The Purpose of this paper is to review the fever protocol used in the consulting nurse office as compared to the protocol suggested by the nursing research articles. In the consulting nurse office, we use a protocol for fever in which we assess the symptoms of patients who call us and we triage then with the protocol. The first thing we do is make sure they are not in need of emergency medical attention, then we go over their symptoms carefully to make sure they can safely take care of themselves at home.If we find they are not in need of immediate medical care, we give them home care instructions. One of the instructions is to give Tylenol or Motrin for any fever above 100 F.According to the research articles, treating a fever is not always in the patients best interest. Fever has beneficial effects on the body and should only be treated in a certain population of patients.
The paper will also discuss the physiological, Pathophysiological, behavioral and experiential responses to the phenomena of fever.
A company named Access Health supplies the fever protocol used by the consulting nurse office. The company sells nursing call centers software that they use to triage patients symptoms. They arent used to diagnose, only to help the patient receive the level of care needed according to their symptoms. Physicians give the nurses permission to use these protocols to lessen the amount of calls they have to take care of. The fever protocol is divided into sections.
The first section is emergent in which the symptoms are so severe they need to call 911 or go to an ER. In the fever protocol you would send a person with a temperature over 104 F to the ER. If the had a decreased level of consciousness you would instruct them to call 911. The second section is called urgent within four hours, in this section if a patient has had a recent surgery or procedure or have a serious medical condition such as diabetes or sickle cell and have a fever above 102 they should go to the ER or to their doctors office. The third section is called urgent within twenty-four hours. These patients can call for an appointment with their doctor within the next twenty- four hours for symptoms of a fever above 100 with no improvement with home care. The next section called non-urgent, those symptoms can be cared for at home such as a fever that goes down with Tylenol. The last section is called watchful waiting, which usually requires the patient just to be aware of worsening symptoms and to call back if they occur. If we triage the patient and feel they can safely take care of themselves at home, we give them home care that is in the fever protocol. We instruct them to rest, drink fluids and take Tylenol or Motrin for a fever above 100. We encourage them to continue to take the meds until their symptoms are gone.
One of the physiologic responses to fever is increased heart rate. When a person has a fever, their metabolism increases up to seven percent for each degree increase above normal. The heart rate rises about ten beats per minute for each degree above normal. (Morgan 1990).
Delirium is a pathophysiologic response that can occur with fever. It usually happens if the fever is over 104.
Delirium occurs when the body has a rapid rise in temperature that doesnt trigger the compensatory cooling mechanisms. This phenomena can start a positive feedback situation in which there is an increased metabolic response to stimulate heat production. This response can continue to raise body temperature. (Rowsey 1997).
The study: Pathophysiology of Fever, Part 2: Relooking at Cooling Interventions by P. Rowsey was reviewed for this paper. The research in this study found that treatment of fever is not always necessary and can be harmful. It stated that present day research indicates that fever is not a pathological response to injury or disease but a physiologic response that helps the body fend off infection and inflammation. The article states that a fever activates the release of several substances that help fight infection and tumor growth such as T- lymphocytes and Interferon. Another effect fever has is the production of hypoferremia. Hypoferremia causes the decrease in iron in the blood which helps decrease the growth of bacteria. Fever also starts the Hepatic acute Phase that causes the release of neutrophils. This helps the body get rid of damaged tissues and prepare the body for rebuilding and wound healing. The research shows that cooling the body febrile body can do more harm than good both physiologically and psychologically. By cooling the body too quickly, it can cause shivering and actually cause the core temperature to increase. Taking away clothing and blankets can cause the patient to suffer more stress, increasing more heat production and be more metabolically detrimental than the fever itself. The study found that it is better to treat the uncomfortable symptoms that go along with fever, rather than treating the fever itself.
The study did say that if a fever is over 104, it is most likely an infectious process and should be treated accordingly. (Rowsey 1997).
The article was an overview of several studies. Most the studies involved healthy adults, some of them were done in the critical care setting with seriously ill patient. A few of the physiological studies were performed on animals. The people who call the consulting nurse office run the gamut of levels of illness. We have very healthy people who call, needing instructions because they are ill so infrequently and the other end of the spectrum of the just discharged open-heart patients who are spiking a temperature. The research that was reviewed had enough information to support the change in the protocol. The protocol wouldnt be hard to change but peoples minds are a different matter.
Morgan, S. (1990). A comparison of three methods of managing fever in the neurologic patient. Journal of Neuroscience Nursing, 22, 19-24.
Rowsey,P. (1997). Pathophysiology of fever part: 2 relooking at cooling interventions. Dimensions of Critical Care Nursing, 16, 251-256.