Care for patients with fever

The human body temperature is constant, unlike cold-blooded animals whose body temperature is unstable and fluctuates depending on the ambient temperature. Normally, the body temperature of a person has very slight fluctuations depending on the time of day: in a healthy person, the temperature in the morning is slightly lower than in the evening. Also, children have a higher temperature than adults, and it is higher in women during menstruation. This is due to the intensity of oxidation processes. Physiological fluctuations in the body temperature of a person do not normally exceed 1 ° C.The process of maintaining the constant temperature of the body is called thermoregulation, it ensures the formation and release of heat by the body. With the development of the pathological process in the human body, there is a violation of thermoregulation, which manifests itself through a fever.

Fever is called the adaptive response of the body in response to various stimuli( bacteria, viruses, tissue decay, parasites).

Bacteria and their vital activity products act as centers of human thermoregulation, and, irritating the body's immune system, provoke the release of pyrogen into the blood.

In response to a viral infection, interferon is produced, the formation of which requires a lot of energy costs and can occur only with fever.

Allocate fevers of infectious and non-infectious genesis. The latter arise when the products of decomposition of damaged tissues of the body are sucked in with hemorrhage, introduction of foreign protein, poisoning.

For temperature measurement, a medical thermometer with a calibration of 34 to 42 ° C is used. Temperature is measured more often in the armpit, less often in the inguinal fold, rectum, in the mouth. In the armpit there should not be an inflammatory process, because this leads to a local increase in temperature and distorts the real body temperature. Before thermometry, the armpit is dryed with a towel, since moisture also affects the correct measurement of temperature.

A well-disinfected thermometer must be shaken so that the mercury falls below the scale. Then it is placed in the place of temperature measurement by the bottom end. The patient should tightly press the thermometer to the body for 7-10 minutes. When the patient is unconscious and excited, the hand must be held by the nurse or nurse( the same applies to young children).

The data obtained from the temperature measurement is recorded by the nurse on the temperature sheet, and by the doctor - in the medical history. In a temperature sheet, the thermometry data is recorded in accordance with the measurement time, resulting in a line called the "temperature curve".The temperature curve is a graphic representation of the clinical course of the fever.

The following types of temperature curves are distinguished by the temperature rise: subfebrile - no higher than 38 ° С, febrile - up to 39 ° С, high 39-40 ° С, extremely high - above 40 ° С.

There are several types of fever in height, duration, nature of temperature fluctuations.

The following types of temperature fluctuations are distinguished:

• permanent fever( Jebris continua) - high, prolonged fever with diurnal temperature fluctuations not exceeding 1 ° С.This type is characteristic for typhus and typhoid fever, croupous pneumonia;

• Relaxing fever( Jebris remittens) - fever with diurnal temperature fluctuations over 1 ° C.It is observed with suppurative diseases, focal inflammation of the lungs;

• Intermittent fever( Jebris intermittens) - fever occurs in malaria. Similar to the hectic. The temperature rise can last from 1 hour to several hours, repeated after 1-2 days, depending on the type of pathogen;

• Depleting, or hectic, fever( Jebris hectica) - a fever lasting, with daily fluctuations of 4-5 ° C and a drop in temperature to normal numbers. Occurs with pulmonary tuberculosis, sepsis;

• perverted fever( Jebris inverse.) - fever similar to hectic. In this type of morning there is a maximum temperature rise, and in the evening it drops to normal figures. It occurs with tuberculosis and sepsis;

• atypical fever( Jebris irregularis) - this type of fever is characterized by indefinite duration and irregular, varied daily temperature fluctuations. It occurs in many diseases;

• recurrent fever( Jebris reccurens) - fever is characterized by a regular change of febrile and febrile periods and lasts for several days. The range of temperature can be up to 4-5 ° C.Characteristic of recurrent typhus;

• undulating fever( Jebris undulans) - is caused by a change in the periods of gradual increase in temperature to high figures and gradual reduction of it to subfebrile or normal numbers. It occurs in brucellosis and lymphogranulomatosis.

Care for febrile patients is of great importance for the relief of the patient's condition, his recovery. In the process of care, the work of the nurse is important, which, in direct communication with the patient, monitors the dynamics of his condition, notes the appearance of new symptoms. The nurse conducts medical and hygienic measures, distributes medications at specific times and monitors their intake. An important role is played by taking and administering medicines to the patient by the hour, since a delay or missed reception leads to a malfunction of the medical process and a delay in recovery. The nurse at the bedside of a severe patient needs to know the symptoms of complications of the disease, life-threatening, be able to notice them in time, inform the doctor and provide emergency help.

For care of febrile patients it is necessary to know about the stages of the painful process. Stages can be easily identified with a short-term fever( malaria, influenza) and difficult - with prolonged.

Each stage has its own symptomatology and flow characteristics, so care for the patient at different stages of the febrile process has its own characteristics.

In the first stage of temperature increase, heat production significantly prevails over heat transfer. This stage can last from a few hours to several days. Objectively, it manifests itself as a headache, muscle pain, weakness, thirst, sometimes a pallor of the limbs. A rapid rise in temperature is usually tolerated by patients poorly due to shaking body chills. The patient should first of all be warmed: cover with a warm blanket, cover with warm heaters( to prevent burns, the warmer should not be very hot and in contact with the body, for this it should be wrapped in a towel), give the patient hot hot tea, herbal tea. In this stage, you need to monitor the patient's condition, organs and systems( measure blood pressure, pulse, follow diuresis).

In the second stage of maximum temperature rise, there is a relative equilibrium between heat production and heat transfer. This is the most stable period of the feverish process. Its duration can also be from several hours to several days. The temperature rises as a result of the chills, the trembling in the muscles( and, consequently, the pain in them) decreases, the spasm of the peripheral vessels decreases, and there is a hyperemia( reddening) of the skin.

