2017 HCHB_digital

Fever
What is fever
Fever is defined as a rise in the normal body temperature and is generally
considered present when body temperature rises above 38°C. Normal body
temperature varies by person, age, activity, and time of day (usually lower in the
morning and higher at night). Many other factors, such as the menstrual cycle,
can also affect temperature.
The average normal body temperature in adults is considered to be 37°C,
with a range of 36.1 to 37.2°C. Temperature measured under the arm or in the
ear is usually about 0.5°C lower than oral body temperature, and that in the
rectum about 0.5°C higher. It is important to remember that the reading on a
thermometer is not the most important indication as to how sick a person is. Do
not underestimate or dismiss a perception that a person feels hot when a hand
is placed on their forehead or looks “off-colour”.
Other symptoms
Depending on the cause of the fever, other symptoms may also be present such
as aching muscles, cough, earache, enlarged lymph glands, headache, loss of
appetite, pain (which may cause irritability in a child), shivering, tiredness or a
rash.
Causes
Fever is a common medical symptom that is most often associated with infection
although it may occur with a number of other conditions such as:
• allergic reactions
• cancer (most commonly leukaemia, lymphomas, renal cancer)
• cerebral haemorrhage (stroke)
• immunological disorders (eg, lupus erythematosus)
• metabolic disorders (eg, gout, porphyria)
• myocardial infarction (heart attack)
• thromboembolic events (eg, deep venous thrombosis, pulmonary embolism).
Vaccinations, some medicines, and extreme sunburn can also cause a fever.
Body temperature is controlled by an area of the brain called the hypothalamus
which acts like a thermostat. Body temperature is normal when the heat
produced within the body, particulary by the liver and muscles, is in balance
with the heat lost by the body. A fever occurs when the hypothalamus resets
body temperature in response to infection (as part of the inflammatory response)
or other body condition. Usually, as a person’s temperature is rising, there is a
feeling of cold until it reaches the new set temperature, when there becomes a
feeling of warmth. Later, when the thermostat is reset to its normal level, the
body eliminates excess heat through sweating and shunting of blood to the skin.
Initial assessment
Customers presenting with symptoms such as skin discolouration (pale, ashen,
blue, or mottled), respiratory changes (faster breathing rate or visible use of chest
muscles), reduced activity levels (difficulty in rousing, lack of response to social
cues, continuous crying), a faster heart rate, or reduced skin turgor (degree of
skin elasticity) are likely to have a serious underlying reason for their fever and
should be referred to a doctor immediately. For all other customers, run through
the Refer to Pharmacist questions and refer those with a "yes" answer to a
pharmacist.
Treatment
Controversy surrounds the usefulness of fever and whether it should be treated
with antipyretic (temperature-lowering) medicines (eg, paracetamol, ibuprofen)
or not. Research has shown that fever can help fight infection by enhancing
the body’s immunological response, and creating an unbearable environment
for some pathogens. Most experts recommend that antipyretics be used only
occasionally, if at all, in low-grade fevers to relieve discomfort rather than
specifically to lower body temperature. These medicines will not shorten the
duration of an illness.
TREATMENT OPTIONS
Category Examples Comments
Antipyretics
[GENERAL SALE]
eg, aspirin (Aspro, Disprin range)
eg, ibuprofen 25s (Nurofen range)
eg, ibuprofen suspensions (Fenpaed,
Nurofen for Children)
eg, ibuprofen + paracetamol >25s
(Maxigesic, Nuromol)
eg, paracetamol suspensions (Pamol,
Panadol Colour Free, Paracare)
Consider occasional antipyretic use to make the person feel more comfortable. Paracetamol is not
recommended for routine use before or after vaccination as it may reduce the effectiveness of childhood
vaccinations to stimulate lasting immunity (infection-fighting ability). If taking paracetamol for pain relief, be
careful not to double-up with other combination medicines containing paracetamol.
All non-steroidal anti-inflammatory drugs (NSAIDs, eg, ibuprofen, aspirin) have risks involved with use and
may not be suitable for people on certain other medications or with some medical conditions (eg, asthma,
kidney disease). Advise customers to stop taking if stomach upsets, increased bruising or prolonged bleeding
occur. Aspirin has an increased risk compared with ibuprofen and is generally not the preferred NSAID.
Aspirin is not recommended for children or adolescents under 18 years old (see Childhood Pain and Baby
Teething: Treatment options).
Ibuprofen may be used in children aged over three months, but caregivers should seek medical advice before
using if the child is aged less than one year.
Significant learning
opportunity: Wound care
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Page 70 HEALTHCARE HANDBOOK 2017-2018 Common Disorders