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    Careplan

    Fever (Adult Inpatient)

    Nov.18.2020

    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 care

    A. The patient will achieve the following goals:

    • Body Temperature in Desired Range

    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

    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]

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    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.

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