Fever - Fever or pyrexia is defined as “ a Rise in the body temperature above 99 ° F (37.2° C )”.

 

 

1.   Fever :

      Fever means a rectal temperature above 38°C or100.4°F or  temperature above 99°F

Some people take it as  normal oral temperature but the rarer individual variations.

Fever or pyrexia is defined as “ a Rise in the body temperature above  99 ° F (37.2° C )”

  The cases of fever are infections, diseases of the nervous system, certain malignant neoplasm’s, blood disease such as  leukemia, embolism and thrombosis, heatstroke from  exposure to hot  environment ,dehydration , surgical trauma an crushing  injuries, skin abnormalities that interfere with het loss, allergic reaction to foreign proteins and pyrogens. Etc.

 

Types of Fever

1.       Constant or continuous fever :

     A continuous Fever is one in which the temperature varies not more than two degrees between morning and evening but the  temperature does not come to normal during the Day.

2.       Intermittent fever :  An intermittent fever shows large variation , i.e, the temperature rises form normal to high  temperature and  comes down at regular intervals.  The Temperature may  vary from few hours  to three days.

3.      Remittent Fever :  in remittent fever, the variation is more than two degree centigrade between morning and  evening  but  fever does not reach normal.

4.      Inverse Fever : In this type, the highest temperature is in the morning and the  lowest temperature in the evening  

5.      Relapsing Fever : In this type, there are  short febrile periods followed by one or more days of normal temperature.

6.      Hectic or swinging fever:  When the difference between the high and low points is very great the fever is called hectic or swinging fever.

7.      Irregular Fever : Fever is entirely irregular in its course, so that it cannot be classified under any special type of fever and is called irregular fever.

 

Stages of Fever :

1.      Onset or Invasion :  It may be sudden or gradual, according to the disease condition.

2.      Fastigium or stadium (height of fever or stage of advance ): Fever remains constant for a few days. Then ,it attains a peak level. The highest point is called the fastigium or stadium.

3.      Defervescence or Decline : It is the period of disappearance of fever.

4.      Lysis: In this the temperature  falls step by step. Temperature comes to normal within 3 to 4 days or within one week, e.g., in typhoid.

5.      Crisis:   In this , the temperature falls suddenly from high fever to normal e.g., respiratory tract infections.

6.      True Crisis:  It is associated with improvement of general health of the Patient .

7.      False crisis: It is not associated with improvement of general condition.

  

Management of a patient with fever (pyrexia)	Management depends upon the degree of fever
Low pyrexia	99°F-101° F
Moderate Pyrexia	101°F-103°F
High Pyrexia	103°F-105°F
Hyper pyrexia	105° F and above

 

Mild Fever can be reduced by cold compress and by giving cold fluids and antipyretics.

 

 In Sever Fever :

1.      Give fluids 3 liter per day.

2.      Give cold sponge to reduce body surface temperature.

3.      Give frequent mouth wash and attend to oral hygiene.

4.      Reduce the external covering  on patient’s body to promote heat loss through radiation and conduction .

5.       Do not induce chills.

6.      Keep clothing and bed liner dry to increase heat loss through conduction and convection.

7.      Provide cool, circulating air.

8.      Limit patient’s physical activity and provide rest.

9.      Administer antipyretic medication as per doctor’s instruction.

10.  In  severe cases , antipyretic injections are given as per doctor’s instruction.

11.  Check temperature ½ hourly and record to assess the general condition of patient.

12.  Highest temperature is seen in thyroid crisis. In the case, antithyroid   drugs are advised.

 

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. It has three stages.

1.      Cold Stage.

2.      Hot Stage .

3.      Sweating Stage.

 

 

1.      Cold stage:  In the cold stage , patient feel chill, extreme shivering and hyperpyrexia.

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.

·         Take temperature immediately after the cold stage.

·         Hot water bags can be given for warmth .this stage last to few minutes.

