Fever (Adult Inpatient)
Clinical Description
- Care of the hospitalized patient experiencing elevated body temperature.
Key Information
- Core temperature monitoring (intravascular, esophageal, bladder) is most accurate. If noncore temperature monitoring is used, only oral and rectal electronic measurement should be used to support clinical decision-making, based on current evidence.
- Fever has a protective role with infection; however, it has been proven harmful in the presence of septic shock or cerebral damage. It may be harmful for patients with heart failure, respiratory comorbidity, hemodynamic instability or neuropsychiatric disorder.
- Recommendations vary regarding temperature value at which antipyretic pharmacologic therapy or active cooling method should be initiated. Management should be individualized by baseline temperature and symptoms.
- Elderly patients, as well as those who have autonomic neuropathy, immunosuppression, sepsis or are receiving continuous renal replacement therapy, may have decreased ability to produce a fever.
Education
Self Management
fever reduction measures
fluid intake
provider follow-up
When to Seek Medical Attention
General Education
admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan
Clinical Goals
By transition of care
A. The patient will achieve the following goals:
B. Patient, family or significant other will teach back or demonstrate education topics and points:
- Education: Overview
- Education: Self Management
- Education: When to Seek Medical Attention
Fever
Signs/Symptoms/Presentation
- diaphoresis
- irritability
- lethargic
- level of consciousness decreased
- seizure activity
- shivering
- skin flushed
- skin pale
- skin warm to touch
- syncope
Vital Signs
- heart rate increased
- blood pressure increased or decreased
- SpO2 (peripheral oxygen saturation) decreased
- core body temperature elevated
Problem Intervention
Promote Normothermia
- Identify and address underlying cause.
- Monitor body temperature and trend; manage variability.
- Provide optimal hydration; consider increased need due to insensible loss.
- Administer antipyretic medication to reduce temperature and discomfort.
- Encourage sleep/rest to minimize oxygen and metabolic demand.
- Provide comfort measures; adjust environment to minimize body temperature (e.g., offer cool cloths, encourage lightweight clothing and covers, reduce room temperature, increase air circulation, decrease stimulation).
- Consider active cooling measures (e.g., external-cooling device, tepid sponge or tub bath, internal-cooling method); cool gradually to avoid shivering.
- Fever Reduction/Comfort Measures
References
- (2020). Bennett, J. E.; Dolin, R.; Blaser, M. (Eds.), Mandell, Douglas and Bennett's Principles and Practice of Infections Diseases. Elsevier. [Expert/Committee Opinion]
- (2021). Potter, P. A.; Perry A. G.; Stockert, P.; Hall, A. M. (Eds.), Fundamentals of nursing. St. Louis: Elsevier. [Expert/Committee Opinion]
- Chan, E.; Chen, W.; Assam, P. External cooling methods for treatment of fever in adults: A systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2010;6(12), 793-825. [Metasynthesis,Meta-analysis,Systematic Review]
- Geijer, H.; Udumyan, R.; Lohse, G.; Nilsagrd, Y. Temperature measurements with a temporal scanner: Systematic review and meta-analysis. BMJ Open. 2016;6(3) doi:10.1136/bmjopen-2015-009509 [Metasynthesis,Meta-analysis,Systematic Review]
- Geijer, H.; Udumyan, R.; Lohse, G.; Nilsagrd, Y. Temperature measurements with a temporal scanner: Systematic review and meta-analysis. BMJ Open. 2016;6(3) doi:10.1136/bmjopen-2015-009509 [Metasynthesis,Meta-analysis,Systematic Review]
- Ignatavicius, D. D.; Workman, M. L.; Rebar, C. R. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Kiekkas, P.; Aretha, D.; Bakalis, N.; Karpuhtsi, I.; Marneras, C.; Baltopoulos, G. I. Fever effects and treatment in critical care: Literature review. Australian Critical Care. 2013;26(3), 130-135. doi:https://doi.org/10.1016/j.aucc.2012.10.004 [Metasynthesis,Meta-analysis,Systematic Review]
- Kiekkas, P.; Aretha, D.; Bakalis, N.; Karpuhtsi, I.; Marneras, C.; Baltopoulos, G. I. Fever effects and treatment in critical care: Literature review. Australian Critical Care. 2013;26(3), 130-135. doi:https://doi.org/10.1016/j.aucc.2012.10.004 [Metasynthesis,Meta-analysis,Systematic Review]
- Kiekkas, P.; Stefanopoulos, N.; Bakalis, N.; Kefaliakos, A.; Karanikolas, M.. Agreement of infrared temporal artery thermometry with other thermometry methods in adults: Systematic review. Journal of Clinical Nursing. 2016;25(7-8), 894-905. [Metasynthesis,Meta-analysis,Systematic Review]
- Niven, D. J.; Gaudet, J. E.; Laupland, K. B.; Mrklas, K. J.; Roberts, D. J.; Stelfox, H. T. Accuracy of peripheral thermometers for estimating temperature: A systematic review and meta-analysis. Annals of Internal Medicine. 2015;163(10), 768-777. doi:10.7326/M15-1150 [Metasynthesis,Meta-analysis,Systematic Review]
- Niven, D. J.; Stelfox, H. T.; Laupland, K. B. Antipyretic therapy in febrile critically ill adults: A systematic review and meta-analysis. Journal of Critical Care. 2013;28(3), 303-310. doi:10.1016/j.jcrc.2012.09.009 [Metasynthesis,Meta-analysis,Systematic Review]
- Niven, D. J.; Stelfox, H. T.; Laupland, K. B. Antipyretic therapy in febrile critically ill adults: A systematic review and meta-analysis. Journal of Critical Care. 2013;28(3), 303-310. doi:10.1016/j.jcrc.2012.09.009 [Metasynthesis,Meta-analysis,Systematic Review]
- O'Grady, N. P.; Barie, P. S.; Bartlett, J. G.; Bleck, T.; Carroll, K.; Kalil, A. C.; Linden, P.; Maki, D. g.; Nierman, D.; Pasculle, W.; Masur, H.; American College of Critical Care Medicine; Infectious Diseases Society of America. Guidelines for evaluation of new fever in critically ill adult patients: 2008 updated from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Critical Care Medicine. 2008;36(4), 1330-1349. doi:10.1097/CCM.0b013e318169eda9 [Metasynthesis,Meta-analysis,Systematic Review]
- Ryan-Wenger, N. A.; Sims, M. A.; Patton, R. A.; Williamson, J.. Selection of the most accurate thermometer devices for clinical practice: Part 1: Meta-analysis of the accuracy of non-core thermometer devices compared to core body temperature. Pediatric Nursing. 2018;44(3), 116-133. [Metasynthesis,Meta-analysis,Systematic Review]
- Ryan-Wenger, N. A.; Sims, M. A.; Patton, R. A.; Williamson, J.. Selection of the most accurate thermometer devices for clinical practice: Part 1: Meta-analysis of the accuracy of non-core thermometer devices compared to core body temperature. Pediatric Nursing. 2018;44(3), 116-133. [Metasynthesis,Meta-analysis,Systematic Review]
Disclaimer
Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.