Definition of Fever:
The body temperature will be different depending on the way it is measured and some environmental factors.
  1. Core temperature: refers to the temperature of inner parts of the body. This would include vital organs, such as heart, brain, liver and blood. It is generally maintain at around 37 °C. When the core temperature is at or over 38 °C, it is recognized as fever. The temperature measured by ear thermometer is one of the representative core temperature.
  2. Body surface temperature: refers to the temperature of the skin. It may simply vary with the environmental temperature and it may not be accurate. For example, fever as in the armpit temperature is suggested to be at or over 37.5°C.
 
Causes of Fever:
There are many causes of fever. The most common cause is an infection, including bacterial, viral, fungal, and parasitic infection. Fever can aid in host defense. There are some immunological reactions that are sped up by temperature. Fever can also enhance leukocyte phagocytosis and reduce bacterial growth. There are other non-infectious causes, including inflammation, immune response and other. Inflammation involves tissue damage (e.g. surgery) and/or cell necrosis (e.g. acute pancreatitis, gout and tumors, etc.), which the fever pattern is usually low grade fever (below or equal to 38.8 °C). Immune response includes allergic reactions and autoimmunity. Other different causes may include vaccination, endocrine disorders, metabolic diseases, and vascular diseases.

Staging of Fever:
  1. Stage of onset of fever: The patient will feel chilled and develop generalized shaking despite a sudden or gradual rise in body temperature. The symptoms at this stage include:
    1. Chill: Muscle contraction through shivering in order to produce more heat and reduces heat loss through the skin. At the end of the chill process, the body temperature will rise about 1~2 °C.
    2. Pale and/or cold skin.
    3. Thirst.
    4. Increasing breathing rate: Because of the increase of metabolism, the concentration of carbon dioxide will elevate and stimulate the respiratory center.
    5. Increasing heartbeat: When body temperature elevated by 1°C, it indicates a 13% increase in the basal metabolic rate. (This results in an increased heart rate)
  2. Stage of extremely high temperature of fever: The body temperature reaches its highest level. Symptoms at this stage include: skin flushing, warm/heated skin, increasing heart rate, increasing breathing rate, felt thirstier, headache, decreased urine output, dehydration, dry and ruptured skin mucous membranes, weakness and poor appetite. Unconsciousness and delirium may even happen.
  3. Stage of remission of fever: The body temperature returns to normal, and normally there are two situations:
    1. The body temperature gradually decreases and usually reaches the normal range within 2~3 days or 1 week, indicating that the disease is improved.
    2. b. Sudden drop in body temperature to normal or lower than normal within 12 to 24 hours indicates that the body cannot resist the invasion of disease. The symptoms of this stage include sweating, reduced chills and dehydration.
 
Treatments for Fever:
A consensus has been reached according to the recent study. Fever is not by itself an illness. It's usually a symptom of an underlying condition.Therefore, the most important thing is to treat the underlying condition, instead of just treating the fever itself. As a result, the treatments of fever should be to improve the sense of comfort, rather than to reduce body temperature.
  1. Adequate environment: Adjusting the room temperature, improving air circulation, avoiding direct wind blowing to the patients and keep the environment comfortable.
  2. Measure the body temperature every 4 hours: Be cautious to the external factors that will affect the temperature, such as exercise, wearing too much clothes and sun exposure. If the external factors presented, the temperature should be measured again after resting for half an hour.
  3. Adequate diet: It is suggested for patient to drink more water (3000mL per day) and replenish electrolytes properly, as well as having frequent light meals.
  4. Hygiene and comfortable: Adding clothes and quilts in the stage of onset of fever; reducing clothes and quilts, helping them take a bath or change clothes if the patient is sweating in the stage of extremely high temperature of fever.
  5. Take a warm bath: It can increase blood circulation and promote heat dissipation. It is advised to control the water temperature at 27°C ~37°C. The bath should last no longer than 20-30 minutes each time. During a sponge bath, the action should be gentle to avoid friction and heat generation or shivering during the process.
  6. Using antipyretics: If the cause of fever is uncertain, it is recommended not using antipyretics to reduce body temperature. Because antipyretics may mask the symptoms of the disease, making the disease hard to assess correctly. However, in patients with known chronic diseases, such as heart and lung disease and febrile seizure, in order to avoid deteriorating previous physical disorder. antipyretics can be used to alleviate the discomfort causing by fever. However, they cannot shorten the course of the disease.
 
Precautions:
  1. Fever in some viral infections may persist for up to 1 week or even longer. and patients experience a fever after returning from an epidemic area should seek medical attention immediately. There isn’t any specific drug for most common respiratory or gastrointestinal viral infections. If the infection is not under control, it is very common to have a fever relapse. However, if patients have a fever of 40 °C or higher or a fever lasting for more than 7 days or if the symptoms become severe, they must seek medical consultation for other special causes.
  2. Ice pillow, cooling patch, etc. can cause local vasoconstriction, which hinders heat dissipation. They are not recommended for routine use.
  3. Patients should seek medical consultation or go to the emergency room if they have a fever with the following conditions: altered state of consciousness, lethargy, neck stiffness, severe headache, sore throat, skin rash, chest pain, shortness of breath, persistent vomiting, bloody stool, painful urination, swollen feet or the swollen part of the skin with redness or burning sensation.
  4. Children should seek medical attention immediately if they have a fever with the following conditions:
    1. Infants under 3 months should immediately seek medical consultation as long as they have a fever.
    2. Complications with twitching, eye hanging, poor mobility or abnormal crying, paralysis of the limbs, and abnormal sensation.
    3. Weakness, difficulty breathing, inability to eat, severe vomiting, headache, purple spots or bleeding spots on the skin.
    4. Continuous fever for more than 2 days or body temperature above 39 °C, and any abnormal conditions.
 
References
  1. Knight, A. (2015). Triage nurse's assessment of a child with a fever. Australian Nursing and Midwifery Journal, 22(10), 28-31. Retrieved from http://search. proquest.com/docview/1678059427?accountid=45174
  2. UpToDate. (2018, Feb. 03). Pathophysiology and treatment of fever in adults. retrieved from https://www.uptodate.com/contents/pathophysiology-and-treatment-of-fever-inadults?search=fever%20nirsing%20care&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=8
  3. UpToDate. (2018, Feb. 03). Patient education:when to worry about fever in adults (the basics)Retrieved from https://www.uptodate.com/contents/ when-to-worry -about-a-fever-in-adults-the-basics?search=fever%20nirsing%20care&topicRef=2734&source=see_link
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