Careplan
Fever (Adult Inpatient)
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
CPG-Specific Education Topics
Overview
description
Self Management
fever reduction measures
fluid intake
provider follow-up
When to Seek Medical Attention
unresolved/worsening symptoms
General Education Topics
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
Safety Education
call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Body Temperature in Desired Range
- Education: Overview
- Education: Self Management
- Education: When to Seek Medical Attention
Correlate Health Status
Correlate health status to:
- history, comorbidity
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care
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.
Associated Documentation
- 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.
