Fever is a protective response by the body to infection or illness and helps fight pathogens. It can be caused by infections, cancers, injuries or other issues. During a fever various body systems are affected like increased heart rate and breathing. There are different types of fevers defined by temperature patterns like intermittent fever with regular spikes. Managing a patient's fever focuses on cooling them through methods like cold compresses, fans, fluids and medication if needed to prevent complications. Vital signs must be monitored closely during fever episodes.

1. Bsc/ part-1/Care of patient having
alteration in temperature

2.  Fever is not a disease but it is a sign.
 Fever is a protective function of the body, because the rise in
temperature prevents the growth of organisms causing the
disease.
 Fever if not too high, hastens the destruction of bacteria by
increasing phagocytosis and by producing immune bodies.
DEFINITION:
Fever or pyrexia is defined as a rise in the body temperature
above 37.2 degrees Celsius.

3. CAUSE OF FEVER CAUSE OF FEVER
Infectious diseases of the nervous system Heat stroke from exposure to hot
environments
Certain malignant neoplasm's Dehydration
Blood diseases such as leukemia surgical trauma and crushing injuries
Embolism and thrombosis skin abnormalities that interfere with heat
loss
allergic reaction to foreign proteins and
pyrogens

4. In fever, all the systems of the body are affected. It may vary
with nature of the disease.
 Respiratory system : shallow and rapid breathing
 Circulatory system: Increased pulse rate and palpitation
 Alimentary system: dry mouth, coated tongue, loss of appetite,
indigestion , nausea, vomiting, constipation or diarrhea
 Urinary system: diminished urinary output, burning
micturition, high colored urine
 Nervous system: headache, restlessness , irritability, insomnia,
convulsions, delirium
 Musculo-skeletal system: malaise, fatigue , body pain, join
pain
 Integumentary system: heavy sweating, hot flushes, goose
flush, shivering or rigors.

5. 1.Onset or invasion: onset or invasion of fever is the period when the
body temperature is rising and it may be a sudden or gradual process.
2.Fastigium or stadium: fastigium or stadium of fever is the period
when the body temperature has reached its maximum and remains
fairly constant at a high level
3. Defervescence or decline: Defervescence or decline of the fever is
period when the elevated temperature is returning to normal. The
fever may subside suddenly (decline by crisis) or gradually (decline
by lysis)
4. Crisis: crisis is a problem return to normal temperature from a very
high temperature within a few hours or days.
5. True crisis: the temperature falls suddenly and touches normal,
accompanied by a marked improvement in the client's condition.

7. 6. False crisis: a sudden fall in temperature not accompanied by
an improvement in the general condition is called false crisis.
It may be a danger signal and not a sign of improvement
7. Lysis: the temperature falls in a zig-zag manner for 2 or 3 days
or a week before reaching normal, during which time the other
symptoms also gradually disappear.
8. Constant fever or continuous fever: constant fever or
continuous fever is one in which the temperature varies not
more than two degrees between morning and evening and it
does not reach normal for a period of days or weeks.
9. Remittent fever: remittent fever is a fever characterized by
variations of more than two degrees between morning and
evening but does not reach normal

8. 10. Intermittent or quotidian fever: the temperature rises from
normal or subnormal to high fever and back at regular
intervals, The interval may vary from few hours to 3 days.
Usually the temperature is higher in the evening than in the
morning.
11. Inverse fever: in this type the highest range oftemperature1s
recorded in the morning hours and the lowest in the evening
which contrary to that found in the normal course of fever.
12. Hectic or swinging fever: when the difference between the
high and low points is very great, the fever is called hectic or
swinging fever .
13. Relapsing fever: relapsing fever is one in which there are
brief febrile periods followed by one or more days of normal
temperature.

9. 14. Irregular fever: when the fever is entirely. irregular in its
course, it cannot be classified under any one of the fevers
described above and it is called irregular fever.
15. Rigor: rigor is a sudden severe attack of shivering in which
the body temperature rises rapidly to a stage of hyperpyrexia as
seen in malaria
16. Low pyrexia: in low pyrexia the fever does not rise between
37.8 degree Celsius.
17. Moderate pyrexia: the body temperature remains between
37.8 and 39.4 degree Celsius,
18. High pyrexia: the temperature remains, between 39.4 and
40.6 degree Celsius.

10. 19. Subnormal temperature: when the body temperature falls
below normal, it is called subnormal temperature. The
temperature may vary between 35 and 36.7 degree Celsius.
20. Hyperthermia: when the body temperature is raised to 105 F
or above it is called hyperthermia.
21. Hypothermia: if the temperature falls below 95 F or 35 C, the
condition is called hypothermia.

11. (a) Regulation of the Body Temperature:
 Care of the clients in fevers focuses on reducing the elevated
body temperature. When a client's temperature is moderately
elevated, various methods of reducing the temperature may be
started.
 The room should be maintained at a comfortable temperature.
 The room should be well ventilated
 The blankets and excess clothing should be removed but
prevent the client from getting draughts.

