Fever Self Care Treatment

Nonpharmacological fever measures

wear lightweight clothing, remove extra blankets, keep room at an ideal temperature

Ideal room temperature

68 degrees Fahrenheit

Fluid levels for children

Increase by 1-2oz per hour

Fluid levels for adults

3-4oz per hour

Appropriate fluids

Water, juice, sports drinks, electrolyte products, and ice pops (NOT anything high in sugar when diarrhea is present)

Never to be used for fever

Alcohol sponging, ice-water baths, ice packs, refrigerated blankets

Acetaminophen for children

10-15mg/kg every 4-6 hours (max 5 doses/day)

Ibuprofen for children

5-10mg/kg every 6-8 hours (max 4 doses/day)

Acetaminophen for adults

325-1000mg every 4-6 hours (max 4000mg/day)

Ibuprofen for adults

200-400mg every 4-6hours (max 1200mg/day)

Acetaminophen Age Restrictions

Not for kids under 2, kids 2-11 dosed by weight

Ibuprofen age restrictions

Approved for fever only in children 6+ months

Acetaminophen onset and peak

relief in 30-60mins, max effect at 2 hours

Ibuprofen onset and peak

relief in 30-60mins, max effect at 2 hours

Children's dosing

dose by weight NOT by age

Alternating drugs

do not alternate acetaminophen and ibuprofen, causes an overdose risk and possible adverse effects

Cough and cold meds & antipyretics

Do not combine products that have the same ingredients

NSAIDS exclusions

pregnant patients, people with uncontrolled HBP, heart failure, renal failure, and Aspirin allergies

Antipyretics limit

Do not take more than 3 days without medical evaluation, should be discouraged before and at the time of vaccinations (okay afterwards)

Fever self care exclusions

infants under 3 months (w/ temp of 100.4 or higher), children 3+months with temp of 104+, fever worsening after 72 hours for children over 2 and over 24 hours for children under 2, history if febrile seizures and other comorbid conditions, accompanying warning signs, and older adults

Counseling Points

Correct thermometer choice and technique, and interpreting readings, weight-based dosing with the supplied measuring device, non-drug measures and hydration, avoiding alternating or duplicate antipyretics, Warning signs and when to seek further care, safe disposal of any mercury thermometers.

Monitoring Points

track temp and comfort, use same thermometer and site 2-3 times/day, do not over check, no improvement or worsening symptoms after 3 days refer to PCP

Hyperthermia

a failure of normal thermoregulation caused by excessive heat exposure or production, including some drugs.

Hyperpyrexia

a temperature above 106°F (41.1°C), usually with mental and physical symptoms. It can occur with either fever or hyperthermia.

Cause of fevers

normally infections (viral, bacterial, fungal, or protozoal), may also be caused by tissue damage, dehydration, heat stroke, medications, and metabolic disorders

Goal of fever treatment

comfort NOT normalizing temperature

rare fever complications

seizures, dehydration, and altered mental status are rare unless temperature exceeds about 106 degrees

Rectal temperature site

Threshold above 100.4F/ 38C, gold standard and the preferred method for infants under 3 months, is invasive, slow to detect rapid changes, and relatively contraindicated in neutropenia, recent rectal surgery or injury, or rectal pathology

Tympanic temperature site

Threshold above 100.4F/ 38C, not suitable for mouth-breathers, uncooperative or confused patients, or most children under 3, pacifier thermometers are an option for young children but are less accurate under 3 months

Oral temperature site

Threshold above 99.5F/37.5C, not recommended under 6 months, accuracy is affected by earwax, ear inflammation, and technique.

Axillary temperature site

Threshold above 99F/ 37.2C, least reliable., must confirm a fever with another method

Temporal (and no-touch infrared) temperature site

Threshold at 100.1F/ 37.8C or higher, fast and noninvasive but not shown to be superior to rectal measurement, no-touch devices were less accurate than rectal in one pediatric emergency study

Fever testing methods to avoid

mercury-in-glass thermometers (environmental concerns) and color-change strips (not accurate enough)

Febrile Seizures

occur in 2-5% of children aged 6 months to 5 years, peaking at 18-24 months, most are simple (nonfocal, under 15 minutes, one episode in 24 hours) and rarely cause lasting neurologic problems

Febrile Seizure Risk Factors

daycare attendance, developmental delay, family history, and a long neonatal hospital stay

Febrile Seizure Reoccurance Risk

higher with multiple prior seizures, a first seizure before age 1, or a family history of epilepsy