Improving Evidence-Based Care for Patients with Pyrexia

Topics: Fever, Thermoregulation, Nursing Pages: 13 (3942 words) Published: June 20, 2013
p37-41w29_ART&SCIENCE 18/03/2011 15:20 Page 37

art & science literature review

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Improving evidence-based care for patients with pyrexia
Scrase W, Tranter S (2011) Improving evidence-based care for patients with pyrexia. Nursing Standard. 25, 29, 37-41. Date of acceptance: December 29 2010.

Summary
Fever or pyrexia is a common clinical condition which nurses treat regularly. Fever and hyperpyrexia are defined in this article with a physiological explanation for this adaptive response. Suppression of temperature elevation prevents the production of antibodies and inhibits cell repair. The aim of this literature review is to encourage nurses to support patients with pyrexia by meeting their subjective needs, providing comfort and avoiding complications.

Authors
Wendy Scrase, nurse, Bryn Llifon nursing home, Bangor, and Siobhan Tranter, lecturer in nursing, School of Health Care Sciences, Bangor University. Email: wendy.scrase@phonecoop.coop

Keywords
Evidence based practice, fever, temperature measurement These keywords are based on subject headings from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.co.uk. For related articles visit our online archive and search using the keywords.

THIS ARTICLE examines the delivery of care to a patient with fever (pyrexia) and evaluates the evidence base for the safe care of such patients. Current knowledge and understanding of the process of fever as an adaptive response has not resulted in changes to clinical guidelines or nursing interventions. Metabolic heat accelerates chemical reactions, which increases antibody production and assists the body’s cells to repair. Commonly prescribed antipyretics inhibit inflammatory action, reduce the temperature, mask the underlying signs of disease and impair the reparative process (Cuddy 2004). Nursing interventions associated with fever continue to be based on institutional habit or ritualistic practices and the belief that fever is harmful to the patient. Nursing care should aim to support the body’s normal physiological processes, provide comfort and avoid complications. The patient’s subjective needs during the stages of fever ought to be prioritised NURSING STANDARD

over routine tasks. In most circumstances finding out the cause is more important than curing the fever. Body temperature measurement is a core competency that nursing students learn early in their training because fever management is commonplace (Holtzclaw 2002). According to National Institute for Health and Clinical Excellence (NICE) (2007) guidelines, fever is an elevation of the body temperature above the normal daily variation. This fundamental sign of illness has traditionally had negative associations among nurses for patients’ wellbeing (Price and McGloin 2003, Thompson 2005). Over the past 20 years, research in immunology and neurophysiology has increased knowledge and understanding of the process of fever (Holtzclaw 2002, Thompson 2005). Although the perception of fever has changed from being part of an acute-phase reaction to an adaptive response, this awareness has yet to be incorporated into fever management practices or clinical guidelines (Holtzclaw 2002, Thompson 2005, Edwards et al 2007). Some literature suggests that there is confusion about the care that patients’ with fever should be receiving (Sarrell et al 2002, Thompson 2005, Walsh et al 2005).

Literature search
A literature search was conducted using the TRIP Database, British Nursing Index, CINAHL, Cochrane Library and PubMed to clarify inconsistencies between established scientific facts about the purpose of fever and its management by nurses. Search terms included fever, pyrexia and nursing, and the purpose of the search was to identify or establish best practice. The search was...

