures commonly accompany an extremely high fever, so take appropriate precautions.
Common pediatric causes of fever include varicella, croup syndrome, dehydration, meningitis, mumps, otitis media, pertussis, roseola infantum, rubella, rubeola, and tonsillitis.
Instruct parents not to give aspirin to a child with varicella or flu-like symptoms because of the risk of precipitating Reye's syndrome.
Fever can occur as a reaction to immunizations and antibiotic therapy.
AGING ISSUES:
An elderly patient may have an altered sweat mechanism that predisposes him to heatstroke when he's exposed to high temperatures.
An elderly patient may have an impaired thermoregulatory mechanism, making temperature change a less reliable measure of disease severity.
An elderly patient may have an altered sweat mechanism that predisposes him to heatstroke when he's exposed to high temperatures.
An elderly patient may have an impaired thermoregulatory mechanism, making temperature change a less reliable measure of disease severity.
PATIENT
COUNSELING:
If the patient isn't hospitalized, instruct him to measure and record his temperature at home. Explain that fever is a response to an underlying condition and that it plays an important role in fighting infection. Advise him not to take an antipyretic until his body temperature reaches 101° F (38.3° C).
If the patient isn't hospitalized, instruct him to measure and record his temperature at home. Explain that fever is a response to an underlying condition and that it plays an important role in fighting infection. Advise him not to take an antipyretic until his body temperature reaches 101° F (38.3° C).
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)