Fever Management Guidelines

Fever Management

• Normal Temperature: 97.5°F - 98.9°F
• Fever Measurement: Confirm fever using a thermometer (FDA-regulated). Accurate measurement is critical, noting the site (rectal, oral, axillary, temporal artery, etc.) and measuring at the same site consistently throughout the illness. Do not use mercury thermometers or color-changing thermometers.

Patient Assessment and Exclusions for Self-Treatment

• Patient Age: Assess patient age (over 2 years)
• Accurate Temperature Measurement: Ensure accurate body temperature measurement method
• Symptoms: Note symptom information, medical history, and allergies.
• Exclusions: Self-treatment exclusion criteria include:
  • Patients >3 months of age with rectal temperature ≥104.0°F (40.0°C) or equivalent
  • Children <3 months of age with rectal temperature ≥100.4°F (38.0°C)
  • Symptoms of infection not self-limiting or severe
  • Risk for hyperthermia
  • Impaired oxygen utilization or immune function (e.g. cancer, HIV, CNS damage)
  • History of febrile seizures or seizures
  • Fevers lasting >3 days with or without treatment.
  • Child with spots or rash
  • Child refusing fluids
  • Child who is very sleepy/irritable/hard to wake up
  • Child who is vomiting/can't keep fluids down
  • Recurrent fever above 104.0°F (40.0°C)

Fever Resolution

• Fever Resolved after 24 hours? If yes, discontinue treatment;
• Fever Resolved after 3 days of treatment? If yes discontinue treatment
• Fever lasting beyond 24-72 hours: Consult with medical professional

Non-Pharmacological Interventions

• Proper Fluid Intake: Encourage adequate fluid intake.
• Lightweight Clothing: Dress appropriate clothing
• Remove Blankets: Remove excessive blankets/clothing
• Sponging Baths: Use tepid/lukewarm water for sponging, avoiding alcohol-containing products.
• Room Temperature: Maintain ambient room temperature between 75°F.
• Bathing in Lukewarm/Cold Water: Lukewarm water baths are not effective in reducing fever, cold water baths are not recommended.

Pathophysiology

• Hypothalamus Control: Core body temperature is controlled by the hypothalamus
• Normal Temperature Range: Normal temperature range is 97.5°F to 98.9°F
• Pyrogens: Fever-producing substances that activate host defenses (endogenous, exogenous)
• Prostaglandins: Prostaglandins are produced in response to circulating pathogens, such as microbes or toxins.

Fever Complications

• Seizures: Febrile seizures occur in 2-5% of children 6 months to 5 years old.
• Dehydration
• Mental Status Changes
• Older Adults: Older adults are at higher risk for complications

Pharmacological Interventions (OTC)

• Acetaminophen (Tylenol): Maximum daily dose varies by age and weight. Generally up to 4 grams/day for adults and 3 grams for elderly, with frequent doses (10-15mg/kg every 6 hours)
• Ibuprofen (Motrin): 1200mg max daily dose,with frequent doses of (200mg every 4-6 hours or 5-10 mg/kg every 6 hours)
• Pregnancy: Tylenol recommended only, as ibuprofen might cause lung shunt openings.

Important Considerations

• Fever Confirmation: Fever MUST be confirmed only with the aid of an FDA-approved thermometer.
• Site Consistency: Maintain the same measurement site throughout the illness
• Consult Doctor: Seek medical advice for persistent fever (greater than 3 days), escalating symptoms, or fever above 104 degrees in any age, or if the child is symptomatic (vomiting, refusal to take fluids, stiff neck etc)

This quiz covers essential guidelines for managing fever, including normal temperature ranges, accurate fever measurement techniques, and criteria for self-treatment exclusions. Understanding these fundamental aspects is crucial for effective patient assessment and ensuring safety in care.