Self Care- Fever

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Anonymous
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114286
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Self Care- Fever
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2011-11-04 21:55:05
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pharmacy fever
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Fall 2011 PT Module III: Fever
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  1. Definition of a FEVER.
    REGULATED rise in CORE body temperature.
  2. What ORGAN maintains body temperature?
    HYPOTHALAMUS
  3. The hypothalamus raises body temperature in RESPONSE to what?
    PYROGEN
  4. Define CORE temperature.
    The temperature of the BLOOD that surrounds the HYPOTHALAMUS
  5. NORMAL core temperature?
    100 F
  6. A FEVER is ________________ & ________________.
    CONTROLLED & ON PURPOSE
  7. An INCREASE in body temperatre due to:
    MALFUNCTIONING of normal thermoregulatory process (Internal) OR
    INSUFFICIENT heat disspiation (External)
    HYPERTHERMIA
  8. Body temperature GREATER than 106 F?
    HYPERPYREXIA
  9. Body temperature where internal DAMAGE begins?
    106 F (Hyperpyrexia)
  10. RECTAL fever temperature?
    102 F
  11. ORAL fever temperature?
    101 F
  12. AXILLARY fever temperature?
    100 F
  13. TYMPANIC fever temperature?
    101 F
  14. Order of site of measurements from GREATEST to LEAST accurate?
    Rectal (~+1), Tympanic (~+.5), Temporal (~+.25), Oral (BASE), Axillary (~-1)
  15. Farenheit TO Celsius Equation?
    C = 5/9 x (F-32)
  16. Celsius TO Farenheit Equation?
    F = (9/5 x C) + 32
  17. Fever Etiology:
    INFECTIOUS ORIGIN
    • Most Common
    • Higher with BACTERIAL than VIRAL infections
    • Elderly and Immunocompromised
  18. Fever in the IMMUNOCOMPROMISED?
    100.4 F
  19. Fever Etiology:
    NON-INFECTIOUS ORIGIN
    • Malignancies
    • Tissue Damage (surgery)
    • Antigen-antibody rxn
    • Inflammation
    • Metabolic Disorders
    • Dehydration
  20. Cause of fever from MALIGNANCIES, TISSUE DAMAGE or ANTIGEN-ANTIBODY RXN?
    Increase in the release of PYROGENS
  21. Cause of fever from METABOLIC DISORDERS (hyperthyroidism)?
    Increase in the bodies METABOLIC RATE and the body increases temperature
  22. Cause of fever in DEHYDRATION?
    Decrease in HEAT DISSIPATION because cannot release sweat
  23. Fever Etiology:
    DRUG-INDUCED
    • 3-5%
    • Hypersensitivity most common
  24. Factors to identify DRUG FEVER?
    • TEMPORAL relationships
    • Fever PERSISTS after improvement of 1st condition
    • Other SYMPTOMS are present
  25. Similarities between DRUG fever and INFECTION fever?
    HIGH fever and CHILLS
  26. Idiosyncratic drug reactions:
    GENERAL ANESTHETICS (succinylcholine)
    MALIGNANT HYPERTHERMIA
  27. Malignant Hyperthermia SYMPTOMS?
    • Rapid ONSET- w/in hours
    • Temp GREATER than 104 F
    • Muscle RIGIDITY
    • Metabolic ACIDOSIS (low serum pH, Inc CO2)
  28. Idiosyncratic drug reactions:
    ANTI-PSYCHOTIC MEDS
    (phenothiazines, butyrophenones, thioxathenes)
    • NEUROLEPTIC MALIGNANT SYNDROME
    • (dopamine receptor blockers)
  29. Neuroleptic Malignant Syndrome (NMS) SYMPTOMS?
    • GRADUAL onset- w/in 2 weeks or any time
    • HIGH fever, muscle RIGIDITY, ABNORMAL body movements, SWEATING, TACHYCARDIA, hyper OR hypo TENSION, INCONTINENCE, & altered CONSCIOUSNESS