 

 

2.           Hot stage :   Hot stage is the second stage in the stage of fever  remove stage in the stage of fever remove extra blankets and hot water bags. Shivering stop. But may be restless and anxious. Temperature may continue to rise .

·         Cold sponging & ice cap compresses can  be given.

·         Cold drink can be given .

·         Cover with only bed sheets. Check TPR and record every 15 minutes.

3.      Sweating Stage : It is also called as  “perspiration stage “ the patient sweat profusely , wipe the patient  with a towel and cover him with a sheet. Stimulating drinks like tea can be given .during all the three stage, take temperature and make a chart.

 Nursing intervention of Patient with Fever .

·         Monitor vital signs.

·         Assess skin color and temperature.

·         Monitor white blood cell count and other pertinent laboratory record.

·         Remove excess blankets when the patient feel warm ,but provide extra warmth when the patient feel chilled.

·         Provide adequate food and fluids (e.g,2500-3000ml per day )to meet increased metabolic demand and prevent dehydration .

·         Measure intake and output and maintain I /O chart

·         Maintain prescribed intravenous fluids.

·         Reduce physical activity to limit heat production.

·         Administer antipyretic and anti  biotic (drugs that reduce the level of fever ) as ordered.

·         Provide cool circulating air by using a fan to increase heat loss through convection.

·         Provide a tepid sponge bath to increase heat loss through conduction .

·         Apply ice pack to axillae  and groins(avoid if shivering )

·         If shivering  give medications e.g ,meperidine ,butorphanol.

 

                   Nursing Care Plan :

            Assessment :

·        Obtain core temperature during each phase of febrile episode.

·      Assess for contributing factors such as dehydration ,infection ,or environmental temperature.

·      Identify physiological response to temperature.

·      Identify physiological response to temperature .

·      Obtain all vital signs .

·      Observe skin color

·      Assess client comfort and well  being.

·      Determine phase of fever : chill

 

     Intervention :

·      Obtain blood cultures when ordered blood specimens are obtained to coincide with temperature spikes when the antigen –producing organism is most prevalent.

·      Initiate therapies to minimize heat production .

·      Reduce the frequency of activities that increase oxygen demand such as excessive turning &ambulation .

·       Allow rest periods.

·      Limit physical activity

·      Initiate therapies  to maximize heat loss.

·      Reduce  external covering on client’s body to promote heat loss through radiation and conduction .Do not induce shivering.

·      Keep clothing and bed linen dry to increase  heat loss through conduction and convection.

·      Initiate therapies to meet requirement   for increased metabolic rate .

·      Provide supplemental oxygen therapy as ordered  to improve oxygen delivery to body cells.

·      Provide  measures to stimulate appetite and offer  well –balanced meals.

·      Provide Fluids to replace fluids lost through insensible water loss and sweating .

·      Initiate therapies to promote client comfort.

·      Encourage oral hygiene because oral mucous membranes dry easily  from dehydration.

·      Control Temperature of the environment without inducing shivering.

·      Identify onset and duration of febrile episode phases.

·      Examine previous temperature measurement for trends.

·      Initiate health teaching as indicated .

Nursing Care Plan

Diagnosis:

Increased body temperature ,altered risk for hyperthermia.

Planning Goals:

·      Clint will regain normal range of body temperature.

·      Clint will attain sense of comfort and rest.

 

Intervention :

1.   Instruct client to reduce external covering and keep clothing and bed linen  dry .

2.   Instruct client  to monitor temperature at home and administer acetaminophen  every 4 hour as ordered for   temperature over 39° C(102.2°F) .

3.   Instruct client to limit physical activity and increase frequency of rest periods over  next 2 days.

4.   Instruct client to increase fluid intake.

Evaluation

1.   Body temperature will decline within next 8 hours.

2.    Client will verbalize increased satisfaction with rest and sleep pattern.

3.   No evidence of postural hypotension during ambulation.

4.   Ask client about sleep pattern.

5.   Ask client about any dizziness with postural changes.