Fever
Also Consider: Culture Results, Diarrhea, Lactic Acid, UTI, WBC Count
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Fever Definition
Temperature > 100°F or 37.8°C
Two temperature measurements > 99°F (or > 37.2°C) oral or > 99.5°F (>37.5°C) rectal
Increase in temperature > 2°F or 1.1°C, over baseline
Goal is to identify and treat the underlying cause of the fever, and prevent spread to others if the underlying cause is contagious.
Fever may indicate the presence of Sepsis, which needs urgent evaluation and treatment. Do not just give acetaminophen for fever.
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change
Not eating or drinking as much as usual
Acute decline in ADL abilities
Chills, rigors, or diaphoresis (sweats)
Respiratory: New cough, trouble breathing, abnormal lung sounds
GI: Nausea, vomiting, diarrhea, constipation, abdominal distention or tenderness
GU: New or worsened incontinence, pain with urination, blood in urine
Very low urinary output (<30cc/hr)
Skin: any new skin condition, i.e., rash, redness suggesting cellulitis, signs of infection around existing pressure ulcer or surgical wound
Fingerstick glucose (patients with diabetes)
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
New onset T>101.3° regardless of any other symptoms (unless under treatment already or medical staff already aware), OR
New onset T>100 and at least 1 of:
Heart Rate >100
Systolic Blood Pressure <100
Respiratory Rate >20
Oxygen saturation (O2sat) <90%
Notify medical staff & resident representative within the next 16 hours.
T>100° or 2°F over baseline, with other symptoms or signs of illness (unless under treatment already or medical staff already aware)
Notify medical staff on the next business day
T>100° or 2°F over baseline, with no other symptoms and otherwise stable.
SBAR Report
Situation: "Fever of ___________, associated with:" (acute symptoms) (low blood pressure) (tachycardia) (low oxygen saturation)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
When the problems started, how severe they are, getting worse or staying the same, what treatments have been used.
Abnormal Vital Signs
MOLST / Advance Directives
Recent illness, antibiotics, surgery
General observation of patient condition
Blood glucose, if elevated
Similar symptoms in other patient on unit or in facility
Diuretic Use & recent dose changes
Fluid restriction, thickened liquids
Tube feeding rate and water flush orders
Availability of IV or clysis hydration (i.e., PICC line)
Assessment: I am concerned about: __________
Recommendations/Requests:
Labs: CBC with manual diff, CMP/Chem14, Lactic Acid, Blood cultures
Chest X-ray with lateral view if possible
Influenza / RSV or other viral testing
Antibiotic if bacterial infection is diagnosed
Straight catheterization for urine sample for urinalysis and culture (unless patient is able to collect clean-catch, midstream urine)
Stool culture and C diff testing if diarrhea is present.
Increase tube feed water flushes
Change fluid restriction orders
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Implement infection prevention measures if patient may be contagious - contact the infection prevention nurse for isolation & precaution recommendations.
Monitor vital signs, fluid intake/urine output every 4-8 hrs for 2-3 days
Offer fluids frequently
Place on Intake & Output monitoring
Place on 24-hour report for 2-3 days
Obtain lab results (if ordered), and notify medical as needed of:
Significantly abnormal values in blood count or metabolic panel (refer to appropriate Situation)
WBC > 12,000 or neutrophils > 90%
Abnormal Lactic Acid level
Infiltrate or pneumonia on chest x-ray
Positive C. Diff
Positive virus result on swab - also notify infection prevention nurse
Urine results suggest infection and symptoms or signs present (Refer to “UTI” Situation)
Only give acetaminophen, if ordered, for discomfort, fever > 103°F, or if chronic cardiopulmonary problems are present
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative daily
Update advance directives if appropriate
2025-04-27
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