Pyrexia – Body temperature above normal range. (also hyperthermia, fever)

Types of Fever

1. Intermittent Fever – The temperature fluctuates between periods of fever and periods of normal/subnormal temperature.
2. Remittent Fever – The temperature fluctuates within a wide range over the 24 hours period but remains above normal range.
3. Relapsing Fever – The temperature is elevated for few days, alternated with 1 or 2 days of normal temperature.
4. Constant Fever – Body temperature is consistently high.
• Very high temperatures (41-42°C) cause irreversible brain cell damage.

Clinical Signs of Fever

a. Onset (cold or chill stage) of fever

• Increased heat rate
• Increased respiratory rate and depth
• Shivering
• Pale, cold skin
• Cyanotic nail bed
• Complaints of feeling cold
• “goose flesh” appearance of the skin
• Cessation of sweating
• Rise in body temperature

b. Course of Fever

• Absence of chills
• Skin that feels warm
• Feeling of being neither hot nor cold
• Increased pulse and respiratory rates
• Increased thirst
• Mild to severe dehydration
• Drowsiness, restlessness, delirium and convulsions
• Herpetic lesions of the mouth (fever blisters)
• Loss of appetite to eat
• Malaise, weakness ad aching muscles

c. Defervescence (fever abatement)

• Skin that appears flushed and feels warm
• Sweating
• Decreased shivering
• Possible dehydration

Nursing Interventions in Clients with Fever

1. Monitor vital signs
2. Assess skin color and temperature.
3. Monitor WBC, Hct and other pertinent laboratory records.
   a. Elevated wbc levels indicate presence of infection.
   b. Elevated Hct indicates dehydration.
4. Remove excess blankets when the client feels warm; provide extra warmth when the client feels chilled.
5. Provide adequate foods and fluids. To provide additional calories and to prevent dehydration.
6. Measure Intake and Output.
7. Maintain prescribed IV fluids as ordered by the physician.
8. Promote rest. To reduce body heat production.
9. Provide good oral hygiene. To prevent herpetic lesions of the mouth.
10. Provide cool, circulating air using a fan. To dissipate heat by convection.
11. Provide dry clothing and bed linens. To ensure comfort.
12. Provide TSB (Temperature of water 80-98°F). To enhance heat loss by evaporation and conduction.
13. Administer antipyretics as ordered. Temperature of 38.5°C and above usually require administration of antipyretic.