05.01 Fever

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Fever (Picmonic)
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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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