12.  Exposure to cool by an electric fan
 Administration of cool drinks
 Application of cold compress and ice bags
 Cold sponging and cold packs
 Cold Ice cold lavages and enemas
 Use of hypothermic blankets or mattresses
# When surface cooling is used, treatment is directed at
not only cooling the body but also for preventing shivering.
Shivering must be prevented because it increases metabolic
activity, produces heat, increases the oxygen usage markedly,
increases circulation, and may cause hyperventilation and
respiratory alkalosis. It takes longer time to reduce body
temperature in a shivering client.

13.  High calorie diet is indicated in fevers as the cellular
metabolism is greatly increased during fever. The oxygen
consumption in the body tissues increases approximately13 %
for each centigrade degree of rise in temperature or 7 % for
each Fahrenheit degree.
 Easily digestible and palatable diet prefererebly ,fluid diet up
to 3000 ml (if not contraindicated) in 24 hours. As the
digestive process is slowed down & to prevent dehydration and
to eliminate the waste products.
 Excessive fluid loss through sweating nausea vomiting, or
diarrhea is resolved by intravenous fluids with physician order.
 Encourage intake of plenty of fluids to prevent burning
micturition

15.  Maintain intake and output chart
 Small and frequent solid diet if patient could tolerate it.
 Never force a client to take any food he dislikes.
 Soft diet containing plenty of fluids and fruits will help to
evacuate the bowels regularly.

16.  All clients having fever should be asked to take complete bed
rest.
 To ensure rest. And sleep, provide a unit, which is calm, quiet,
without bright lights and glares.
 Help the client to change the position regularly.
 The clothing should be light, loose, smooth and non-irritating.
 Cotton garments are helpful, since they absorb the sweat and
help in the evaporation.

17.  Care of the mouth is very essential for clients having fever for
many days. There maybe cracked lips and coated tongue.
 If the oral hygiene is not maintained, many complications may
arise, e.g., parotitis ,sords and crusts, herpes etc.
 Mouth care is given 4th hourly or even more frequently for
those clients having fevers for many days.
 Apply emollients to the dry lips to prevent cracking.
 Care of the skin and pressure points are essential to prevent
bedsores.
 Sponge bath is given daily to keep the client clean.
 If profuse sweating is present, frequent sponging is essential.
 A 4 hourly back care may be given with special attention to the
pressure points. If the temperature is remaining high, the cold
sponging may be given to bring down the temperature

18.  Never leave a client with high fever alone.
 Rigors and convulsions may occur at any time and the nurse
should keep all the articles ready to act quickly on such
occasions.
 If the client has a fever over103 F for a long time it may lead to
delirium and convulsions.
 If the temperature is remaining high for a long time
irreversible changes may occur in the brain cells.
 If the temperature is not coming down with cold applications,
antipyretic drugs eg:paracetamol may be given with the advice
of the doctor.
 Surface cooling should be done gradually as, Sudden cooling
can lead to serious side effects such as cardiac arrhythmias.

19.  When the temperature is brought down to the desired level, the
client should be protected with warm blankets to prevent them
going to hypothermia.
 If any type of cold applications is used, the nurses should
inspect the skin for discoloration or lesions and apply a cream
or oil to the affected area

20.  Clients with fever need constant intelligent observation by the
nurses.
 The vital signs are to be checked frequently to know the
progress or regression of the disease.
 Any worsening of the client's condition should be noted and
reported immediately.
 When any type of cold applications is applied, the temperature
should be taken by the rectal method to get an accurate body
temperature.
 Measure and evaluate the urinary output periodically.

21. Rigor is characterized by three stages:
1.First stage or cold stage:
The client shivers uncontrollably. The skin is cold, face is
pinched and pale, the pulse is feeble and rapid. The
temperature rises rapidly to 39.4degree Celsius or above.
During this stage,
 Cover the client with blankets and apply warmth with hot
water bags.
 Give warm drinks.
 Protect the client from falling.

22. 2. Second Stage or Hot stage:
The skin feels hot and dry and client feels very thirsty. The
shivering stops. The clients may be restless. The temperature
may continue to rise.
During the second stage,
 Remove all the dress and blankets and hot appliances. Cover
him only with a thin blanket.
 Give him cool drinks Cold compresses are applied to the
forehead to relieve congestion and headache.
 The temperature is carefully recorded every 10 to 15 minutes.
 Watch pulse and respirations carefully.
 If the temperature goes very high (40.5 degree Celsius) cold
sponging may be started. Watch for the early signs of
sweating.

23. 3. Third Stage or Stage of Sweating:
The clients sweat profusely. The temperature falls. The pulse
improves. Acute discomforts are diminished. The client may go
into a state of shock and collapse if not cared properly.
During the third stage,
 Change the clothes that are wet with sweat or with cold
applications.
 Give a quick sponge and dry the client.
 Put on clean dry clothes and cover the client with a light
cotton blanket.
 Sweet drinks may be given to treat fatigue.
 Make him comfortable.

24.  Let the client sleep.
 Continuous watching is necessary.
 Take T.P.R. every 15 minutes, without disturbing the client.
 When the temperature comes down and the pulse is not
improved, it should be considered as a false crisis and the
client's condition may deteriorate unless carefully watched.