Hey guys this is Tammy with NurseMinder and today we are talking all about vital
signs and in particular temperature. I often get asked what is a fever or I'll
have students come to me and say my patient is 37.5 what should I do?
So we're gonna talk a little bit about temperature and fever right after this.
Welcome back! My name is Tammy and this is NurseMinder and on this channel we
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Welcome to the vital signs temperature video. Where we are asking the question "what is a
fever". Now in the previous episode I did go over how to use a tempadot to take a
temperature and I'm gonna link that video up here but we're gonna really
focus on what is a temperature in this video. So in order to understand what a
fever is we need to understand the things that are happening inside
our body that helps us determine what our normal temperature is. So we have
this baseline - as you can see here 37 degrees Celsius 98.6 Fahrenheit and this
is considered our setpoint. Kind of like where cells will function in their best
but we have a range and typically earliest in the morning is when our
temperature is the lowest and we might be down around 36 degrees Celsius or 97
Fahrenheit; and it is highest in the middle of the afternoon and we can go
all the way back 37.5 C / 99.5 Fahrenheit Now it's important to note that these
numbers are, that I'm presenting here, those may be different than what your
textbooks and your resources are providing for you but just note the
concept here is that we have a range of normal temperatures that we can move in
and out of throughout the day, and that is a normal phenomenon. This is all
controlled by the thermoregulatory Center and this is located in the
hypothalamus and what body temperature truly is is really just the difference
between the heat that our body is producing - whether that is through
cellular activity or through exercise, or maybe you're wrapped up between a
whole bunch of different blankets and heating, heating tools; so it's the
temperature between heat production and the heat that we lose through
respiration through all sorts of other activities. Maybe you are holding on to a
cold drink in your hand and it in the end essentially what we have is this
kind of range that I talked about here; about where we normally like to sit and
where we are comfortable. Consider the thermoregulatory center in your brain
to be very much like a thermostat. You set the temperature in your house and as
soon as the temperature gets too low there is a set point in which the
furnace will kick on and come back up. And so in this case we're gonna say
that's 36 degrees. Once the temperature in the house reaches 36 degrees the
furnace kicks on to increase our temperature and in our body what that
looks like is we start to feel cold and we start to put on blankets and we start
to shiver and maybe your teeth are chattering and inside your blood vessels
are constricting and getting smaller to bring all the heat back towards the core
of the body. Now just like that temperature on your thermostat when that
gets too hot in the house, it needs to stop running the furnace and that's the
same thing in our body. In the hypothalamus, when we reach a certain set
point - 37.5 is what I have in my example - again check your agency's policy but
when we reach that point the activities that are increasing body
temperature are slowed down, and so you'll start to find that our body will
create an atmosphere which we can get rid of heat. That's when we start to
sweat, our face gets flushed, we have increased breathing because we want to
blow off the heat - and our vessels will vasodilate which means that they get
really wide and they bring all of that blood to the surface of the skin so we
can get rid of the heat through with the temperature in the room. Now in a fever,
what happens is someone comes along and they have reset the thermostat, and this
is the same in the body. This can be because of injury, disease, infection, but
something is in there playing with the thermostat and it says "nope we want it
to be 39" and that's because some of these
diseases function better in a hotter environment, and sometimes this is
because there is an interruption in how the hypothalamus is receiving messages.
Now a low-grade fever - this is where we get a lot of confusion in the workplace
as to when should we be concerned. So a low-grade fever is a slight elevation
and here I've got between 37.6 and 38.5 some people may be a little bit more
concerned as it gets to 38 and that's fine. In the hospital we typically don't
get too excited about running tests until we reach 38.5, but there are
exceptions. So a low-grade fever is just a slight elevation. It might be
accompanied with feelings of, um, just feeling tired and fatigued. However if it
comes along with a rash or swelling or maybe a stiff neck or chest pain you
would definitely want to seek medical attention before the fever gets higher
than that. Now a high-grade fever is greater than 38.6 Celsius or 101
Fahrenheit and this is typically where you're going to start to see us in the
hospital order blood work. We might order blood culture, a urinalysis.
We're going to do chest x-rays to see if maybe it's the lungs. You're gonna see a
whole host of client-specific, patient-specific interventions to identify the
cause of that fever. Now it's important to note here that in our children and
our geriatric population the temperatures are different. In infants, in
particular, once it gets greater than 38 degrees if I come back a slide, 38 degrees
and rectal is the preferred method in children. Then we would start to be
concerned. Geriatric population this is a little bit more about knowing their
baseline. I see that my word baseline is separated there no big deal. I know
someone's gonna pick it up and point it out so I thought I would share it with
you. We might find that a geriatric can go as low as 35.7, 35.6,
even 35.4 - I have seen in some patients up too low 37s, 37.3 and this
might be their normal which means a temperature of 37.4 might in
fact be a low grade fever. For your geriatric population,
in this case, we'd like to try and get a baseline, like look at their trends to
know where they normally sit. And the key thing here is to watch for changes of
1.1 degrees Celsius or 2 degrees Fahrenheit above their baseline and that
will help you further indicate or identify if they are having a fever. Now
did you know that fevers have patterns! This is really geeking out there. I always
like to dig a little, bit further so for those who are geeky like me stay tuned
we're going to talk about the fever's patterns and then we're going to talk about
some of the general treatment. Things you might recognize and see in hospital or
in the community. Number one: intermittent fevers this is where your temperature
will return to normal at least once in a 24-hour period. Now this is pretty common
for those who have gram-negative and gram-positive infections. That's
something we do with our blood work to identify. Abscess and sepsis patients.
