Fever
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Study Tools For Fever
Fever (Picmonic)
Pediatric Fever (Cheatsheet)
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Outline
Overview
- Temp >38 C or 100.4 F
- Benefits of a fever include
- Increase WBC activity
- Increase antibody production
- Brief, self-limiting illnesses that cause a fever are very common
- A small proportion of febrile cases may have a serious, life threatening infection.
Nursing Points
General
- Causes of Fever
- Infections (viral & bacterial)
- Ear Infections
- Strep Throat
- Respiratory Infections
- Gastroenteritis
- Cellulitis
- Urinary Tract Infections
- Meningitis
- Other
- Medications
- Kawasaki disease
- Juvenile Idiopathic arthritis
- Malignancies
- Infections (viral & bacterial)
Assessment
- Elevated temperature
- Temperature Guidelines
- Axillary & Tympanic – birth to 5 yrs.
- Oral >5 yrs
- Rectal is the most accurate but there are a lot of contraindications
- Physical Symptoms
- Flushed skin
- Diaphoresis
- Chills
- Malaise
- Temperature Guidelines
- Complications
- Dehydration
- Sunken fontanelles
- Lack of tears when crying
- Dry mucous membranes
- Decreased urine output
- Febrile Seizure
- Seizure associated with elevated temperature and no underlying medical cause
- Most common in children 6 months to 5 years
- Generally last 5 minutes with child returning to baseline within 60 minutes
- Dehydration
Therapeutic Management
- Determine & treat underlying cause
- Prevent sepsis
- Provide fluids
- See Dehydration lesson
- Non-pharmacologic fever reducing measures
- Wear minimal clothing, exposing skin to air
- Remove blankets, covers
- Medications
- Acetaminophen
- Preferred
- Max 5 doses/24 hours
- Ibuprofen
- Approved from 6 months on
- Avoid acetylsalicylic acid (Aspirin) due to risk for Reye’s syndrome
- Retake temperature after medication administration (30 minutes)
- Acetaminophen
- Special considerations
- Neutropenic patients
- Admission for cultures and IV abx
- < 2 months old
- Increased concern for UTI’s and meningitis
- Admission for cultures and IV abx
- Neutropenic patients
Nursing Concepts
- Thermoregulation
- Infection Control
- Safety
Patient Education
- When to notify provider of fever
- Dispelling myths about fevers
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Transcript
Hi guys, in this lesson we are going to talk about pediatric fevers. We are going to look at common causes, what to include in your assessment and how to treat it!
Okay let’s start by thinking about the big picture of fevers. Our clinical definition of a fever is anything >38C or 100.4F and fevers are a really important part of the body’s immune response against infection that works by doing things like increasing the number of WBC’s and also increasing the production of antibodies.
Most of the time fevers in kids are caused by a viral or bacterial infection. You can see in the list on the left some of the most common infections we see in kids. Listed on the right are some causes of fever that are not infections.
We aren’t going to go into detail about all these different diagnoses you see here, but I do want you to link what you learn about fevers here in this lesson with the topics you see here. We have lessons for you that go over the majority of these diagnosis so check those out for more details.
Our assessment of fever really starts with making sure we get an accurate temperature. Axillary and Tympanic measurements are what you will probably see used most often for kids <5 years of age and Oral temperatures are used for older kids. Be cautious of using a taking a temperature rectally because there are a lot of contraindications for this. The cheatsheet on vital signs goes over all the specifics on how to take a kids temperature.
When a kid is fevering we expect to see other symptoms like flushed skin, sweating, chills, decreased appetite and feeling tired.
During your assessment also want consider what may be causing the fever. Some really helpful clues are things like, pulling at ears, cough, sore throat, signs of meningitis and rashes.
The most common problem we see associated with fevers in kids is dehydration. We’ve done a whole lesson for you on dehydration so take a look at it for more info on how to assess and treat dehydration.
The next complication I want to highlight is called a febrile seizure and these usually happens in kids ages 1 month to 6 years of age. They are associated with a fever that is going up really quickly and they usually last <5 minutes. The main thing to know for a febrile seizure is that while they are incredibly scary for parents they usually don’t cause any long term problems for the child and kids outgrow them by around 6 years.
Management of fevers is all about identifying a cause, providing fluids and giving medications to help bring the fever down.
Medications we use to treat fever are acetaminophen and ibuprofen. Acetaminophen can be used with any age, while ibuprofen can usually be used from 6 months on.
Two patient groups that we treat a little differently when it comes to fever are infants less than 2 months old and neutropenic patients. Infants who are less than 2 months old are very difficult to evaluate and they are at an increased risk for meningitis and UTI’s. If these things go untreated they can end up with brain damage or long term damage to their kidneys. Because of these risks they are usually admitted for a full work up- which may include a lumbar puncture, blood culture, urine culture and antibiotics.
Neutropenic patients with fever are discussed in the Pediatric Oncology Basics Lesson so refer to it for a bit more info on how their fevers are managed.
Because most fevers are caused by a virus and are managed at home, it’s super important to educate parents. There are a lot of myths out there about fevers that can really stress parents out. There’s even a term for this called Fever Phobia. So make sure to speak to parents about appropriate cooling measures and how to give medications safely.
When it comes to administering medications there are some debates on when and if they should be treated, but the general consensus is that if the child is uncomfortable, give them some medications to bring it down. Teach parents they can alternate between acetaminophen and ibuprofen. And make sure they know to never, ever give Aspirin because it can cause something called Reye’s Syndrome which causes brain damage. Reye’s Syndrome is covered in the neuro med/surg course if you need a refresher on that.
