Care for febrile patients
Depending on the degree of temperature increase, the following types of fevers are distinguished:
• subfebrile - 37-38 ° C;
• febrile - 38-39 ° С;
• high fever -39-40 ° С;
• pyretic - over 40 ° С;
• Hyperpyretic - 41-42 ° С;is accompanied by severe nervous events and is life-threatening.
Fever is characterized not only by fever, but also by disruption of all body systems. The degree of temperature increase is important, but not always critical for assessing fever severity.
Fever is accompanied by increased pulse and respiration, lower blood pressure. Common symptoms of intoxication, headache, weakness, feeling of heat and thirst, dry mouth, lack of appetite;decreased urination, increased metabolism due to catabolic processes. Rapid and severe fever( for example, with pneumonia) is usually accompanied by chills, which can last from a few minutes to 1 hour, more rarely - longer.
With severe shiver, the patient's appearance is typical: due to the sharp narrowing of the blood vessels( capillarospasm), the skin becomes pale, the nail plates acquire a cyanotic color( cyanosis);experiencing a feeling of cold, the patients tremble, their teeth chatter.
For a gradual increase in temperature is characterized by a slight chill.
At high temperature, the skin has a characteristic appearance: red, warm( "fire").
The lytic drop in temperature is accompanied by a profuse sweat.
With fever, the body temperature is usually higher than the morning. The rise in temperature above 37 ° C gives reason to suspect the disease.
The fluctuation of body temperature during the day and the whole period is of great importance.
Main types of fever
1. Fever fever( febris continua) - the heat persists for a long time;during the day, the difference between morning and evening temperatures does not exceed 1 ° C;is characteristic of croupous pneumonia, stage II of typhoid fever.
2. Relapsing fever( febris remittens) - the temperature is high, the daily temperature fluctuations exceed 1-2 ° C, the morning minimum is above 37 ° C;is characteristic of tuberculosis, purulent diseases, focal pneumonia, stage III of typhoid fever.
3. Intermittent febris( febris intermittens) - short-term temperature rises to high digits strictly alternate with periods( 1-2 days) of normal temperature;is observed with malaria.
4. Wavy( circulating) fever( febris undulams) - there are periodic temperature increases, and then lowering the level to normal numbers;such "waves" follow one after another for a long time;is characteristic of brucellosis, lymphogranulomatosis.
5. Recurrent fever( febris recur / ens) - a strict alternation of periods of high fever with febrile periods, while the temperature rises and falls very quickly;The febrile and febrile phases last for several days each;is characteristic of recurrent typhus.
6. Reverse type of fever( febiis inversa) - morning temperature is higher than evening;sometimes observed with syphilis, tuberculosis, brucellosis.
7. Wrong fever( febrisiiregularis) - differs in various and irregular daily fluctuations;often observed with rheumatism, endocarditis, sepsis, tuberculosis. Another fever is called atypical( irregular).
A sharp decrease in elevated temperature( within a few hours) to the norm is called a crisis, a gradual decrease( for several days) by lysis.
Sometimes there is a short-term rise in temperature for several hours( one-day, or ephemeral, fever - febris ephemera or febriculara);occurs in light infections, overheating and sun exposure, after a blood transfusion, sometimes after intravenous administration of drugs.
Fever of up to 15 days is called acute, lasting more than 45 days - chronic.
The most common cause of fever are infectious diseases and the formation of tissue disintegration products( for example, necrosis in myocardial infarction).Fever - most often the body's reaction to infection. Sometimes an infectious disease may not manifest as a fever or temporarily occur without a rise in temperature( tuberculosis, syphilis, etc.).The degree of increase in temperature depends to a large extent on the patient's body: for the same disease in different persons, it can be different. Thus, in young people with high reactivity of the body, the infectious disease can occur with a temperature of up to 40 ° C and higher, while the same disease in older persons with weakened reactivity - with normal or subfebrile temperature. The degree of temperature increase does not always correspond to the severity of the disease, but is also related to the individual characteristics of the body's response.
An increase in the temperature of non-infectious origin is often observed in malignant tumors, necrosis of tissue( for example, in infarction), hemorrhages, rapid disintegration in the blood of red blood cells, abaissement of subcutaneous or intravenous foreign substances of protein nature. Significantly less frequent is fever in diseases of the central nervous system, as well as of reflex origin. In this case, temperature rises are more often observed in the daytime, so there is a need for hourly thermometry.
With fever, all types of metabolism are disrupted. The amount of nitrogen excreted in the urine increases, hyperglycemia develops, and sometimes glucosuria: fat metabolism increases, water-salt balance is disturbed.
