FEVER

Fever also known as Pyrexia, in the simplest of explanation is the temporary rise
in temperature, and it is a response from the immune system which is a defence
mechanism from an infection. Fever in both children and adult can be very
uncomfortable; however, a low fever can be of greater concern because it may
mean that there’s a serious infection.

Fever ordinarily is not a cause for concern because it is not a disease but a
symptom of a disease so there are circumstances when the need for medical
prowess is advised. We cannot talk about fever without first touching on
Temperature.

TEMPERATURE

Temperature is actually the difference between the heat that our body is
producing, whether it is through cellular activity or exercise or from blankets,
heating equipment etc so it’s the temperature between heat production and heat
that we lose through respiration or holding a cold drink in hand.. The normal
temperature varies from time to time, but we have an averagely concluded
temperature which is about 36.5 to 37.0 C and it is regulated by the
thermoregulatory centre which is located in the hypothalamus.

In fever the thermostatic set point is altered by disease, injury or infection,

maintenance regulation becomes almost impossible becomes the infection is
playing with it, the body says I want to be 37 c and the infection says you must
be 39 c because what ever is the invasion functions better in a hotter environment
so there is an interruption on how the hypothalamus is receiving messages.

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 WAYS TO TAKE TEMPERATURE

There are five ways to take a person's interna temperature:

 Rectal method: inserting a rectal thermometer into the anus

 Temporal method: placing a forehead thermometer on the forehead
 Oral method: putting a thermometer under the tongue and closing the
mouth
 Tympanic method: placing a thermometer in the ear
 Axillary method: placing a thermometer under the arm

For babies and toddlers up to 3 years of age, it is especially important to take the
child's temperature using the rectal method. The oral and tympanic methods are
both accurate, but only when done properly.

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 FACTORS THAT AFFECT TEMPEARTURE

There are several factors that will fluctuate temperature among populations such
as:

1. Thyroid hormone will change temperature

2. Menstrual cycle will change temperature
3. Age and weight are a factor
4. Certain disease like cancer will increase temperature

LOW GRADE FEVER.

This happens to be a slight elevation between 37.6 c and 38.5 c and it can be
accompanied with feeling of tiredness and fatigue but if it comes along with a
rash or swelling or maybe a stiff neck or chest pain, this is appropriate time to
seek medical attention before the fever gets higher

HIGH GRADE FEVER

This elevated temperature is greater than 38.6 c and this is when as a nurse or
medical practitioner, we might start to order some blood work like a blood culture,
urinalysis, even chest x-ray to see if it’s the lungs just to identify the cause of that
fever, it is very key to note that in paediatrics and geriatrics the temperatures are
different. In infants particularly, once it gets greater than 38 c, rectal is the
preferred method in children.

Almost any infection can cause a high-grade fever, particularly if the body has
not been exposed to the pathogen before and has no immunity to it. A high fever
can also occur if certain infections are left untreated and either get worse or start
to affect other organs.

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PATTERNS OR TYPES OF FEVER.

1. INTERMITTENT FEVER: Temperature returns to normal at least once

every 24 hours and this is commonly found in gram negative and positive
infections, abscess, sepsis patients.

2. REMITTENT FEVER: This temperature doesn’t return to normal

baseline, if baseline is 37 c, temperature remains elevated e.g. 38.3 to 38.5,
back down to 38.3 then up to 38.7, then back to 38.3 and then maybe shoots
to 39, it continually stays elevated and bounce back and this is caused by
infectious diseases that is caused by bacterial, virus, fungi, parasites etc so
this particularly about identifying what’s happening with the patient.

3. SUSTAINED FEVER: This is when the temperature does not return to

normal (baseline) and this is mostly seen in drug induced fevers where it
leads to hyper metabolic state and your cells are on acceleration, producing
more heat, increasing body temperature.

4. RELAPSING FEVER: This is where one or more recurrent episodes of a

fever occur, each fever can last from hours to days but what important is
that there is one or more days in between the next onset of a fever, so you
have 1,2 3 4 days and the fever spikes up, relaxes for another 1234 days
and spikes up again and this happens consistently. For this particular type
of fever, intervention such as Tylenol, ibruprofen, aspirin are designed to
reset that thermostatic set point bringing it back to normal. That’s the goal
of therapy.

