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The article Noninfectious Causes of Fevers in adults by Steele, Franco-Paredes, and Chastain (2018) summarizes that when a fever is detected in hospitalized patients, health workers begin immediate antibiotic treatment without determining the cause of the fever. This approach is incorrect since fever is not always associated with viral diseases. Therefore, before prescribing antibiotics, a healthcare professional must determine the cause of the fever. Excessive use of antibiotics can lead to antibiotic resistance in a patient, which can be dangerous when identifying some diseases, the treatment of which is possible only with antibiotics.
Fever is a symptom of an infectious process, although many noninfectious etiologies also cause fever. Scientists note that “in outpatient and inpatient settings, fever can be observed in 30-50% of patients, with the highest frequency occurring among those who enter the intensive care unit, which may be the result of many etiologies” (Steele et al., 2018, p. 38). Therefore, nurses should consider noninfectious fever through a detailed anamnesis and physical examination.
Pathophysiology
Pyrexia or fever is when the body’s thermoregulatory system becomes disrupted, allowing for an increase in body temperature. A healthy person’s temperature is 98.6° F (37° C) and can vary as much as 1° C throughout the body, rising or falling in some areas of the body. Thermoregulation of the body is controlled by the hypothalamic center of thermoregulation, which balances “metabolic heat production and heat generated by respiration and evaporation” (Steele et al., 2018, p. 40). Body temperature can deviate from the norm in case of violation of the mechanisms of thermoregulation. Hyperthermia is an increase in body temperature; hyperthermia is often called fever, although this is clinically incorrect.
Fever and hyperthermia are two different conditions of the body. Fever can occur due to the “activation of neurons, which leads to vasoconstriction, diverting blood from the periphery to the internal organs to keep warm” (Steele et al., 2018, p. 40). In contrast, hyperthermia often results from a combination of external heat exposure and a loss of the body’s ability to lose heat when the body temperature rises above 105.8° F (41° C). At the same time, the average standard temperature for fever is 101° F (38.3° C) or higher.
This temperature is often a sign of infectious disease; fever often results from complex interactions with microbial pathogens or “pyrogenic cytokines, including tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, ciliary neurotrophic factor, interferon (IFN)-gamma, and IFN-alpha released by myeloid and endothelial cells, with the fenestrated capillaries comprising the organ vasculum lamina terminalis in the anterior hypothalamus” (Steele et al., 2018, p. 40). The most common causes of noninfectious etiology of fever or hyperthermia include autoimmune diseases, trauma, inflammatory conditions, environmental factors, or drugs.
Patient-Centered Medical and Nursing Management
The most important part of the nursing management of fever is to prevent dehydration? Ventilate the room to avoid overheating and provide the patient with an opportunity to rest, as the increased temperature can cause physiological stress and fatigue. Patients with hyperthermia need immediate temperature reduction, including the use of antipyretic drugs. At the same time, the use of antipyretics for fever is recommended at 104° F (40° C); at a lower temperature, there is no consensus among experts on artificial reduction.
The medical management of fever primarily focuses on medication treatment, using drugs like acetaminophen, ibuprofen, and nonsteroidal anti-inflammatory drugs that help lower fever and limit associated physiological effects, although side reactions are possible. Before starting treatment for fever, the health care provider must determine the etiology of the increase in body temperature. The nurse should conduct a detailed anamnesis and physical examination to detect clinical signs of noninfectious causes of fever.
In any case, the nurse should not start antibiotic therapy until a definitive diagnosis is made. According to NANDA, a problem-oriented diagnosis must include elements like nursing diagnosis, related factors, and defining characteristics. The nurse should also provide patient education about possible self-medication similar to those used by the nurse and warn about the dangers of antibiotics taken with no reason.
Application to Nursing Practice
In my clinical practice, I will use the discussed knowledge to treat patients with fever and hyperthermia. It is imperative to consider related factors and defining characteristics, such as the presence of microbial organisms that caused the fever or overheating factors of the body when making a diagnosis. An incorrect diagnosis can lead to inappropriate treatment and harm the patient’s health. It is especially dangerous to prescribe antibiotics before the diagnosis confirmed the viral or bacterial nature of the fever.
I was not aware of the extent to which negligence when prescribing antibiotics can lead to the patient becoming resistant to them. Therefore, I intend to carefully consider the diagnosis when a high body temperature is detected in a patient. One of the main indicators that will help distinguish fever from hyperthermia is that during hyperthermia, extremely high body temperature is recorded, while with fever, the temperature rises only by a few degrees. In general, a high body temperature during a fever helps fight germs, and most doctors do not recommend using medication to lower the temperature immediately unless it exceeds the 104 ° F (40 ° C) limit. At the same time, the delay in the prescription of antipyretic drugs for hyperthermia can be very dangerous.
Reference
Steele, G. M., Franco-Paredes, C., & Chastain, D. B. (2018). Noninfectious causes of fever in adults.The Nurse Practitioner, 43(4), 38–44. Web.
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