Patients in this stage complain of headache, weakness, dry mouth, feeling hot. There are rapid heartbeats( tachycardia), rapid breathing( tachypnea), there may be a decrease in blood pressure - hypotension.

At this stage, metabolic disorders occur. In the body, carbohydrates, fats, proteins begin to decompose, and at the same time, the intake of nutrients decreases due to a decrease in digestion and absorption. All this leads to the exhaustion of the body. Patients lose weight. In this stage, much attention should be paid to the state of the cardiovascular system, timely prescribing medications to reduce the pulse, with hypotension to maintain blood pressure at a normal level. Patients need a rich vitaminized drink, a fever antipyretics.

In the third stage, when the temperature decreases, the heat production decreases, the heat transfer is increased. Decrease in temperature can occur by the type of lysis - it is a slow, long-term decrease in temperature, or but the type of crisis, when the temperature decreases rapidly for several hours.

A critical drop in temperature is difficult to tolerate due to the symptoms of acute heart failure.

There are three stages of the fever process:

• the stage of temperature increase;

• stage of maximum temperature rise,

• temperature reduction stage.

A sharp drop in temperature below the normal level occurs with worsening of the general condition of the patient. The patient develops general weakness, thirst, and chills can appear again. Skin pads turn pale, cold sweat, blood pressure decreases, heart rate increases, but becomes small, mild, breathing frequent. Developing collapse.

With a favorable course of critical temperature decrease, the patient has increased sweating, breathing and pulse remain normal, feverish excitement passes, the patient falls asleep.

The severity of the course of periods of febrile process depends on the disease that caused the fever, the general condition of the body, the functional state of the nervous, endocrine, cardiovascular system of the patient, the intensity of the oxidative processes.

When the temperature rises, there is a metabolic disorder in the body. Violated water-salt balance, increased fat metabolism, increases the release of nitrogen in the urine, increases blood sugar, often observed glucosuria. With fever, the number of cardiac contractions increases by 10 beats per minute with an increase in temperature by 1 ° C.Also, accordingly, the temperature and the heart rate increase, respiration becomes more frequent.

The increase in temperature reflects the state of the organism's reactivity, its ability to fight infection. But it is not always possible to regard the fever as favorable to the patient's body process. Excessive temperature increase, like lowering it below the norm, is always hard for patients and has an adverse effect on the body, therefore, in the treatment of fever, an individual approach to each patient is necessary.

Patients with fever require special attention and care. In different periods of the febrile process, caring for the patient has its own characteristics. When hyperthermia, the patient needs to ensure peace, bed rest. The patient should be warmly covered, if necessary( with a shaking chill), warm with warmers. You need to drink it with hot sweet tea. In the period of maximum temperature rise as a result of excitation of the central nervous system, the patient may behave inadequately: he can jump out of the room, jump out of the window, etc. Such patients require constant supervision of the nurse. It should monitor the pulse rate, the level of blood pressure. If the patient's condition worsens, the nurse should immediately inform the doctor about it.

With high temperature figures, large fluctuations, long duration of febrile process, the patient is severely depleted. To maintain the patient's body, replenish energy costs, increase its resistance, it is necessary to include in the diet of the patient high-calorie, high-protein and easily assimilated foods in liquid or semi-liquid form. The patient can be fed chicken broth with mashed vegetables, porridges. During a period of fever, the patient's appetite is reduced, so the patient needs to be fed often, but in small portions. When hyperthermia in the body of the patient accumulate toxic products, which have a damaging effect on the cells of the body. To remove toxic substances, the patient needs a copious, vitaminized drink, it is possible to give fruit and berry juices, fruit drinks, mineral water without gas( to prevent flatulence) to the

patient. In the diet of the patient, consumption of table salt is limited. In this period, the patient has dry mouth, may appear small ulcers( aphthous stomatitis), cracks in the corners of the mouth. To alleviate the condition, the nurse should lubricate the mouth of the patient with a solution of furacilin( nitrofural), treat the sores with a 3% solution of hydrogen peroxide, grease the crack with sterile vaseline oil or any fat cream. If the temperature rises excessively, the patient may experience a sharp headache, to reduce it, an ice pack or cold compress is placed on the forehead. To do this, in a cold water( preferably with ice), moisten a piece of hygroscopic tissue, folded in several layers, slightly squeezed and superimposed on the forehead. After 3-5 minutes it is replaced with another, and so it can be continued for an hour. Occasionally, acetic acid is added to the water. To reduce the temperature, wiping with cool water is also used. To prevent complications from the cardiovascular system, you can wipe the area of ​​large vessels, hearts with vodka. The nurse must ensure that the patient does not freeze, so that there are no drafts and noises in the ward.

The nurse must take care of the skin of the patient, carry out the prophylaxis of pressure sores. With constipation, a cleansing enema is made. Often the setting of a cleansing enema helps to reduce the temperature and normalize the patient's condition. In case of severe fever, the patient should be physiologically dispatched in bed to the ship.

With a critical drop in temperature, the patient develops acute cardiovascular failure, which is manifested by a sharp decrease in blood pressure, increased pulse, breathing, excessive sweating, the skin pales, becomes cold. This condition requires urgent medical attention. The nurse must immediately inform the doctor and quickly fulfill his appointment. The patient is injected with drugs that increase blood pressure: caffeine, adrenaline. In this state, he should change the bed linen and bed linen, it must be warmed, give hot drink.

A critical drop in temperature occurs with croupous pneumonia, malaria, influenza.

When the temperature is lowered( slowly, gradually), the patient's condition does not usually worsen. There is a slight sweating, weakness, the patient can fall asleep. Sleep in this case is the best medicine!