  30. THERAPEUTICS for NMS?
    • ICE bath if temp GREATER than 106
    • Muscle RELAXANTS
    • IV Fluids
  31. Thermoregulation:
    Heat LOSS & Heat GENERATION are EQUAL
    NORMAL Thermoregulation
  32. Thermoregulation:
    INC Heat LOSS & DEC Heat GENERATION
    HYPOTHERMIA
  33. Thermoregulation:
    DEC Heat LOSS & INC Heat GENERATION
    FEVER
  34. The ______________________ is the __________ & determines the SET-POINT for body temp.
    HYPOTHALAMUS & FULCRUM
  35. How heat is LOST from the body?
    • CONDUCTION
    • EVAPORATION- sweat
    • RADIATION
  36. How heat is GENERATED in the body?
    (at the cellular level)
    • LIVER
    • Skeletal MUSCLE contraction
    • METABOLIC Activity (thyroid & adrenal gland)
  37. Thermoregulation MECHANISM for INCREASE body temp stimulus?
    Stimulus-- Hypothalamus-- Capillaries DILATE & Sweat glands ACTIVATE-- DEC. Body Temp
  38. Thermoregulation MECHANISM for DECREASE body temp stimulus?
    Stimulus-- Hypothalamus-- Capillaries CONSTRICT & Skeletal Muscles ACTIVATE-- INC. Body Temp
  39. How do ANTICHOLINERGICS increase body temperature?
    Block SWEATING
  40. What are BEHAVIORAL compensatory mechanism to temeprature change?
    • ADD Clothing
    • RUBBING Hands
    • ADJUSTING AC
    • SEEKING Shade
  41. What re PHYSIOLOGIC compensatory mechanism to temperature change?
    • Sweating
    • Vasodilation
    • Shivering
    • Vasoconstriction
  42. The RELEASING of Hormones at different TIMES in a day? (change in body temp thru-out day?
    CIRCADIAN RHYTHM
  43. The NORMAL variation in temperaure thru-out the day?
    ~ 2 degrees
  44. Body temp PEAKS in __________ & ____________ and is LOWEST in ________________________.
    • Late AFTERNOON & Early EVENING
    • Early hours of MORNING
  45. PYROGENS _________________ the thermoregulatory set-point.
    INCREASE
  46. How does Fever EFFECT the pyrogen?
    IMPAIRS the pathogens REPLICATION and METABOLIC processes
  47. Pyrogen and Fever MECHANISM?
    Exogenous pyrogen-- Phagocytic Cell (cytokine)-- Endogenous pyrogen--Hypothalamus (prostaglandin derivatives)-- Elevated Temp
  48. EXOGENOUS Pyrogens
    MICROORGANISM or TOXIN (which stimulates release of endo pyrogens--cytokines)
  49. ENDOGENOUS Pyrogens
    • Interleukin- 1
    • Interleukin- 6
    • Tumor Necrosis Factor alpha
  50. Endogenous pyrogens trigger the SYNTHESIS & RELEASE of _______________________.
    PROSTAGLANDIN E (the agent that directly adjusts set-point)
  51. MERCURY Thermometer ADVANTAGES:
    • Patient Familiarity
    • Low cost
    • Light Weight
    • Compact
  52. MECURY Thermometer DISADVANTAGES:
    • Break
    • Difficult to read
    • Takes up to 5 min
  53. ELECTRONIC Thermometer ADVANTAGES
    • Quick- 30 to 60 sec
    • Durable
    • Easy to Read
    • Probe Covers
  54. ELECTRONIC Thermometer DISADVANTAGES
    • Batteries
    • Calibration
    • Higher Cost
  55. INFRARED Thermometer ADVANTAGES:
    • Fast (5 sec)
    • Accurate
    • Non-invasive
  56. INFRARED Thermometer DISADVANTAGES:
    • Incorrect placement
    • Expensive
    • Batteries
    • Calibration
  57. When to NOT use ORAL route to take temeprature?
    • Mouth breathers
    • Recent oral surgery
    • Not fully alert
    • Patient LESS than 3 yrs
    • W/in 20 mins SMOKED or drank HOT/COLD beverage
  58. When to NOT use RECTAL route to take temperature?
    • Patient LESS than 6 mos
    • Neutropenic
    • Recent rectal injury
    • Diarrhea
    • Impacted stool
  59. When to NOT use TYMPANIC route to tkae temperature?
    • Patient LESS than 6 mos
    • Wax impaction
    • Otitis media
    • Sleeping on side (on ear)
  60. When to NOT use AXILLARY route to take temperature?
    • Activity
    • Bathing
  61. When to NOT use TEMPORAL route to take temperature?
    • Sweating
    • Hot/Cold compress
    • Open scars/sores
  62. Complications of fever:
    A SEIZURE with a FEVER and no other CAUSE?
