FEVER/PYREXIA

PYREXIA-Body temperature is the degree of hotness or coldness of a body. 

  • Pyrexia -Greek- pyr meaning fire.
  • Febrile- Latin- febris meaning fever.


Definition - When body temperature rises above 99 °F.or 37 °C. It is called pyrexia or fever.

Categorize Fever-

  • Low-grade: 37.3 to 38.0 C (99.1 to 100.4 F)
  • Moderate-grade: 38.1 to 39.0 C (100.6 to 102.2 F)
  • High-grade: 39.1 to 41 C (102.4 to 105.8 F)
  • Hyperthermia: Greater than 41 C (105.8 F)

Causes

  • Infection
  • Disease of nervous system
  • Certain malignant neoplasm
  • Dehydration
  • Surgical trauma and crushing injuries
  • Skin abnormalities that interfer with heat loss
  • Blood diseases such as leukaemia,embolism, and thrombosis.
  • Heat strok from exposure to hot environment
  • Allergic reaction to foreign proteins and pyogens.

Sign and symptoms of Fever 

  • Flushed face
  • Loss of Appetite 
  • Hot dry skin 
  • Anorexia
  • Dehydration 
  • Muscle pain 
  • Joint pain
  • Headache
  • Nausea and sometimes vomiting
  • Constipation and sometimes diarrhea 
  • Body aches
  • Scant highly colored urine.
  • Increased heart rate, respiratory rate and depth.
  • Shivering, pale cold skin.
  • Cyanotic nail beds.

 Types of Fever-

  • Constant pyrexia or continuous fever- There is temperature varies not more than two degrees between morning and evening and does not reach normal for a period of days or weeks. eg Typhoid, UTI                                                       
  •  Intermttent or Quotidian Fever/Swinging Fever/Hectic Fever - Temperature rises from normal or subnormal to high fever and back at regular intervals. The interval may vary from few hours to three days,usually temperature is higher in the evening than in the morning. eg. Malaria, Kala-azar
  • Remittent Fever- Remittent fever is a fever characterized by variation of more than two degree between morning and evening but does not reach normal.eg. Infection endocarditis 
  • Inverse Fever- In this type the highest range of temperature is recorded in the morning hours and the lowest in the evening. which is contrary to that found in the normal course of fever.
  • Relapsing Fever -Febrile episodes are separated by intervals of normal temperature. The fever when occur may last from 2-9 days and then temperature gets normal. The fever may relapse after a period of few day repeating same cycle Eg. Borrelia infections
  • Irregular Fever-  When fever is entirely irregular in its course it is called irregular fever.
  • Sustained Fever- Constant body temperature .Continuously above 38 °C. Or 100.4°F.That demonstrate little fluctuation.

Stages Fever 

  • On-set or invasion- it is period when body temperature is rising.
  • Fastigium or stadium- of fever is the period when the body temperature has reached its maximum and remains fairly constant at a high level.
  • Defervescence or Decline- period when the elevated temperarure is returns to normal. The fever may subside suddenly or gradually.
  • Crisis- Crisis is a sudden return to normal temperature from a very high temperature with in a few hours or days. Crisis is divided into true crisis and false crisis.
  • Lysis-Lysis is the gradual return  to normal  temperature.

NURSING CARE OF PATIENT WITH PYREXIA

Objectives-

  • To increase heat loss.
  • Reduce heat production.
  • Prevent complication.
  • Promoting balance between heat production and heat loss.

Nursing  care of patient with pyrexia Assessment   

  • Obtain frequent temperature reading.
  • Assess for contributing factors such as dehydration, infection environmental temperature.
  • Identify physiological response to fever.
  • Obtain all vital signs.
  • Assess skin colour and temperature.
  • Assess for presence of thirst, malaise.
  • Assess clients comfort and well being.
  • Observe for shivering and diaphoresis.

Nursing Intervention 

 A. Maximize heat loss-Minimize external covering on clients body, keep clothing and bed linen dry,prevent patient from getting draughts.Expose patient to cool air by an electical fan. reduce the frequency of activities that increases oxygen demand,such as excessive turing and ambulation, allow rest period, limit physical activity.

  • Administation of cool drinks.
  • Application of cold compress and ice bags.
  • Cold sponging and cold packs.
  • Cold bath.
  • Use of hypothermic blanket.

 B. Prevent shivering-shivering is prevented because it increases metabolic activity. Produces heat, increases oxygen demand, and circulation.May cause hyperventilation and respiratory alkalosis.


C.  Promote client comfort-

  • Encourage oral hygiene.
  • Prevent dehydration.
  • Control temperature of environment.
  • Provide complete bed rest.
  • The clothing should be light,loose, smooth, cotton,non irritating.

 D. Satisfy supplement for increased metabolic rate-

  • Provide supplemental oxygen therapy .
  • Replace fluid lost.
  • Provide high caloric diet- because oxygen consumtion in body tissues increases.
  • Diet should be easily digestible and palatable Fluid intake upto3000ml.
  • Encourage patient to take plenty of fluid.
  • Maintain intake out put chart.
  • Provide small frequent feeds.
  • Plenty of fluid and fruits will help to evacuate bowel regularly.

E. Maintenance of personal hygiene-

  • Frequent mouth care.
  • Care of skin and pressure points.
  • Give sponge bath daily.
  • If temperature remains high cold sponging is given to bring down the temperature.

F. Safety of patient

  • Never leave a patient alone.Rigor and convulsions may occur at any time constant observation is important .
  • Evaluate urine output periodically.

G.Rest and sleep 

Calm and quiet environment should be provided to the client. Client should be asked to take adequate rest. The client should be rest in a comfortable position.

 

#