NR602 Week 5: Homework- MyEvaluations Log

In primary care, one of the most common reasons for an office visit in young children is fever. Although fever is common in children and often a benign part of illness, the child’s history must be evaluated thoroughly. In certain situations, the child’s condition may call for more than a routine examination. Some principles for evaluating fever are reviewed in this lesson, but note that the field and advice for monitoring, controlling, and the purpose of fever in children continue to evolve. For example, the advice to give an over-the-counter fever reducer prior to immunizations is no longer recommended to ensure that full immune response from vaccinations can occur (Prymula et al., 2009). Below are some areas to consider in evaluating fever in a primary care setting in infants and children.

There are a few definitions of fever, but the most widely accepted parameter is 100.4°F or 38°C rectal (Hay, Levin, Deterding, & Abzug, 2018). However, the AAP notes that normal fever in children can range from 97 to 100.4 degrees (Sullivan & Farrar, 2011). The methods with which temperature can be evaluated vary and mercury thermometers should not be used.

Below are some important points about accurately measuring pediatric temperatures.

(Craig, Lancaster, Taylor, Williamson, & Smyth, 2002; Society of Pediatric Nurses, 2007; Sullivan & Farrar, 2011)

Fever is not an illness, but a manifestation of changes in the body that occur most frequently as a systemic response to fight foreign material. In the body, endogenous pyrogens cause the hypothalamus to reset internal temperature regulation to a higher point. Fever aids in arresting invader reproduction and causes increased neutrophil and T-lymphocyte production (Hay et al., 2018; Sullivan & Farrar, 2011). The range of causes of fever is broad, from neurological disease and malignancies to common infections and even medications. Although it may cause discomfort in the child, there is some data to support that fever may even help in building immunity and in speeding up recovery from an illness (Sullivan & Farrar, 2011). No evidence to date supports the idea that teething causes fever above 38.4°C (Hay et al., 2018).

Below is a list of considerations in evaluating any infant or child with fever.

(Hay et al., 2018; Sullivan & Farrar, 2011)

Additional workup is needed in children without an obvious exam finding who are younger than 3 months of age, have a fever for longer than 72 hours, have a very high fever, or have a reoccurring fever for more than 7 days . In these cases, a CBC, urinalysis, and anterior/posterior/lateral chest radiograph should be considered.NR602 Week 5: Homework- MyEvaluations Log

Fever can be a frightening experience for parents. Proper anticipatory guidance should be a routine part of well-child care, as well as sick visits. This includes how to measure temperature accurately, when to use over-the-counter medications, and when to call the healthcare provider’s office. Reminding the parents of the goals of care and offering parents information on when and how to properly treat a fever (particularly with a sick child) can help ease a parent’s concerns. Oftentimes, parents need to know how to help their child feel better. These suggestions can be of benefit and assist the parents as well.

Prescriptions Writing – Practice

(Hay et al., 2018; Sullivan & Farrar, 2011)

Week 5: References