    • FEBRILE SEIZURE
    • In Children 6mos to 5ys
    • Last LESS than 15 min
    • Antiepileptic/Antipyretic drugs not recommended
  63. Drug-induced fever:
    HYPERSENSITIVITY
    ANY DRUG
  64. Drug-induced fever:
    INTERFERES W/ HEAT DISSIPATION
    • Antichoilnergics
    • TCA (tricyclic antidepressants)
    • Phenothiazines
    • Amphetamines
  65. Drug-induced fever:
    INCREASED METABOLIC RATE
    Thyroid Hormones
  66. Drug-induced fever:
    MODIFIED BEHAVIORAL RESPONSE
    Sedatives
  67. Drug-induced fever:
    RELEASE OF ENDOTOXINS or ENDO PYRO CELL DEATH
    • Antibiotics
    • Chemotherapies
  68. Drug-induce fever:
    DRUG ADMIN or VEHICLE or VENOUS IRRITATION
    Chemotherapies
  69. Drug-induced fever:
    ANTIBODY-ANTIGENIC COMPLEXES
    • Biological drugs
    • Cardiovascular
  70. Drug-induced fever:
    STRUCTUALLY MIMICS ENDO PYROGENS
    Interferons (INF)
  71. Exclusions to Self-Care:
    CHILDREN
    • Less than 6mos w/ rectal >101 F
    • History of seizures
    • Rash or spots
    • Refuse to drink
    • Very sleepy, irritable, hard to wake up
    • Vomitting
  72. Exclusiond to Self-Care:
    EVERYONE
    • Rectal temp >104 F
    • Symptoms of infection
    • Risk for hyperthermia
    • Imapired oxygen use
    • Impaired immune system
    • CNS damage
  73. NON-PHARMACOLOGIC Treatments of fever:
    • Increase fluid (Child: 1oz/hr Adult: 2-4oz/hr)
    • Light Clothing
    • Remove blankets
    • Keep room at 78 F
  74. What non-pharmacological treatments NOT to use?
    • Body Sponging
    • Alcohol use
    • Ice baths
  75. PROSTAGLANDINS are synthesized from__________________.
    ARACHIDONIC ACID
  76. ARACHIDONIC ACID is derived from _______________________________ via ________________________________.
    PHOSPHATIDLINOSITOL & PHOSPHOLIPASE A2
  77. The TWO pathways Arachidonic acid is a PRECURSOR to?
    • Cyclic (cyclooxygenase/PGH2 Synthase)
    • Linear (lipoxygenase)
  78. What TWO catalytic activities does PGH2 SYNTHASE (COX)exhibit?
    • Cyclooxygenase
    • Peroxidase
  79. State of COX-1?
    CONSTITUTIVE-- active all the time/every day processes
  80. State of COX-2?
    INDUCIBLE-- activated by cytokines, growth factors, and endotoxins
  81. COX forms PGH2 as an ____________________________ which is then converted to other __________________________.
    • TRANSIENT INTERMEDIATE
    • PROSTAGLANDIN TYPES
  82. Where is COX ENZYME bound?
    Plasma MEMBRANE of ER.
  83. What does COX ENZYME utilize as a substrate?
    ARACHIDONIC ACID
  84. Arachidonic Acid enters the enzyme thru the _______________________ & approaches the _____________________.
    • HYDROPHOBIC CHANNEL
    • HEME GROUPS
  85. Site of Synthesis & Biological Activity of:
    PGD2
    • Mast Cells (Allergic Rxn)
    • Vasodilation
  86. Site of Synthesis & Biological Activity of:
    PGE2
    • Kidney, Spleen, Heart
    • Vasodilation, Enhance platlet aggregation, Enhance bardkinin and histamine, GI protection, ELEVATION OF THERMREG SET-POINT
