Chapter 6 - Fever

Question 1

Fever

Answer 1

• Most common reason for visits to pediatrician office
• Leading cause of visits to ER in children 15 y.o. and younger
• Self-limited and nonthreatening but can cause great discomfort and can indicate serious underlying conditions
• Defined by body temperature exceeding 100 degree Fahrenheit
• Body temperature is regulated by the hypothalamus and increases in response to pyrogens

Question 2

Hyperthermia

Answer 2

• Malfunctioning of normal thermoregulatory process

- Due to excessive heat exposure or production

Question 3

Hyperprexia

Answer 3

• Body temperature exceeding 106 degrees Fahrenheit
• Causes mental and physical damage
• Can stem from fever or hyperthermia

Question 4

Fever Pathophysiology

Answer 4

• Skin temperature can vary widely but the core temperature should be within a narrow range
• Pyrogens - fever producing substances that activate host defenses and increase set point
• Can be exogenous (toxins or foreign invaders) or endogenous (from damaged tissue)
• Need endogenous to reset temperature, exogenous can’t do it alone
• PGE2 reacts to circulating pyrogens and interacts with hypothalamus to raise the core temperature
• Can be from infection, drugs, vigorous activity, or idiopathic, and much more
• Fever isn’t as pronounced in the elderly and children

Question 5

Fever Clinical Presentation

Answer 5

• Symptoms are nonspecific making it hard to determine symptomatically
• Accurate temperature measurement is PARAMOUNT
• Investigation into cause of fever is also important and needs to be treated over the fever alone
• Discomfort, headache, malaise, chills, tachycardia, myalgia, irritability, anorexia can all accompany fever
• If children are still alter and play normally, the fever isn’t much of a concern

Question 6

Fever Detection

Answer 6

• Subjective - feeling part of the body for warmth
• Thermometer - most accurate method to detect a rise in core temperature
• Various types: rectal, axillary, oral, temporal, and tympanic
• Rectal is considered gold standard but isn’t patient preferred
• Don’t use glass/mercury thermometers
• High temperatures occur in the late afternoon and early evening
• Infared (less evasive, tympanic & temporal), electronic (pen or pacifier), and color changing (less accurate) thermometers are also available in certain situations

Question 7

Thermometer Types + Fever Temperatures

Answer 7

Rectal: > 100.4 F
Oral: > 99.7 F
Axillary: > 99.3 F
Tympanic: > 100.0 F
Temporal: > 100.1 F

• *Oral + 1 = Rectal, Tempanic, and Temporal
• *Oral - 1 = Axillary

Question 8

Fever Complications

Answer 8

• Risk factors are rare but may include acute complications like seizures, dehydration, muscle damage, and mental status change
• Seizure can occur, but isn’t a huge concern in children unless it is recurring
• Serious detrimental effects are more common in hyperpyrexia
• Those who can’t dissipate heat well, like the elderly, are at a great risk of complications

Question 9

Fever Treatment

Answer 9

• Should focus on the cause rather than the fever itself
• Most are short duration and can be host-defense benefits, so treating is mainly to increase the benefit:risk and decrease discomfort
• Due to possible benefits, preferred to not treat when possible

Question 10

Fever Treatment Goal

Answer 10

Alleviate Discomfort

Question 11

Treatment Approach

Answer 11

• Antipyretics

- Good for self-care, but good to get a medical evaluation first to identify cause of fever

Question 12

Fever Nonpharmacologic Treatment

Answer 12

• Fluid intake to prevent dehydration
• Sponge bath and ice baths only for extreme temperatures about 104 F
• Wear light weight clothing, maintain a comfortable room temperature, remove blankets
• Increase fluids by 30-60 mL/hour in kids
• Increase fluids by 60-120 mL/hour in adults
• If diarrhea is present, avoid high sugar fluids (Gatorade)

Question 13

Fever Pharmacologic Treatment

Answer 13

• Antipyretics inhibit PGE2 synthesis by inhibiting COX enzyme
• APAP and Ibuprofen are most commonly used
• Don’t use either for more than 3 days for fever
• Can have duplicate therapy and inappropriate dosing easily

Question 14

APAP - Fever

Answer 14

• Achieved temperature reduction in 2 hours
• Kid Dosing: 10-15 mg/kg q 4-6 h, max of 75 mg/kg/day
• Adult Dosing: 325-1000 mg q 4-6 h, max of 4000 mg/day in adults
• Loading dose is controversial
• Available as a suppository as well but not reliable

Question 15

Ibuprofen - Fever

Answer 15

• Most common NSAID for fever
• Max temperature reduction in 2 hours
• Kid Dosing: 5-10 mg/kg q 6-8 h, max of 4 doses/day
• Adult Dosing: 200-400 mg q 4-6 h max 1200 mg/day

Question 16

Pharmacotherapeutic Comparison

Answer 16

• Both APAP and Ibuprofen are effective in reducing fever
• Ibuprofen is more effective for kids and adults
• Equally safe, same adverse effects
• Combo therapy is possible but increases the risk of error due to confusion and complexity
• No antipyretic before or immediately after a vaccine due to decreased antibody response

Question 17

Product Selection

Answer 17

• Children less than 3 mo. need a medical evaluation
• Children older than 3 mo. and with a fever of >104 F also need a medical evaluation
• Ibuprofen only usable for children 6 mo. +
• NO aspirin for kids < 15 y.o.
• Ibuprofen has better dosing intervals

Question 18

Fever Complementary Therapies

Answer 18

NONE recommended at this time

Question 19

Fever Counseling

Answer 19

• Don’t use mercury/glass thermometers
• Explain appropriate pharmacologic and nonpharmacologic treatments
• Highlight methods for safe antipyretic use and discourage complementary therapies
• Measure with the same thermometer at the same site over course of illness
• Should see a fever reduction by 1-2 degress within 30-60 minutes of antipyretic use

Question 20

Fever Patient Outcomes

Answer 20

• Parameters: temperature and discomfort
• Improving overall comfort and well being should be the main goal
• Monitor associated symptoms daily
• Consult health care provider if symptoms don’t improve or worsen after 3 days

Question 21

Drug Fever

Answer 21

• Fever response to the administration of a medication

- D/C drug causing the fever immediately

Question 22

Normal Body Temperature

Answer 22

• 98.6 F

- 37 C

Question 23

Febrile Seizure

Answer 23

Seizure accompanied by fever in infants/children in the absence of intracranial infection, metabolic disturbances, or an otherwise defined cause

Question 24

Fever Self-Care Exclusions

Answer 24

• Fever > 3 days
• Underlying medical condition: history of seizures, spots of rash, repeated diarrhea, vomiting, sleepy and hard to wake
• High Fever: > 104 F
• Respiratory symptoms
• Neurological symptoms

Question 25

Pediatric/Adult Exclusions

Answer 25

- Severe symptoms of infection : stiff neck - CNS damage - HIV - Impaired immune function - Impaired oxygen - Risk for hyperthermia