Fever

INTRODUCTION

  Fever occurs because heat loss mechanisms are unable to keep pace with excessive
heat production , resulting in an abnormal rise in body temperature. A fever is
usually not harmful if it stays below 39 degree Celsius.

 A single temperature reading does not always indicate a fever.

 In addition to physical signs and symptoms of infection. Fever determination is

based on several temperature readings at different times of the day compared with
the usual value for that person at that time.

 A true fever results from an alteration in the hypothalamic set point.

DEFINITION

 When body temperature rises above 99 degree f.or 37 degree c. It is called pyrexia or
fever.
CAUSES OF FEVER

1.  Infection
2. Disease of nervous system
3. Certain malignant neoplasm
4. Blood diseases such as leukaemia,embolism, and thrombosis.
5. Heat strok from exposure to hot environment
6. Dehydration
7. Surgical trauma and crushing injuries
8. Skin abnormalities that interfere with heat loss
9. Allergic reaction to foreign proteins and pyrogens.
TYPES OF FEVER

CONSTANT PYREXIA OR CONTINUOUS FEVER- There is temperature varies not more

than two degrees between morning and evening and does not reach normal for a period
of days or weeks.

INTERMITTENT PYREXIA OR QUOTIDIAN FEVER OR SWINGING PYREXIA OR HECTIC

PYREXIA - Temperature rises from normal or subnormal to high fever and back at
regular intervals. The interval may vary from few hours to three days,usually
temperature is higher in the evening than in the morning.

REMITTENT FEVER - Remittent fever is a fever characterized by variation of more than

two degree between morning and evening but does not reach normal
INVERSE FEVER - In this type the highest range of temperature is recorded in the morning
hours and the lowest in the evening which is contrary to that found in the normal course
of fever.

RELAPSING FEVER - Relapsing fever is one in which there are brief febrile periods
followed by one or more days of normal temperature.

IRREGULAR FEVER- When fever is entirely irregular in its course it is called irregular fever.

SUSTAINED FEVER - Constant body temperature .Continuously above 38 degree c. Or

100.4 degree f. That demonstrate little fluctuation.
TERMS USED TO DESCRIBE PHASES OF
FEVER

 ON SET OR INVASION- it is period when body temperature is rising.  fastigium or

stadium- of fever is the period when the body temperature has reached its maximum
and remains fairly constant at a high level.

 DEFERVESCENCE OR DECLINE - Period when the elevated temperarure is returing to

normal. The fever may subside suddenly or gradually.

  CRISIS is a sudden return to normal temperature from a very high temperature with
in a few hours or days. Crisis is divided into true crisis and false crisis
 DEFENCE MECHANISM OF FEVER

  Enhances body immune system by stimulating W.B.C. Production

 Increased temperature reduces the content of iron in blood plasma
 Suppressing the growth of bacteria
 Fever fights again viral infection by stimulating interferon ( body’s natural
virus fighting substance
 Fever result from an alteration in hypothalamus
 Hormones promote the body’s defence against infection
 Induced febrile episode
 Body produces and conserves heat
 Person experiences chill, shivering, and cold Skin becomes warm and
flushed because of vasodilatation
 Body’s inability to promote heat loss or reduce heat production
 Fever is sign of disease
 It is protective function
 Increase in the temperature prevents growth of organism causing disease
 There is destruction of bacteria through phagocytosis and producing
immune bodies.
NURSING CARE OF PATIENT WITH FEVER
OBJECTIVES -
 To increase heat loss
 Reduce heat production
 Prevent complication
 Promoting balance between heat production and heat loss.

