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Fever

Introduction

  • fever is commonly defined as an elevation in body temperature above 98.6 degrees
  • there are many causes of fever in the cancer patient, including:
    • infection
    • tumor
    • dehydration
    • constipation
    • medications and some treatments (Bleomycin, biologic response modifiers)
  • for those cancer patients undergoing active treatment, especially chemotherapy, a fever greater than 100.5 degrees is considered a medical emergency, requiring prompt initiation of antibiotics
  • fever is not usually dangerous in those patients not on active treatment, however, some will require treatment for infection

Assessment

  • for patients in active treatment, temperature should be checked when the patient feels warm, feverish, has rigors or "just feels bad"
  • all patients on active treatment should have a thermometer in the home and be able to interpret it
  • it is not necessary to check the temperature daily, only if symptoms occur
  • elderly patients may not register an increased temperature with infection, other signs and symptoms of infection in these patients may include change in mental status, lethargy, malaise, subnormal temperature
  • seizure activity rarely occurs in adults due to high temperature
  • if the patient is in active treatment, determine the most recent treatment date to assess if he/she is at risk for neutropenia
    • usually occurs 7 to 10 days after chemotherapy has been given
    • encourage the patient and care giver to keep records of treatment dates and labs for the home care nurses

Intervention


For patients in active treatment:
  • call MD for any temperature over 100.5 degrees, may need immediate antibiotic treatment if neutropenic
    • considered a medical emergency
  • hold antipyretics until cultures are obtained
  • once cultures are obtained, acetaminophen or NSAIDs may be administered as needed for comfort
  • steroids, NSAIDs, some analgesics may mask fever in infection
  • call MD for change in mental status in elderly patients who may not develop a fever in response to an infection

Intervention


For patients not in active treatment:
  • comfort measures are the focus of fever management
  • antipyretics (acetaminophen, NSAIDs) for discomfort
  • tepid baths or sponge baths may help bring fever down
  • meperidine can be given for severe rigors
  • increase fluids if not contraindicated
  • not considered a medical emergency but MD may choose to treat uncomplicated infections with antibiotics
  • NSAIDs (e.g.. Naprosyn) may be helpful in tumor fevers

References

Haeuber, D. and Spross, J (1994). "Protective Mechanisms: Bone Marrow" in Gross, J. and Johnson, BL (eds) Handbook of Oncology Nursing, 2nd ed., Boston: Jones and Bartlett, p. 373-399.

Ellerhorst-Ryan, JM (1997). "Infection" in Groenwald, SL, Frogge, MH, Goodman, M, Yarbro, CH, Cancer Nursing: Principles and Practice, 4th ed Boston: Jones and Bartlett, p. 585-603.






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