That doesn't mean this is the only kind of fever these patients can have, but
it's just commonly found, that they will have an intermittent. They'll go febrile
then they'll come back down with it at least once in 24 hours.
That's intermittent. A remittent fever is actually one where it doesn't
return to baseline. If this black line is considered my 37 degrees, my normal
baseline, you'll see here that my temperature is always elevated. Maybe
this is a 38.3 to a 38.5, back down to a
38.3 up to a 38.7, 38.2
up to a 39; it just continually stays elevated and bounces back and
forth about a degree in either direction - A few degrees in either direction of
this new set point. Remember this black line is 37. this
might be 38.3 now and it's bouncing back and forth. This is
common with infectious diseases that are caused by bacteria, viruses, fungi, and
parasites. So they're not diagnostic patterns in the sense but they're more
about identifying what is happening in your patient and using the right
terminology. The third one is called a sustained fever. This is where the
temperature does not return to baseline. Commonly seen in
drug-induced fevers where it leads to a hyper metabolic state and your cells are
really all in hyperdrive, they're all producing more heat, and it's increasing
the core body temperature. And last one is, we have a relapsing fever. This is where
one or more recurrent episodes of a fever occur
Now each fever can be hours to days but what's important is that there is one or
more days in between the next onset of a fever. So here we've got one, two, three,
four days and all of sudden a spike again - come back down for one, two, three, four
days and all sudden spike again. This is a relapsing fever. Now another one of
interest - so typically for these types of fevers we're gonna see a variety of
intervention such as maybe Tylenol, ibuprofen, Aspirin and those are all
designed to reset that thermostatic setpoint bring it back down to normal.
That's the goal of our therapy. Now here's an interesting one is called
neurogenic fever. This is when there is damage or trauma to the central nervous
system and that includes the brain and the spinal cord.
Typically this may be seen with people who have got maybe a spinal cord injury
or they have had a bleed, so maybe a stroke and there is bleeding in the
brain so there is an intracerebral bleeding or there's increased
intracranial pressure as a results of that bleed or other pathology. What's
important to note here is that these are resistant to antipyretic therapy and
they are not associated with sweating. Caring for a fever may require a variety
of interventions. One of the first things we start to feel - there are actually
stages to a fever - we kind of get that prodromal where we just don't feel really well
and then we start to get the hairs on our arms rise and we start to get the
shivers, want to feel like we bundle up in the
covers because we're just cold and then the fever hits. Right. So the treatment
well vary in terms of the patient and what they would accept and in terms of
our goals. So the goal is obviously to get the temperature down and so there
are ways we can do that we can put a cold pack on our forehead, a face cloth,
if it's really hot you can put those cold packs under the armpit and in those
heat-generating areas. take the blankets off, leave one blanket just to help with
that comfort measure, and then we can also give cold fluids. We definitely want to be
drinking a lot because - fevers increase those nonsensible losses, of the
sweating and we can get dehydrated really easily. So there's fluids. Maybe a
cold, cool sponge bath or a shower. But here's the key. When it comes to these
measures to help dissipate the heat, when we get to the point where the patient
starts to shiver, we need to shut it down. Because shivering actually increases
heat and we don't want that to happen. So if you were giving you a sponge bath and you
starts to goosebumpies on your arm- stop the sponge bath and get out of it
because you need to put some clothes on because you're now starting to create
heat and we don't want to do that. Of course there is your Tylenols, your
acetaminophen - sorry same thing - ha, Ibuprofen is what I
meant to say, um Aspirin. Those are all used in fever control - of course Aspirin
do not use it in children we know that there's a risk for Reye's. But there are
medications that we can take to reduce and bring down the setpoint back in that
hypothalamus so that our temperature comes down. Now we do need to find the
cause and we don't always know the cause. There are fevers of unknown origin but
if we do have a cause we can then give antibiotics if that's the case if it's a
fungal we can give antifungals depending on what the issue is and maybe we need
to do some isolation if it's a tuberculosis. Now some fevers are more
common with diseases like Hodgkins or cancer and those treatments be very
different. We need to actually address the cause. So hydration, rest, and
nutrition is important because what happens in a fever is our body goes into
using up our fat stores as opposed to using carbohydrates so we need to keep
refueled and antipyretics should you need them. Of course, always consult your
physician if you have any concerns and stay safe. Thanks for watching now you
know a little bit more about a fever and when you should or shouldn't worry and
of course always checking your age these policies and seeking medical
attention should you think you have a fever that needs some interventions.
Until next time guys, make it a great day :)