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2017 HCHB_digital

Fever What is fever

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 Your new Group 3 CPD project Page 70 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Most people just require bedrest and supportive care (such as keeping up fluid intake, keeping bedding light) to recover from a fever, although other treatments (eg, antibiotics) may be warranted depending on the cause. Anybody with a particularly high fever (above 39°C), who is extremely sleepy or appears very unwell, is refusing fluids, aged under six months or with symptoms suggestive of meningitis (see Childhood Diseases and Immunisation) should aways seek medical attention. Febrile seizures About 2%–5% of children aged three months to six years will experience a tonicclonic seizure during a fever. Children aged eight to 20 months are more at risk. Febrile seizures usually involve loss of consciousness and shaking of the limbs on both sides of the body. Less commonly, a child may become rigid and twitch only part of his or her body. Febrile seizures are thought to be due to a sudden rise in body temperature, and often occur before the caregiver even realises the child is ill. Cool compresses or fever-reducing medicines such as paracetamol or ibuprofen will not prevent a febrile seizure. Most of these seizures resolve themselves after one to five minutes, are harmless, do not require daily medication, and do not cause brain damage, although caregivers should seek further medical advice to establish the source of fever. If a febrile seizure occurs, the caregiver should lay the child on their side, somewhere safe, and stay with them while they recover. Any sharp objects near the child should be removed, and tight clothing loosened. Objects (eg, pacifiers) should not be placed in the child’s mouth and attempts should not be made to stop the seizure. Although most seizures stop on their own, if the seizure persists for longer than five minutes, caregivers should ring for medical advice. Emergency medical assistance should be sought if a seizure lasts longer than 10 minutes. Although alarming for parents, the vast majority of febrile seizures cause no lasting effects. Advice for customers • Be alert for symptoms that may indicate meningitis and seek urgent medical attention if any worrying signs are present or if you are unsure (see Childhood Diseases and Immunisation). »» Classic signs include a fever, stiff neck, headache, sensitivity to light and nausea or vomiting. A rash may or may not be present. • A luke-warm bath or cool compresses may provide comfort. • Dress the person in light clothing and keep bedding light. • Drink plenty of water and/or electrolyte replacement fluids since fever can cause dehydration. • When using a mercury thermometer, always shake before use. Wait 10 minutes after eating anything hot or cold before taking the temperature. »» Tympanic thermometers measure the temperature of the ear drum, but may underestimate temperature if not used properly. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Is the child aged less than six years or has pain with the fever? • Is the fever accompanied by a stiff neck, headache, sensitivity to light, irritability and/or vomiting? This may indicate meningitis (see Childhood Diseases and Immunisation) • Does the person have a temperature above 38°C? • Is the person quite unwell, very lethargic, difficult to arouse, sleepy or appearing delirious? • Is the fever accompanied by a painful, persistent sore throat? • Is the person experiencing heavy night sweats? • Does the person also have diarrhoea? • Has the person been overseas recently? • Is the person with the fever refusing fluids? • Does the person have a rash? • Is fever the only symptom? • Has the fever lasted more than 48 hours? • Does the person have any allergies to medicines? »» Digital thermometers are preferred in children as there is a risk children may bite the glass bulb of a mercury thermometer, releasing its contents. Visit ELearning to start your project www.pharmacytoday.co.nz Facilitated by Dr Alesha Smith Page 71

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