Definition of Fever – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Definition of Fever
Fever is an elevation of core body temperature more than 38°C (100.4degree F) i.e. above the normal daily variation.
or
An elevation of normal body temperature is called fever
or
When the normal temperature is elevated about normal the patient is said to have pyrexia or fever. It is a common indication of illness.
Or
Although a fever technically is any body temperature above the normal I of 98.6°F (37 C), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4°F (38°C)
Classification/Types of Fever:
Sign and Symptoms of Fever:
Depending on what’s causing fever, additional fever signs and symptoms may include:
- Sweating
- Shivering
- Headache
- Muscle aches
- Loss of appetite
- Dehydration
- General weakness
High fevers between 103°F (39.4°C) and 106°F (41.1°C) may cause:
- Hallucinations
- Confusion
- Irritability
- Convulsions
- Dehydration
If a patient’s complaints to you with fever –
Ask about-
➤ Onset.
➤ Duration: Acute /chronic (Duration of episodes of fever)
➤ Intensity-Low grade or high grade
➤ Type/character of fever- Continued /Remittent/Intermittent
➤ Diurnal variation: Evening rise of fever-TB -Relieved spontaneously or by medication
➤ Associated symptoms:
- Chills & rigor in Malaria, UTI & ascending cholangitis, Subsides with chills.
- Unconsciousness in Cerebral malaria, meningitis, encephalitis,
- Dysuria in UTI
- Night sweat.
- Lymphoma & TB.
Definition of Hyperpyrexia:
Hyper means abnormally increased and pyrexia refers to fever. A fever is when the body’s temperature rises above the normal 98.6 degrees Fahrenheit. Hyperpyrexia occurs when the body’s temperature rises above 106.7 degrees Fahrenheit. This is considered a medical emergency and requires immediate treatment.
Causes of Hyperpyrexia (>107°F):
1. Cerebral malaria
2. Pontine haemorrhage
3. Heat stroke
4. Septicemia
5. Lobar pneumonia
6. Atropine & Datura poisoning
7. Acute pyelonephritis.
Definition of Hyperthermia:
Hyperthermia is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.
Causes of hyperthermia:
1. Exposure to prolonged heat
2. Prolonged muscular exertion
3. Older age
4. Cardiovascular disease
5. Damage to spinal cord or brain.
Sign and Symptoms of Hyperthermia:
Sign and symptoms of hyperthermia include:
1. An elevated body temperature,
2. Headache,
3. Nausea,
4. Weakness,
5. Dizziness,
6. Fainting,
7. Muscle cramps,
8. Seizures,
9. Confusion, and
10. Coma
Definition of Hypothermia:
Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6°F (37°C). Hypothermia occurs as your body temperature passes below 95°F (35°C).
Sign and Symptoms of Hypothermia:
A. Mild hypothermia
Signs and symptoms of mild hypothermia include:
1. Shivering
2. Dizziness
3. Hunger
4. Nausea
5. Faster breathing
6. Trouble speaking
7. Slight confusion
8. Lack of coordination
9. Fatigue
10. Increased heart rate
B. Moderate to severe hypothermia
As your body temperature drops, signs and symptoms of moderate to severe hypothermia include:
1. Shivering, although as hypothermia worsens, shivering stops
2. Clumsiness or lack of coordination
3. Slurred speech or mumbling
4. Confusion and poor decision-making, such as trying to remove warm clothes
5. Drowsiness or very low energy
6. Lack of concern about one’s condition
7. Progressive loss of consciousness
8. Weak pulse
9. Slow, shallow breathing
Causes Hypothermia:
Specific conditions leading to hypothermia include:
1. Wearing clothes that aren’t warm enough for weather conditions
2. Staying out in the cold too long
3. Unable to get out of wet clothes or move to a warm, dry location
4. accandental fills in water, as in a boating accident
5. Inadequate heating in the home, especially for older people and infants
6. Air conditioning that is too cold, especially for older people and infants
Treatment of Hypothermia:
Depending on the severity of hypothermia, emergency medical care for hypothermia may include one of the following interventions to raise the body temperature:
- Blood rewarming. Blood may be drawn, warmed and re-circulated in the body. A common method of warming blood is the use of a hemodialysis machine, which is normally used to filter blood in people with poor kidney function. Heart bypass machines also may need to be used.
- Warm intravenous fluids. A warmed intravenous solution of salt water may be injected into a vein to help warm the blood.