  87. Site of Synthesis & Biological Activity of:
    PGF2
    • Kidney, Spleen, Heart
    • Decrease in introcular pressure
  88. Site of Synthesis & Biological Activity of:
    PGH2
    Intermediate Precursor
  89. Site of Synthesis & Biological Activity of:
    PGI2
    • Heart, Vasc. Endothelial
    • Vasodilation, enhance bradykinin and histamine, GI protection
  90. Site of Synthesis & Biological Activity of:
    TXA2
    • Platelets
    • Enhance platelet aggregation
  91. Site of Synthesis & Biological Activity of:
    TXB2
    • Platelets
    • Vasoconstriction
  92. General Characteristics of NSAIDs
    • Inhibit Cyclooxygenase activity of PGH2 synthase
    • Inhibit formation of prostaglandins
    • Inhibit blood clotting by blocking thromboxane
    • Inhibit GI protective effects of PGs
  93. Aspirin MECHANISM?
    • Non-specific COX-1/COX-2 Inhibitor
    • Acetlylates SERINE
    • Prevents BINDING of AA to active COX enzyme
    • IRREVERSIBLE (cells can re-synthesize PGH2 synthase)
  94. Aspirin DOSE?
    • 325-650mg q 4-6hrs
    • 1000mg q 4-6hrs
  95. Aspirin OVERDOSE?
    • Chronic (accumulation over time)
    • Acute (mild <150mg/kg, moderate 150-300mg/kg, >300mg/kg)
    • USUALLY 100mg/kg x 2days
  96. Aspirin OVERDOSE MANAGEMENT?
    • Ipecac (not recommended)
    • Charcoal (must use w/in 2 hrs of ingestion)
    • Gastric Lavage
    • NO Supportive Care
  97. Aspirin ADVERSE EFFECTS?
    • Decreased platelet agg
    • GI upset/ulcers
    • Tinnitus
    • Increased BP
    • Edema
  98. Aspirin CONTRAINDICATIONS?
    • Allergy (asthma, chronic urticaria, nasal polyps, cross-sensitivity w/ NSAIDs the tartrazine)
    • Children <16yrs (Reyes syndrome)
    • Pregnancy (C/D)
  99. Aspirin PRECAUTIONS?
    • Bleeding disorders
    • Peptic ulcer disorder (PCD)
    • Gout
    • Renal Failure
    • Sever liver disease
    • Edema/Fluid retention (CHF, HTN)
  100. Drug Interaction:
    ASA & ALCOHOL
    Increased Risk if GI ULCERS and prolonged BLEEDING TIME
  101. Drug Interaction:
    ASA & NSAIDs
    • 1. Increased risk of BLEEDING and ULCERS
    • 2. ASA and IBU compete--- IBU wins= no cardio protection [take ASA 30min before IBU or 8hrs after]
  102. Drug Interaction:
    ASA & METHOTREXATE (MTX)
    Increased levels can cause MTX TOXICITY (goes thru kidneys..competition)
  103. Drug Interaction:
    ASA & ANTICOAGULANTS
    Increased BLEEDING risk
  104. Drug Interaction:
    ASA & ANTI-HYPERTENSIVES
    • ANTAGONIZED causing fluid retention which decreases effectiveness
    • RENAL effects
  105. Drug Interaction:
    ASA & SULFONYLUREAS
    ASA knocks SAs of protein binding site----more free drug---RAPID REDUCTION OF SUGAR
  106. Drug Interaction:
    ASA & VALPROIC ACID
    ASA knocks it off protein binding site---more free drug---INCREASED LEVELS OF DRUG
  107. Drug Interaction:
    ASA & ANTIDEPRESSANTS (SSRIs)
    Increased risk of BLEEDING
  108. Acetaminophen MECHANISM?
    • Competively blocks HYDROPHOBIC channel (AA cannot enter COXase active site)
    • EQUAL antipyretic, but NOT anti-inflammatory ("peroxide tone")
  109. Why does APAP not have an ANIT-INFLAMMATORY response?
    • Weakly inhibits BOTH COX enzymes
    • PEROXIDE TONE-- inflammation has leukocytes--generates peroxides--decrease blockage of enzymes
  110. THREE differences of APAP and ASPIRIN?
    • APAP has NO effect on THROMBOXANE synthesis in platelets
    • MORE ACTIVE in central tissues
    • LACKS anti-inflammatory, blood thinning and GI side effects
  111. Acetaminophen OVERDOSE?
    • Chronic-- > 4g/day (hepatotoxicity and kidney damage)
    • Acute-- > 7.5g (140mg/kg...w/in 2-3hrs---nausea, vomitting, abdominal pain, guarding, excitation then stupor, liver failure 2-6 days)