5. NEUROGENIC FEVER: This is when there is trauma to the CNS and

that includes the brain and spinal cord. Typically, this may be seen with

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 people who have spinal cord injury, a bleed or maybe a stroke and there’s
bleeding in the brain (intracerebral bleeding) or there increased intra
cranial pressure as a result of that bleed or other pathology. This particular
fever is resistant to antipyretic therapy and they are not associated with
sweating.

STAGES OF FEVER
Prodromal Phase (0-24 hours)

1. Onset of Infection or Inflammation: The prodromal phase begins with the onset
of infection or inflammation, which triggers the production of pyrogens, such as
cytokines and prostaglandins.
2. Increased Body Temperature: The body temperature begins to rise, but it may
not reach the threshold for fever (usually 100.4°F or 38°C).
3. Non-Specific Symptoms: The individual may experience non-specific
symptoms, such as fatigue, headache, and muscle aches.
4. Immune System Activation: The immune system is activated, and white blood
cells, such as neutrophils and macrophages, begin to migrate to the site of
infection or inflammation.

Febrile Phase (24-72 hours)

1. Establishment of Fever: The febrile phase is characterized by the establishment

of fever, with a body temperature that exceeds 100.4°F (38°C).
2. Increased Metabolic Rate: The metabolic rate increases, leading to an increase
in heat production and a rise in body temperature.
3. Vasodilation: The blood vessels dilate, allowing more blood to flow to the skin
and muscles, which helps to dissipate heat.

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4. Sweating: The individual may experience sweating, which helps to cool the
body.
5. Shivering: The individual may experience shivering, which generates heat.

Defervescence Phase (72 hours or more)

1. Resolution of Infection or Inflammation: The defervescence phase begins with

the resolution of the underlying infection or inflammation.
2. Decrease in Pyrogen Production: The production of pyrogens decreases, and
the hypothalamus returns to its normal temperature-regulating function.
3. Return to Normal Body Temperature: The body temperature returns to normal,
and the individual recovers from the fever.
4. Recovery: The individual may experience a period of recovery, during which
they may feel fatigued, weak, and lethargic.

CAUSES OF FEVER

There is fever of unknown origin but other causes vary.

1. Fungi infection
2. Viral infection like tuberculosis, HIV etc
3. Cancer and Hodgkins disease
4. Bacterial infection
5. Auto immune disease like rheumatoid arthritis
6. Problem to the hypothalamus

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 PATHOPHYSIOLOGY

The pathophysiology of fever involves a coordinated response between the

immune system, the nervous system, and the endocrine system.

Initiation of Fever:
1. Infection or Inflammation: The initiation of fever begins with the presence of
an infectious agent, such as a bacterium, virus, or fungus, or an inflammatory
stimulus, such as tissue damage or trauma.
2. Recognition of Pathogen-Associated Molecular Patterns (PAMPs): The
immune system recognizes the presence of PAMPs, which are molecules
associated with pathogens, through pattern recognition receptors (PRRs) on
immune cells.
3. Activation of Immune Cells: The recognition of PAMPs activates immune
cells, such as macrophages and dendritic cells, which produce pro-inflammatory
cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-
1β), and interleukin-6 (IL-6).

Production of Pyrogens:
1. Pro-Inflammatory Cytokines: The pro-inflammatory cytokines produced by
immune cells, such as TNF-α, IL-1β, and IL-6, are pyrogens, which are
substances that induce fever.
2. Pyrogenic Cytokines: These cytokines are produced in response to the presence
of PAMPs and are responsible for inducing fever.

Transmission of Pyrogens to the Hypothalamus:

1. Blood-Brain Barrier: The pyrogens produced by immune cells are transmitted
to the hypothalamus, which is the temperature-regulating center of the brain,
through the blood-brain barrier.

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2. Cytokine Receptors: The hypothalamus has cytokine receptors, which
recognize the pyrogens and trigger a response.

Hypothalamic Response:
1. Production of Prostaglandins: The hypothalamus produces prostaglandins,
such as prostaglandin E2 (PGE2), in response to the pyrogens.
2. Stimulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis: The
prostaglandins stimulate the HPA axis, which leads to the production of
adrenocorticotropic hormone (ACTH) and cortisol.

