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Patient Care - Fever
Fever
A.
General comments.
The cause of fever should be determined as rapidly as possible.
Deleterious
effects of fever include increased tissue catabolism,
dehydration, precipitation or exacerbation of congestive heart
failure,
acute brain syndrome, and convulsions (rare in adults).
Observation of
the fever curve may be helpful in establishing the diagnosis or in assessing
the efficacy of antibiotic therapy. The decision when to treat fever is often
difficult.
When the origin of fever is unknown, administration of salicylates
is contraindicated unless it is imperative that temperature be lowered. In
critically ill febrile patients, antibiotics may be
given after appropriate cultures have been obtained.
Treatment of fever is indicated when the deleterious effects
previously listed are harmful to the patient, or when the patient's discomfort
is extreme.
B.
Treatment
Antipyretic drugs are the treatment of choice in most cases.
The two types
most commonly used are salicylates and para-aminophenol derivatives
(acetaminophen). These
drugs act mainly on the CNS to lower the body temperature.
Salicylates
may be given orally, IV, or PRo.
Caution Patients with Hodgkin's disease or other lymphomas or with
gram-negative
sepsis occasionally are very sensitive to salicylates and
may become
hypothermic and hypotensive after small doseS. Although
this is rare, it is wise to use other antipyretic agents in patients
experiencing
a marked fall in temperature after administration of small
doses
of aspirin. Since salicylates cause a prolongation of prothrombin
time, patients
taking warfarin drugs should be given acetaminophen. In
addition to being effective antipyretic agents, these drugs also
possess
significant analgesic properties.
2. Hypothermic blankets may be effective but require close monitoring of rectal
temperatures. Shivering may be a problem. The
use of the blanket should be discontinued when the rectal temperature drops
to about 38 C, 3.
Tepid sponge baths with water-alcohol mixtures may be used but are less effective
in adults than in children.
4. Ice baths are reserved
for cases of extreme hyperthermia such
heatstroke
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