Ferdinand B.

Fever is defined as elevated body temperature due to a break in

thermoregulation that arises when a body produces or absorbs more
heat than it dissipates. It is a sustained core temperature beyond
the normal variance, usually greater than 39 °C (102.2 °F).
A fever is a temporary increase in your body temperature, often due to
an illness. Having a fever is a sign that something out of the ordinary is
going on in your body. For an adult, a fever may be uncomfortable, but
usually isn't a cause for concern unless it reaches 103 F (39.4 C) or
higher. For infants and toddlers, a slightly elevated temperature may
Symptoms

You have a fever when your temperature rises

above its normal range. What's normal for you
may be a little higher or lower than the average
normal temperature of 98.6 F (37 C).

Depending on what's causing your fever,

additional fever signs and symptoms may include:

• Sweating
• Chills and shivering
• Headache
• Muscle aches
• Loss of appetite
• Irritability
• Dehydration
• General weakness
 Causes

Fever occurs when an area in your brain called the hypothalamus (hi-
poe-THAL-uh-muhs) — also known as your body's "thermostat" — shifts
the set point of your normal body temperature upward. When this
happens, you may feel chilled and add layers of clothing or wrap up in
a blanket, or you may shiver to generate more body heat, eventually
resulting in an elevated body temperature.
Normal body temperature varies throughout the day — it's lower in the
morning and higher in the late afternoon and evening. Although most
people consider 98.6 F (37 C) normal, your body temperature can vary
by a degree or more — from about 97 F (36.1 C) to 99 F (37.2 C) —
and still be considered normal.
Fever or elevated body
temperature might be caused
by:

• A virus
• A bacterial infection
• Heat exhaustion
• Certain inflammatory
conditions such as rheumatoid
arthritis — inflammation of the
lining of your joints (synovium)
• A malignant tumor
• Some immunizations, such as
the diphtheria, tetanus and
acellular pertussis (DTaP) or
 Sometimes the cause of a fever can't be identified. If you have a
fever for more than three weeks and your doctor isn't able to find
the cause after extensive evaluation, the diagnosis may be fever of
unknown origin.
Complications

Children between the ages of 6 months and 5 years may experience

fever-induced convulsions (febrile seizures), which usually involve loss
of consciousness and shaking of limbs on both sides of the body.
Although alarming for parents, the vast majority of febrile seizures
cause no lasting effects.

If a seizure occurs:

• Lay your child on his or her side or stomach on the floor or ground
• Remove any sharp objects that are near your child
• Loosen tight clothing
• Hold your child to prevent injury
• Don't place anything in your child's mouth or try to stop the seizure
• Most seizures stop on their own. Take your child to the doctor as soon
as possible after the seizure to determine the cause of the fever.
Prevention

You may be able to prevent fevers by

reducing exposure to infectious
diseases. Here are some tips that can
help:

• Wash your hands often and teach

your children to do the same,
especially before eating, after using
the toilet, after spending time in a
crowd or around someone who's
sick, after petting animals, and
during travel on public
transportation.
• Show your children how to wash
their hands thoroughly, covering
• Carry hand sanitizer with you for
times when you don't have access
to soap and water.
• Try to avoid touching your nose,
mouth or eyes, as these are the
main ways that viruses and bacteria
can enter your body and cause
infection.
• Cover your mouth when you cough
and your nose when you sneeze,
and teach your children to do
likewise. Whenever possible, turn
away from others when coughing or
sneezing to avoid passing germs
along to them.
• Avoid sharing cups, water bottles
Nursing Assessment and
Rationales for Fever

Assessment is necessary to
identify potential problems that
may have led to fever and name
any episode during nursing care.