References: Agbolosu NB, Cuevas LE, Milligan P, Broadhead RL, Brewster D, Graham SM (1997) Efficacy of tepid sponging versus paracetamol in reducing temperature in febrile children. Annals of Tropical Paediatrics. 17, 3, 283-288. Aksoylar S, Akşit S, Cağlayan S, Yaprak I, Bakiler R, Cetin F (1997) Evaluation of sponging and antipyretic medication to reduce body temperature in febrile children. Acta Paediatrica Japonica. 39, 2, 215-217. Alexander MF, Fawcett JN, Runciman PJ (Eds) (2006) Nursing Practice: Hospital and Home. The Adult. Third edition. Churchill Livingston Elsevier, Edinburgh. Cuddy ML (2004) The effects of drugs on thermoregulation. AACN Clinical Issues. 15, 2, 238-253. Dougherty L, Lister S (Eds) (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Seventh edition. Wiley-Blackwell, Oxford. 522-528. Edwards H, Walsh A, Courtney M, Monaghan S, Wilson J, Young J (2007) Improving paediatric nurses’ knowledge and attitudes in childhood fever management. Journal of Advanced Nursing. 57, 3, 257-269. Ferguson A (2007) Evaluation and treatment of fever in intensive care unit patients. Critical Care Nursing Quarterly. 30, 4, 347-363. Helyar S (2006) Clinical corner: management of pyrexia during blood transfusion. British Journal of Nursing. 15, 5, 257. Henker R, Carlson KK (2007) Fever: applying research to bedside practice. AACN Advanced Critical Care. 18, 1, 76-87. Holtzclaw BJ (2002) Use of thermoregulatory principles in patient care: fever management. Online Journal of Clinical Innovations. 5, 5, 1-23. Jevon P (2010) Does giving paracetamol to lower raised temperature interfere with the body’s natural defence response to infection? Nursing Times. 106, 1, 14. Jiang Q, Cross AS, Singh IS, Chen TT, Viscardi RM, Hasday JD (2000) Febrile core temperature is essential for optimal host defense in bacterial peritonitis. Infection and Immunity. 68, 3, 1265-1270. Kiekkas BP, Brokalaki H, Theodorakopoulou G, Baltopoulos GI (2008) Physical antipyresis in critically ill adults. American Journal of Nursing. 108, 7, 40-49. Kozier B, Erb G, Berman A, Snyder S, Lake R, Harvey S (2008) Fundamentals of Nursing: Concepts, Process, and Practice. Eighth edition. Pearson Education, Harlow. Krikler S (1990) Pyrexia: what to do about temperatures. Nursing Standard. 4, 25, 37-38. Lenhardt R, Negishi C, Sessler DI et al (1999) The effects of physical treatment on induced fever in humans. American Journal of Medicine. 106, 5, 550-555. Mackowiak PA (2000) Physiological rationale for suppression of fever. Clinical Infectious Diseases. 31, Suppl 5, S185-S189. Marieb EN, Hoehn K (2010) Human Anatomy and Physiology. Eighth edition. Pearson Benjamin Cummings, London. Marik PE (2000) Fever in the ICU. Chest. 117, 3, 855-869. National Institute for Health and Clinical Excellence (2007) Feverish Illness in Children: Assessment and Initial Management in Children Younger Than 5 Years. RCOG Press, London. Olsen DM, Graffagnino C (2005) Managing temperature in brain-injured patients. Nursing. 35, 7, 32cc1-32cc2. Outzen M (2009) Management of fever in older adults. Journal of Gerontological Nursing. 35, 5, 17-23. Price T, McGloin S (2003) A review of cooling patients with severe cerebral insult in ICU (Part 1). Nursing in Critical Care. 8, 1, 30-36. Price T, McGloin S, Izzard J, Gilchrist M (2003) Cooling strategies for patients with severe cerebral insult in ICU (Part 2). Nursing in Critical Care. 8, 1, 37-45. Royal College of Nursing (2007) Standards for Assessing, Measuring and Monitoring Vital Signs in Infants, Children and Young People. RCN Guidance for Children’s Nurses and Nurses Working with Children and Young People. RCN, London. Sarrell M, Cohen HA, Kahan E (2002) Physicians’, nurses’, and parents’ attitudes to and knowledge about fever in early childhood. Patient Education and Counseling. 46, 1, 61-65. Sharber J (1997) The efficacy of tepid sponge bathing to reduce fever in young children. American Journal of Emergency Medicine. 15, 2, 188-192. Thompson HJ (2005) Fever: a concept analysis. Journal of Advanced Nursing. 51, 5, 484-492. Tortora GJ, Derrickson BH (2009) Principles of Anatomy and Physiology. Twelfth edition. John Wiley and Sons, Hoboken NJ. Wagner DV (2006) Unplanned perioperative hypothermia. AORN Journal. 83, 2, 470-476. Walsh AM, Edwards HE, Courtney MD, Wilson JE, Monaghan SJ (2005) Fever management: paediatric nurses’ knowledge, attitudes and influencing factors. Journal of Advanced Nursing. 49, 5, 453-464. Watts R, Robertson J, Thomas G (2003) Nursing management of fever in children: a systematic review. International Journal of Nursing Practice. 9, 1, S1-S8. Woodrow P (2003) Assessing temperature in older people. Nursing Older People. 15, 1, 29-31.
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