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KEY CONCEPTS

KEY CONCEPTS

  • image Fever can be a by-product of various infectious or pathologic processes, vaccinations, medications, and environmental exposure, or of vigorous activity.

  • image Normal body temperature fluctuates and is regulated in the thermoregulatory center of the anterior hypothalamus. During a fever, prostaglandins cause an increase in the hypothalamic temperature set point and thereby increase production of heat in the periphery.

  • image In a community setting, pharmacists should COLLECT key information on medications, medical history, immunizations, recent travel, social history, barriers of care, and course of fever.

  • image Using the gathered data, pharmacists should ASSESS information to differentiate symptoms from surrounding conditions, determine appropriateness for self-care, evaluate history for causes of fever, and consider most appropriate medication for fever.

  • image Goals of therapy include relieving discomfort, reducing body temperature, and when appropriate treating the underlying cause of fever.

  • image Nondrug treatments include the use of cooling blankets, which should only be used along with antipyretics. Appropriate hydration and the use of fans also contribute to decreasing body temperature.

  • image Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce fever, but they can adversely affect the gastrointestinal tract and platelets. For this reason, acetaminophen is the preferred agent to reduce fever in most patients. Therapy with NSAIDs and acetaminophen combinations can be used in most but not all patients.

  • image Medical evaluation should be sought if symptoms of fever do not resolve with over-the-counter treatment within 24 hours in children younger than 2 years, 48 hours in other children and 3 days in adults. Also, medical evaluation should occur in patients with alarming symptoms regardless of their temperature.

PATIENT CARE PROCESS

Patient Care Process for Fever

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Collect

  • Patient demographics (eg, sex, age, pregnancy)

  • Active medical problem list

  • Medication history/list (prescription and over the counter) and adherence

  • Inquire about immunizations

  • Inquire about history of allergies and adverse effects

  • Inquire about recent travel, climate, and social activities

  • Gather log of temperatures and duration of current symptoms

  • Collect information pertaining to the patient’s medication experience (eg, beliefs, expectations, and cultural considerations related to medications)

  • Inquire about the patient’s ability to access medications, considering ability to pick up medications and ability to afford medications

  • Inquire as to how the process of managing medications works at home (eg, pill boxes, calendars, reminders)

Assess

  • Decipher appropriateness of self-care for the patient

  • Complete differential diagnosis between fever, hyperthermia, and hyperpyrexia

  • Evaluate activities and social factors that may predispose patient to fever

  • Assess recent travel and environmental potential causes of fever

  • Analyze the patient’s active and prior medical conditions for associations with fever

  • Assess the indication, safety, adherence, and effectiveness of each medication the patient is taking

  • Understand patient’s willingness to take over-the-counter therapy for fever and if religious/cultural barriers to therapy exist

  • Consider interactions between current over-the-counter, prescription, and herbal medications when assessing therapy options for fever

Plan

  • Develop a care plan to reduce fever and underlying cause

  • Identify the monitoring parameters such as temperature and discomfort to assess ongoing effectiveness, safety, ...

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