FEVER

Pediatric

Fever is defined as:

• rectal temperature over 101.5 degrees F (38.5 C)
• oral temperature over 99.5 degrees F (37.5 C)
• axillary temperature over 99.0 degrees F ( 37.2 C)

A. Obtain and record telephone triage assessment that includes:

• Fever
  onset	duration	degree	route

• Associated symptoms and behavior
  feeding problems	change in normal play behavior or lethargy
  abnormal cry	respiratory symptoms
  irritability	change in urination or stooling
  seizure	limping or refusal to use an extremity
  rash	localized swelling or erythema
  tugging at ears	vomiting or diarrhea
  sore throat	difficulty swallowing
  cough	runny nose
  headache	urine output in past 8 hours

   

• Use of antipyretics including:

  • type
  • time of last dose
  • amount administered
  • have the caller read the concentration (i.e. mg/ml) from the label of their bottle.
  • calculate accurate dose based on child's weight to insure proper dosing by parent.

B. Risk Factors which increase the acuity of a patient with a fever:

• Infants< 3 months of age

  exposed to organisms for which they have no immunity, placing them at higher risk of systemic infections

  passive immunity from birth decreases before the infant's own immune response is fully competent

• Immunosuppressed
  congenital (rare) acquired (HIV/AIDS) chemically induced (chemotherapy, corticosteroids)

• Splenic Dysfunction

  lack the ability to mount effective response if spleen removed or have developed functional asplenia (i.e. sickle cell anemia, splenectomy) (Henderson, Brownstein, 1994)

   

C. See Immediately

• Triage nurse should advise the use of an ambulance when the patient's current status is life threatening, may deteriorate enroute to hospital, or anxiety level is too high to safely drive to closest ED.
• Fever >101 degrees F.(38.3 degrees C.) with history of high risk factors
• Fever >105 degrees (40.6 degrees C.) in any age
• Rash with purple or red spots or dots
• Seizure
• Difficulty breathing
• Stiff neck
• Behavior changes which sound like the child is very ill to the nurse
  • lethargy or confusion
  • difficult to arouse or unresponsive
  • inconsolable crying
  • limp, weak, or not moving
• Dehydration (no urine output > 8 hours, sunken eyes, crying without tears, etc.)
• Difficulty swallowing or new drooling
• Pain
  • abdominal pain (see Abdominal Pain Protocol)
  • arm, leg, or joint pain with no known injury

D. See Within 24 Hours:

• Pain (i.e., abdominal pain, difficulty walking, urination, ear, throat, etc.)
• Fever > 24 hours with no other symptoms
• Fever > 72 hours
• Recurrent or intermittent fevers
• Persistent cough with a fever
• Child acts sick
• Past medical history of diabetes, steroid use, cystic fibrosis, asthma, seizures
• Vaginal or penile discharge

E. Home Care Advice:

• Encourage fluids, especially calorie containing liquids such as popsicles, juice, etc.
• Dress lightly, cover with lightweight blanket for comfort if desired (avoid shivering)
• Administer antipyretic
  • acetaminophen 10-15 mg/kg q 4-6 hours
  • ibuprofen 10 mg/kg q 6-8 hours for children over 6 months old
  • do NOT use aspirin
• Lukewarm (85-90 degrees F) tub bath for comfort or fever >104 after antipyretic
  • do NOT use rubbing alcohol
• Encourage quiet activity to avoid production of excess body heat
• Reassure the caller
  • fevers up to 104 degrees F in children are uncomfortable but not harmful
  • use of antipyretic usually lowers the fever by 2-3 degrees F
• Monitor fever every 2-4 hours

F. Call Back If:

• Fever is greater than 105 degree F (40.6 degrees C)
• Child looks worse
• Develops rash, difficulty breathing, seizure, headache, neck pain, dehydration
• Increased parental concern, anxiety, or new questions
• Develops any new symptoms or if symptoms change

(Briggs, 1997; Brown, 1994; Schmitt, 1994; Steger-Osterhaus, 1995)

©2006 RnCeus.com