Systemic Response:
1. Increased Body Temperature: The hypothalamus increases the body
temperature by increasing the production of heat and reducing the loss of heat.
2. Vasodilation: The hypothalamus causes vasodilation, which increases blood
flow to the skin and muscles, leading to increased heat loss.
3. Sweating: The hypothalamus stimulates sweating, which helps to cool the
body.
4. Shivering: The hypothalamus stimulates shivering, which generates heat.

Consequences of Fever:
1. Increased Metabolic Rate: Fever increases the metabolic rate, which can lead
to weight loss and muscle wasting.
2. Dehydration: Fever can lead to dehydration, especially if the individual is not
drinking enough fluids.
3. Electrolyte Imbalance: Fever can lead to electrolyte imbalances, especially if
the individual is not replacing lost electrolytes.
4. Organ Dysfunction: Severe or prolonged fever can lead to organ dysfunction,
such as kidney or liver failure.

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Resolution of Fever:
1. Resolution of Infection or Inflammation: The resolution of fever occurs when
the underlying infection or inflammation is resolved.
2. Decrease in Pyrogen Production: The production of pyrogens decreases, and
the hypothalamus returns to its normal temperature-regulating function.
3. Return to Normal Body Temperature: The body temperature returns to normal,
and the individual recovers from the fever.

GENERAL SIGNS AND SYMPTOMS OF FEVER

• A low-grade fever is defined as an oral temperature of 99.1 to 100.4 F (37.3 to

38 C) in adults.

Symptoms include:

 Feeling hot
 Headache
 Achy eyes
 Thirst
 Loss of appetite

• Moderate-grade fever is defined as an oral temperature of 100.6 to 102.2 F

(38.1 to 39.0 C) in adults.

Symptoms include those listed above, plus:

 Sweating
 Dizziness or light-headedness
 Muscle and body aches
 Fatigue
 Nausea
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• High-grade fever is defined as an oral temperature of 102.4 to 105.8 F (39.1 to
41 C) in adults.

It can cause all of the above, plus:

 Chills and shivering

 Extreme weakness
 Increased heart rate
 Pale skin
 Stomach upset
 Vomiting
 Decreased urine

• Hyperpyrexia is the term for an exceptionally high fever over 106.7 F (41.5 C).
It can occur in people with a severe infection or a brain hemorrhage.7

Symptoms include:

 Extreme confusion
 Hallucinations
 Loss of consciousness
 Shallow, rapid breathing
 Hot, dry, red skin
 Rapid but weak heartbeat
 Dilated pupils
 Inability to urinate
 Seizure

SYMPTOMS AND SIGNS OF FEVER IN INFANT AND CHILDREN

 Shaking or shivering (chills)

 Nonstop crying or crying when touched
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 Refusal or inability to drink enough fluids
 Lasting diarrhea or repeated vomiting
 Signs of dehydration, such as peeing less than usual, lack of tears when
crying, or seeming less alert
 A child who has any other complaint, like earache, headache, sore throat,
a rash, or pain while peeing
 A who child looks or acts very sick
 Trouble breathing
 Trouble swallowing spit or fluids
 Purple or blood-coloured spots on the skin
 The child is less responsive or non-responsive

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SIGNS AND SYMPTOMS OF FEVER IN ADULT

 You have a temperature higher than 104°F.

 Night sweats or swollen lymph nodes.

Seek emergency care if any of the following occur with your fever:

 Earache
 Headache
 Mental confusion
 Stiff neck
 Trouble breathing or chest pain
 Severe pain anywhere in the body
 Swelling or inflammation anywhere in the body
 Pain when urinating or urine that smells bad
 Inability to bring your temperature down after being exposed to high heat
outside
 A new or strange skin rash
 Persistent vomiting, diarrhea, or stomach pain

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  Unusual sensitivity to light

If you are receiving chemotherapy and your fever lasts more than one hour, seek
emergency medical care.

DIAGNOSIS

The diagnosis of fever involves a combination of physical examination, medical

history, laboratory tests, and imaging studies.

Physical Examination:

1. Vital signs: The healthcare provider will check the patient's vital signs,
including temperature, pulse, blood pressure, and respiratory rate.

2. General appearance: The healthcare provider will observe the patient's general
appearance, including any signs of distress, sweating, or flushing.

3. Head and neck examination: The healthcare provider will examine the patient's
head and neck, including the ears, eyes, nose, and throat.