When you are caring for a pediatric patient with a fever, your priority nursing concepts will be thermoregulation, infection control and safety.
Okay guys that’s it for our lesson on pediatric fevers. Let’s recap and highlight the most important things.
First- fevers are extremely common and most of the time caused by viral infections.
Our assessing of a kid with a fever depends on getting an accurate temp. From there is important to look for a possible cause of the infection and pay really close attention to their hydration status.
Complications that can occur from a fever are dehydration and shock, sepsis and febrile seizures.
Management is all about medicating and hydrating. So we’re giving antipyretics like acetaminophen and ibuprofen as well as antibiotics and fluids when indicated.
Our exceptions for this are infants <2 years old and kids with neutropenia.
That’s it for our lesson on Fever in Pediatric Patients. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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Study Plan Lessons
Communicating with Other Nurses
Conflict Management (Patient, Perioperative Team, Family) for Certified Perioperative Nurse (CNOR)
CRNA
Daily Charting
Day in the Life of a Labor Nurse
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Addicted Newborn
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Antepartum Testing Case Study (45 min)
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Betamethasone and Dexamethasone in Pregnancy
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Butorphanol (Stadol) Nursing Considerations
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Certified Nurse Midwife
Chorioamnionitis
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Day in the Life of a Postpartum Nurse
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Discomforts of Pregnancy
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Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Emergent Delivery (OB) (30 min)
Emergent Delivery for Certified Emergency Nursing (CEN)
Epidural
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Erythroblastosis Fetalis
Eye Prophylaxis for Newborn
Eye Prophylaxis for Newborn (Erythromycin)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Family Planning & Contraception
Family Planning & Signs of Pregnancy – Live Tutoring Archive
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Fetal Heart Monitoring Like A Pro – Live Tutoring Archive
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HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
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Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hepatitis B Vaccine for Newborns
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Hydralazine (Apresoline) Nursing Considerations
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Hyperbilirubinemia (Jaundice)
Hyperemesis Gravidarum
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Inserting a Foley (Urinary Catheter) – Female
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Isotonic Solutions (IV solutions)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
Mastitis
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Mechanisms of Labor
Meconium Aspiration
Meds for Postpartum Hemorrhage (PPH)
Meds for PPH (postpartum hemorrhage)
Menstrual Cycle
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Newborn of HIV+ Mother
Newborn Physical Exam
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Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
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Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
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Nursing Care Plan for Newborn Reflexes
Nursing Case Study for Maternal Newborn
Nutrition Assessments
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OB (Labor) Nurse Report to OB (Postpartum) Nurses
OB Course Introduction
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Obstetric Trauma for Certified Emergency Nursing (CEN)
Obstetrical Procedures
Opioid Analgesics in Pregnancy
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Oxytocin (Pitocin) Nursing Considerations
Pediatric Vital Signs (VS)
Physiological Changes
Phytonadione (Vitamin K)
Phytonadione (Vitamin K) for Newborn
Placenta Previa
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Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Discomforts
Postpartum Hematoma
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Postpartum Interventions
Postpartum Physiological Maternal Changes
Postpartum Thrombophlebitis
Precipitous Labor
Preeclampsia (45 min)
Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Labs
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Preload and Afterload
Premature Rupture of the Membranes (PROM)
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Rh Immune Globulin in Pregnancy
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Tips & Advice for Newborns (Neonatal IV Insertion)
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Enuresis
Epiglottitis
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Epispadias and Hypospadias
Famotidine (Pepcid) Nursing Considerations
Fever
Fever Case Study (Pediatric) (30 min)
Flu Symptoms Nursing Mnemonic (FACTS)
Fluid Compartments
Fluid Pressures
Fluid Shifts (Ascites) (Pleural Effusion)
Fluid Volume Deficit
Fluticasone (Flonase) Nursing Considerations
Gas Exchange
Gentamicin (Garamycin) Nursing Considerations
Glucose Lab Values
Gluten Free Diet Nursing Mnemonic (BROW)
Guaifenesin (Mucinex) Nursing Considerations
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hematocrit (Hct) Lab Values
Hemoglobin (Hbg) Lab Values
Hemophilia
Hierarchy of O2 Delivery
Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
Immunizations (Vaccinations)
Imperforate Anus
Impetigo
Indomethacin (Indocin) Nursing Considerations
Influenza – Flu
Integumentary (Skin) Assessment
Intussusception
Intussusception for Certified Emergency Nursing (CEN)
Iron Deficiency Anemia
Isolation Precaution Types (PPE)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Lactulose (Generlac) Nursing Considerations
Leukemia
Levels of Consciousness (LOC)
Levetiracetam (Keppra) Nursing Considerations
Lung Sounds
Marfan Syndrome
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
Nephroblastoma
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Intussusception
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
Spina Bifida – Neural Tube Defect (NTD)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
Sudden Infant Death Syndrome (SIDS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Thorax and Lungs Assessment
Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
White Blood Cell (WBC) Lab Values
X-Ray (Xray)
ADLs (Activity of Daily Living) Nursing Mnemonic (BATTED)
Emotions and Motivation
Growth & Development Theories
Maslow’s Hierarchy of Needs in Nursing
Psychological Disorders
State of Consciousness
Stress and Crisis