1. Assess for signs of fever.

Assess for fever signs and
symptoms, including flushed face,
weakness, rash, respiratory
distress, tachycardia, malaise,
headache, and irritability. Monitor
for reports of sweating, hot and dry
 2. Assess for signs of dehydration as a result of fever.
Look for signs of dehydration, including thirst, furrowed tongue, dry
lips, dry oral membranes, poor skin turgor, decreased urine output,
increased concentration of urine, and weak, fast pulse.
3. Monitor the patient’s heart rate and blood pressure.
HR and BP increase as fever progresses.
 4. Identify the triggering factors for fever and review the client’s
history, diagnosis, or procedures.
Understanding the changes in temperature or the cause of
hyperthermia will help guide the treatment and nursing interventions.
 5. Determine age and weight.
Extremes of age or weight increase the risk of the inability to control
body temperature. The elderly are prone to hyperthermia because of
the physiologic changes related to aging, the presence of chronic
diseases.
 6. Accurately measure and document the client’s temperature every
hour or as frequently as indicated, or when there is a change in the
client’s condition.
Using a consistent temperature measurement method, site, and
device will help make accurate treatment decisions and assess trends
in temperature. Use two modes of temperature monitoring if
 7. Monitor fluid intake and urine output.
Fluid resuscitation may be required to correct dehydration. The
significantly dehydrated patient is no longer able to sweat, which is
necessary for evaporative cooling.
 8. Loosen or remove excess clothing and covers.
Exposing skin to room air decreases heat and increases
evaporative cooling.
 9. Provide a tepid bath or sponge bath.
A tepid sponge bath is a non-pharmacological measure to allow
evaporative cooling. Do not use alcohol as it can cool the skin rapidly
and may cause shivering.
 10. Apply ice packs to the patient.
Surface cooling by placing ice packs in the groin area, axillae, neck,
and torso is an effective way of cooling the core temperature. When
the patient’s core temperature is lowered to 39ºC, it is necessary to
remove the ice packs from the patient to avoid overcooling which can
result in hypothermia.
 11. Monitor the skin during the cooling process.
Prolonged exposure to ice can damage the skin. Cover ice packs with a
towel and regularly adjust the site of application to mitigate skin
damage.
 12. Ice water immersion.
Ice water immersion is the most efficient noninvasive technique
for lowering core body temperature. This cooling technique can
lower body temperature at about 0.15ºC to 0.35ºC per minute.
 13. Adjust and monitor environmental factors like room
temperature and bed linens as indicated.
Room temperature may be accustomed to near normal body
temperature, and blankets and linens may be adjusted as indicated
to regulate the patient’s temperature.
14. Modify cooling measures based on the patient’s physical
response. Monitor the patient for shivering.
Excessive cooling or cooling too rapidly may cause shivering,
which increases metabolic rate and temperature. Shivering
should be avoided as it will hinder cooling efforts.
 15. Raise the side rails and lower the bed at all times.
Helps ensure the patient’s safety even without the presence of
seizure activity.
 16. Provide nutritional support or as indicated.
Food is necessary to meet the increased energy demands and high
metabolic rate caused by accompanying fever. Food must be
appealing to the patient because lack of appetite is common with
fever.
 17. Provide mouth care as needed.
Application of water-soluble lip balm can help with dryness and cracks
caused by dehydration.
 18. Keep clothing and bed linens dry.
Promotes comfort and helps prevent chilling since
diaphoresis occurs.
 19. Encourage adequate fluid intake.
If the client is alert enough to swallow, provide cool liquids to help
lower the body temperature. Additionally, if the patient is dehydrated
or diaphoretic, fluid loss contributes to fever.
Patient teaching and home care interventions

Some interventions above can be adapted for home care use.

Providing health teachings to the patient and family aids in coping with
disease conditions and could help prevent further complications of
hyperthermia.

• Determine if the client or significant others have a functioning

thermometer at home and know how to use it.
• Educate the patient and family members about the signs and
symptoms of hyperthermia and help identify factors related to the
occurrence of fever.
• Teach emergency treatment for hyperthermia and hyperpyrexia at
home. Immediately move the person to a shady area if they are
outdoors. Provide cooling measures such as placing them in a tub of
cool water or sponging with cool water.
• Advise clients to monitor symptoms of
hyperthermia during times of high outdoor
temperatures.
• Preventive measures include minimizing time
spent outdoors, use of air conditioning, use of fans,
increasing fluid intake, taking frequent rest
periods, limiting physical activity, cool baths, and
showers.
• When going outside during warmer weather,
advise clients to wear lightweight clothing, loose-
fitting clothes, wear a hat, and minimize sun