A 1 ° C rise in temperature is usually accompanied by an acceleration of the heart rate by 10 beats. Breathing during fever increases in parallel with an increase in the rhythm of heartbeats and body temperature.
During the fever are distinguished:
• the period of rising temperature( stadium incrementi);
• a period of high temperature( fastigium);
• the period of temperature decrease( star decrementi).
The course of fever is divided into three main periods, which the nurse needs to know, since the tactics of her behavior have their own peculiarities.
• 1st period is a period of fever, accompanied by a sharp chill, blue lips, cyanosis of the limbs, headache and general poor health, when the heat production prevails over the heat transfer. The duration of this period is from several hours to several days and even weeks. The rapid increase in temperature is tolerated most severely by patients due to tremendous chills, pains and aches throughout the body.
During this period, the nurse must warmly cover the patient, cover with warmers, especially the feet, drink sweet tea or other hot drinks, prevent drafts and follow the patient's directions.
• 2nd period - the period of maximum temperature increase;is characterized by an increase in the toxic state, headache, a feeling of heat, dryness in the mouth, a sharp weakness, an aching all over the body. At the height of fever, delusions and hallucinations are possible. Increased heat transfer and increased heat production are in relative equilibrium. The duration of the period is from several hours to several weeks.
In addition to the violation of thermoregulation, with a fever, the metabolism is disturbed. On the one hand, combustion increases, and on the other hand, due to a decrease in the digestion and absorption function, the intake of nutrients decreases. This leads to the fact that the body's own tissues, carbohydrates of the liver, fat of fatty tissue begin to "burn".Protein is disintegrated. The patient is exhausted. The higher the temperature, the larger its range, the longer it lasts, the greater the depletion. Increased excitability makes it necessary to establish an individual post of a nurse or a minor nurse. If this is not possible, then relatives can be admitted with whom the nurse held a conversation explaining the specifics of caring for the seriously ill. Involvement of relatives is impossible with an infectious disease( with the imposition of quarantine).In such a case, the staff list of the hospital is reviewed and persons( nurses) trained for caring for the seriously ill are provided.
If the patient's condition worsens during observation, it is necessary to inform the doctor on duty. During this period, the patient should be given a high-calorie and easily assimilated food in liquid or semi-liquid form in small portions 5-6 times a day, plentiful drink( fruit and berry juices, fruit drinks, mineral water).The patients dry mouth, cracks on the lips, so you should periodically wipe the mouth with a weak solution of sodium hydrogencarbonate and lubricate the lips with any fat.
With a sharp headache, an ice pack is placed on the forehead( as the ice melts, it needs to be changed), or a cold compress of a folded fourfold and a linen napkin or towel soaked in cold water.
A nurse should ensure that the room is warm and quiet, and also monitor pulse and blood pressure.
• The third period is the period of temperature decrease. Heat production is reduced, and heat output is increased. Decrease in temperature, especially critical, is difficult for patients to suffer because of the often acute cardiovascular insufficiency. A rapid drop in temperature below the normal level is accompanied by a sudden sharp deterioration in the patient's condition. There is a strong weakness, thirst, a feeling of cold, chills. Sometimes the weakness is so great that the patient is not able to complain and react to the environment. His skin turns pale, then turns blue, becomes covered with a cold sweat, and limbs become colder. Arterial blood pressure drops sharply, the pulse becomes frequent, small, soft( "threadlike pulse"), breathing becomes more frequent and becomes superficial. Pupils dilate. Acute vascular insufficiency develops.
The crisis can have a favorable course, when a decrease in temperature is accompanied by a profuse sweating;pulse and breathing are not accelerated, consciousness is restored, and feverish excitement and insomnia are replaced by sleep.
In the case of an unfavorable critical condition, the nurse or nurse in the emergency room immediately informs the doctor on duty about the worsening of the patient's condition. In case of delay and untimely provision of care due to sharp acute cardiovascular insufficiency, a fatal outcome may occur.
The doctor on duty evaluates the patient's condition, provides emergency care, makes appropriate appointments, to which the nurse in charge must proceed immediately. As a rule, substances that increase blood pressure are introduced into the skin: mezaton, adrenaline. Patient obkladyvayut warmers, give a strong warm tea or coffee, change his native, and, if necessary, bed linen. A critical drop in temperature can be with croupous pneumonia and a number of infectious diseases.
A gradual decrease in body temperature is called a lytic. It is accompanied by the appearance of a small sweat on the skin and weakness. Usually, after lowering the temperature, the patient falls asleep.
For long-term fever patients, the nurse must monitor the skin integument performed by the nurse. In the absence of such a staff nurse should take over these functions. Their main content is the prevention of pressure sores. All physiological controls patients with severe fever should perform in bed.