ASSESSMENT –
 Obtain frequent temperature reading
 Assess for contributing factors such as dehydration, infection environmental
temperature
 Identify physiological response to fever
 Obtain all vital signs
 Assess skin colour and temperature
 Assess for presence of thirst, malaise
 Assess clients comfort and well being
 Observe for shivering and diaphoresis
NURSING INTERVENTION OF FEVER-

 Minimize heat production- reduce the frequency of activities that increases oxygen
demand,such as excessive turing and ambulation, allow rest period, limit physical
activity.
 Maximize heat loss -minimize external covering on clients body, keep clothing and
bed linen dry,prevent patient from gettting draughts.Expose patient to cool air by an
electical fan
  Maximize heat loss- Administation of cool drinks Application of cold compress and
ice bags Cold sponging and cold packs. Cold bath Use of hypothermic blanket
 Prevent shivering -shivering is prevented because it increases metabolic activity
Produces heat, increases oxygen demand, and circulation.May cause
hyperventilation and respiratory alkalosis
  Promote client comfort- Encourage oral hygiene, Prevent dehydration Control
temperature of environment. Provide complete bed rest The clothing should be
light,loose, smooth, cotton,non irritating
 Satisty supplement for increased metabolic rate- provide supplemental oxygen
therapy . Replace fluid lost Provide high caloric diet- because oxygen consumtion in
body tissues increases. Diet should be easily digestible and palatable Fluid intake
upto3000ml.
  Encourage patient to take plenty of fluid - Maintain intake out put chart. Provide
small frequent feeds. Make food palatable. Plenty of fluid and fruits will help to
evacuate bowel regularly.
 Maintenance of personal hygiene— Frequent mouth care Care of skin and pressure
points. Give sponge bath daily.If temperature remains high cold sponging is given to
bring down the temperature.

 Safety of patient— Never leave a patient alone.Rigor and convulsions may occur at
any time constant observation is important . Evaluate urine output periodically.
  
DEFINITION OF RIGOR

  A rigor is a sever attack of shivering which may occur at the onset of disease
characterized by a rise in temperature.
STATES OF RIGOR

 FIRST STAGE- also called as cold stage -Patient shivers uncontrollably skin is cold. Face
is pinched and pale,pluse is feeble and rapid. Temperature rises rapidly to 103 degree f.
Patient will feel cold

 SECOND STAGE OF RIGOR It is also called as hot stage - During this stage patient
become uncomfortably hot. His skin is very hot and dry. Patient will complain of extreme
thirst and headache. Shivering stops.

 THIRD STAGE OF RIGOR It is also called sweating stage - Patient begins to sweat
profusely, temperature decreases,pluse rate also decreases. Discomfort subsides,
patient may go into a state of shock and collapse, if not cared properly.
CARE OF PATIENT WITH RIGOR

 A patient suffering from rigor should never be left alone. First stage care- during shivering
attack he should be given hot drinks and have blanket put around him,until he feels warm.
Apply warmth with hot water bag.

 During the hot stage patient should be given cool drinks, and cold compresses or an ice bag,
applied to his head will help to relieve headaches. patient temperature is recorded every 10
to 15 min. Give tepid sponging. it is important to observe carefully for first signs of swatting.
Remove all blankets and hot appliances .Cover patient with thin bed sheet.

 Sweating is one of the bodys usual ways of reducing temperature, but the sweating must be
wiped from pt’s face, neck and chest. At the end of the rigor patient may feel very exhausted
and nurse should ensure that the patient is comfortable.
  Change patient’s clothing and also change linen.
 Observation must be continued at regular intervals until the temperature has
remained regular.
 Sweet drinks may be given to trat fatige.
 When temperature comes down and pluse is not improved it is considered as false
crisis,and patient’s condition may deteriorate.
HYPOTHERMIA 

  If the temperature falls below 95 degree f. Or 35 degree c. The condition is called
hypothermia.
NURSING CARE OF PATIENT WITH
HYPOTHERMIA.

 Patient is rewarmed by placing him in a warm room, with warm blankets and drinks. prevent
a further decrease in body temperature removing wet clothes, replacing them with dry cloth.
 If possible give hot liquids such as soup
 Avoid alcohol and caffeinated fluid .
 keep the head covered.
Thank you