4. Chest and lung examination: The healthcare provider will examine the patient's
chest and lungs, including listening to the lungs with a stethoscope.

5. Abdominal examination: The healthcare provider will examine the patient's

abdomen, including checking for tenderness, guarding, or rebound tenderness.

Medical History:

1. Chief complaint: The healthcare provider will ask the patient to describe their
chief complaint, including the onset, duration, and severity of the fever.

2. Medical history: The healthcare provider will ask the patient about their
medical history, including any previous illnesses, allergies, or medications.

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3. Travel history: The healthcare provider will ask the patient about their travel
history, including any recent travel to areas where infectious diseases are
common.

4. Exposure history: The healthcare provider will ask the patient about their
exposure history, including any exposure to sick contacts or contaminated food
and water.

Laboratory Tests:

1. Complete blood count (CBC): A CBC is a blood test that measures the levels
of different types of blood cells, including white blood cells, red blood cells, and
platelets.

2. Blood cultures: Blood cultures are tests that check for the presence of bacteria
or other microorganisms in the blood.

3. Urinalysis: Urinalysis is a test that checks the urine for signs of infection,
including the presence of white blood cells, red blood cells, or bacteria.

4. Imaging studies: Imaging studies, such as X-rays, computed tomography (CT)

scans, or magnetic resonance imaging (MRI) scans, may be ordered to check for
signs of infection or inflammation in the body.

Diagnostic Criteria:

1. Temperature: A temperature of 100.4°F (38°C) or higher is generally

considered to be a fever.

2. Duration: The duration of the fever can vary, but it is typically considered to
be a fever if it lasts for more than 24 hours.

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3. Severity: The severity of the fever can vary, but it is typically considered to be
a fever if it is accompanied by other symptoms, such as chills, sweating, or
headache.

MANAGEMENT OF FEVER

Treatment will vary in terms of the patient and what they would accept in terms
of our goal which is to get the temperature down and so there are ways to don
that.

1 Place a cold pack on the forehead, a face cloth, and if its really hot, place
the cold packs under the armpit and in those heat generating areas,
2 Take off blankets if any for proper vent
3 Give cold fluids, hyrdration is very key in the management of fever, and so
drinking a lot is needed because fever increases non sensible losses of the
sweating and we can get dehydrated really easy.
4 A cold cool sponge bath or shower may be necessary.

NOTE: When we get to the point where the patient starts to shiver, during
any of these management therapy, we need to stop, because shivering
actually increases heat and we don’t want that to happen, so if giving a
sponge bath to a patient and you start seeing goose bump on the arm, stop
immediately and get back to cover because that patient is now starting to
create heat and that’s not needed.

5 The use of Tylenol (acetaminophen), ibuprofen, aspirin are all used in the
control of fever and again do not use aspirin in children because there is a
risk for Reye’s syndrome (a serious condition that causes swelling in the
liver and brain)

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 6 Rest, hydration and nutrition is important because what happens in fever is
that our body goes up using our fat storage as opposed to using
carbohydrate.

Other management comes from diagnosing the cause of fever,

A. Antifungal medications if caused by a fungi infection such as
candidiasis, tinea pedis (a fungi skin infection that starts in the toe,
B. Isolation if fever is caused by tuberculosis
C. Antibiotics if caused by bacteria and other microbes

CONCLUSION

Fever is both a sign and a symptom

Fever is a defence and a protective response initiated by the body to fight
off infections
The best choice of antipyretic drug is paracetamol as it is better tolerated
by our body and has never adverse effect compared to NSAID

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REFERENCES

Albiniak, P. & McClellan, S. (2001). Rules of engagement,

Broadcasting & Cable 131, 9 - 12.

Braverman, J. (1996). To hasten the homecoming: How America fought World

War Il through the media. Landham, MD:

Madison Books.

Etzioni, A. (2001, October 23). Censorship of war news undermines public

trust. USA Today, p. A3.

Hammon, W.M. (1998) Reporting Vietnam. Lawrence, KS:

University of Kansas Press..

Kennedy, W.V. (1993). The Military and the media: Why the press cannot be
trusted to cover a war. Westport, CT:

Praeger Publishers.

Massing, M. (2001, June), Press watch. The Nation 273, p. 6, 23.

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