- Airway rewarming. The use of humidified oxygen administered with a mask or nasal tube can warm the airways and help raise the temperature of the body.
- Irrigation. A warm saltwater solution may be used to warm certain areas of the body, such as the area around the lungs (pleura) or the abdominal cavity (peritoneal cavity).
Acute fever:
Fever persisting less than 2 weeks is called acute fever.
Causes of Acute Fever:
1. Abscess anywhere in the body.
2. Pyogenic or viral meningitis
3. Malaria
4. Pneumonia
5. Upper respiratory infection
6. Enteric fever
7. Urinary tract infection
Chronic fever:
Fever persisting more than 2 weeks is called chronic fever.
Causes of chronic fever:
1. Kala-azar
2. Tuberculosis
3. Lymphoma
4. Chronic malaria
5. Enteric fever persisting more than 2 weeks
6. Leukemia
7. Aplastic anaemia
Phases of fever:
The patient has nonspecific symptoms just before the temperature.
1. Prodromal phase: The patient has nonspecific symptoms just before the temperature.
2. Onset or invasion phase: Obvious mechanism for increasing body temperature.
3. Stationary phase: The fever is sustained.
4. Resolution phase: The temperature is return to normal.
Nursing Management of a Patient with Fever/High Fever/Hyperpyrexia:
A fever is considered an important body defense for destroying infectious microorganism when fever remains below 102°F and the patient has not have a chronic medical condition such as typhoid, malaria, surgical infection etc.
1. Give full bed rest.
2. Cold sponging
3. Antipyretic drugs should be given
4. If the temperature is higher than 105.8°F or if high temperature is unchanged after a sufficient response time with conventional intervention. Some investigation should be done for prepared diagnosis and treatment
5. When the patient feels shivering cover with blanket or heavy cloth
6. Keep patient in a warm but not hot environment
7. Remove blanket or a heavy clothing once shivering subsides
8. Limit activity.
9. Temperature should be measured 2 hourly & maintain the chart.
10. Provide liberal amounts of fluid
11. Provide light and high caloric diet.
12. Administer antipyretic drug according to physician orders.
13. Promote room ventilation
14. Tepid or cold sponging or bath 30 minutes after administrating antipyretic.
15. Discontinue physical cooling measures if the patient begins to shiver
Definition of Rigor:
Rigor is an attack of intense shivering when the heat regulating center in the brain is disturbed. It is seen in certain infections like malaria, in allergic reaction after I.V infusion and in blood transfusion.
or
Rigor is a severe shivering attack of the body which is caused when the heat regulating mechanism of the body is disturbed. Shivering occurs due to vigorous contraction.
Stages of Rigor:
1. Cold stage: This is the first stage. The patient feels cold, chilling and shivering. It is accompanied by a rapid rise of temperature and patients need blanket.
2. Hot stage: In this stage the temperature reaches high. In this stage the patient stops shivering and starts feeling hot, perspires and remove blanket.
3. Sweating or perspiration stage: The patient sweats profusely, body temperature comes down and patient again feels cold,
Causes of Rigor:
1. Infective conditions like malaria, pneumonia, filarial.
2. After or duration infusion of IV drips, e.g. – glucose or glucose saline.
3. After or during blood transfusion,
4. Drug reactions.
5. Urinary tract infection.
6. Viral infection.
Nursing Management of Rigor
In the cold stage, patient feels chill, extreme shivering and hyperpyrexia.
A. Management of cold stage:
- Inform the doctor, reduce activities, such as excessive turning, that increase oxygen demand.
- Allow rest.
- Provide supplementary oxygen.
- Offer hot drinks.
- Provide extra blankets
- Give more fluids.
- Take temperature immediately after the cold stage.
- Hot water bags can be given for warmth.
B. Management of hot stage:
- Remove extra blankets and hot water bags
- Cold sponging and ice cap compresses can be given.
- Cold drink can be given.
C. Management of sweating stage:
- Wipe the patient with a wet towel and cover him with a sheet
- Stimulating drinks like tea can be given.
- During all three stages, take temperature and make a chart.
Nice to Know
Pyrexia of unknown origin (PUO):
It may be defined as a consistently elevated body temperature of more than 38°C (100.4degree F) persisting for more than 3 weeks without diagnosis despite initial investigations during 3 days of inpatient care or after more than two outpatient visits,
Normal values:
- There is a normal diurnal variation of about 0.5°F. It is minimum in the early morning and highest in the late afternoon.
- A recovering patient of febrile illness may show normal variation of about 1°C.
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