  112. Acetaminophen OVERDOSE MANAGEMENT?
    • N-ACETYLCYSTEINE
    • 140mg/kg x1 dose, then 70mg/kg x17 doses
    • TOTAL= 18 doses
  113. Acetaminophen DOSAGE?
    • 325-650mg q 4-6hrs
    • 1000mg q 4-6hrs
    • 1300mg q 8hrs
    • Child: 10-15 mg/kg q 4-6hrs (Max 5 doses OTC)
  114. Acetaminophen ADEVERSE EFFECTS?
    • GI Upset
    • Jaundice-- in toxicity
    • Bleeding-- in presence of alcoholism/liver disease
  115. Acetaminophen CONTRAINDICATIONS?
    SEVERE active liver disease
  116. Acetaminophen DRUG INTERACTIONS?
    • Alcohol- increased hepatocity--increase bleeding--increase liver toxicity
    • Wafarin-- in high doses or long duration can increase effect of warfarin
  117. Acetaminophen CLINICAL PEARLS?
    • DRUG OF CHOICE (< 2 alcoholic drinks/day, pregnancy, anti-coag therapy)
    • Dosing OTC label is 2yrs but safe at ANY age
  118. Traditional NSAID MECHANISM?
    • Non-specific COX-1/COX-2 inhibitors
    • Competively blocks HYDROPHOBIC channel
  119. Ibuprofen DOSAGE?
    • 200-400mg q 4-6hrs
    • Child > 6mos: 5-10 mg/kg q 6-8hrs
    • REVERSIBLE
  120. Naproxen DOSAGE?
    220-440mg q 8-12hrs (for 1 dose w/in 1 hour can take ONE other 220mg tablet)
  121. Ketoprofen DOSAGE?
    12.5-25mg q 6-8hrs
  122. Traditional NSAID OVERDOSE
    • NOT toxic
    • CNS and GI symptoms
    • NO antidote--SUPPORTIVE CARE
  123. Traditional NSAID ADVERSE EFFECTS?
    • GI
    • Edema/Fluid Retention
    • Platelet aggregation
    • Photosensitivity
    • Increase BP
  124. Traditional NSAID CONTRAINDICATIONS?
    • Allergy to other NSAIDs or ASA
    • Caution with CHF, EDEMA, HIGH BP
    • Pregnancy (C/D)
    • Renal Insufficiency
    • Sever Liver Disease
  125. NSAIDs are associated with ______________ risk of ____________________.
    INCREASED & CV EVENTS
  126. Patients who SHOULD NOT self care with NSAIDs?
    • > 60yrs
    • History of GI problems
    • Taking a blood thinner or steroid
    • Taking other NSAIDs
    • Drinks > 3 drinks/day
  127. Drug Interactions:
    NSAIDS & BLOOD THINNERS
    Increased risk of BLEEDING
  128. Druf Interactions:
    NSAIDS & DIGOXIN
    Increased levels of DRUG (CHF)
  129. Drug Interactions:
    NSAIDS & MTX
    Increased MTX levels
  130. Drug Interactions:
    NSAIDS & BISPHOSPHATE
    Increased GI UPSET
  131. Drug Interactions:
    NSAIDS & ANTIHYPERTENSIVES
    Antaogonized
  132. Drug Interactions:
    NSAIDS & CYCLOSPORINE
    Increased drug LEVELS, concerning effects on kidneys
  133. Drug Interactions:
    NSAIDS & LITHIUM
    Increased Drug LEVELS
  134. Drug Interactions:
    NSAIDS & ANTI-DEPRESSANTS
    Increased BLEEDING
  135. Drug Interactions:
    IBUPROFEN & PHENYTOIN
    Increased LEVELS of Phenytoin
  136. Recommended NSAID AGES?
    • Ibuprofen: < 6 mos
    • Naproxen: < 12 yrs
    • Ketoprofen: < 16 yrs
    • Aspirin: < 16 yrs
  137. DRUG THERAPY may take up to ______________, but may have results in ____________________.
    • ONE DAY
    • 30-60 MINUTES
  138. DRUG THERAPY would decrease temperature ~_______________.
    2-3 DEGREES
  139. TEMPERATURE should be checked _______________________.
    2-3 TIMES PER DAY.
  140. REFER to MD is symptoms do NOT improve/worsen in ________.
    3 DAYS

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