Nursing Guide to Fever: Nursing Diagnosis, Interventions, & Care Plans

Fever is an elevated body temperature, typically above 100.4°F (38°C), often in response to infection, inflammation, or other medical conditions. It’s a common physiological response indicating the body's defense mechanisms at work. While fever can be beneficial in fighting infections, prolonged or high fever may require medical intervention. Nurses are responsible for accurately assessing body temperature, identifying the underlying cause, and managing symptoms to prevent complications, such as febrile seizures or dehydration. 

Pyrexia Definition

Pyrexia, more commonly known as fever, is a temporary elevation in body temperature, often due to an underlying illness or infection. Pyrexia and fever are used interchangeably in clinical environments, 

Fever etiology and epidemiology 

Fever can be caused by a wide range of conditions, including: 

• Infections: Bacterial, viral, or fungal infections (e.g., influenza, pneumonia, urinary tract infections)
• Inflammatory conditions: Rheumatoid arthritis, systemic lupus erythematosus (SLE)
• Heat-related illnesses: Heat stroke, dehydration
• Malignancies: Certain cancers such as leukemia or lymphoma
• Medications: Drug reactions, especially to antibiotics, antihistamines, and chemotherapy
• Post-vaccination responses: Common in children following immunization 

Epidemiology: 

• Fever is one of the most common clinical symptoms, accounting for many healthcare visits.
• Children under age five and older adults are more susceptible to complications from fevers.
• Infectious diseases remain the leading cause of fever globally, particularly in low-income countries. 

Fever ICD-10 code 

The ICD-10 code for fever is: 

• R50.9 — Fever, unspecified  

Fever diagnosis 

Fever is diagnosed based on an elevated body temperature, typically measured via oral, rectal, tympanic, or axillary methods. The diagnosis also requires identifying the cause of the fever through history, physical examination, and relevant diagnostic tests. 

• History and physical examination: Assess for recent infections, travel, vaccination status, and drug use.
• Laboratory tests: Complete blood count (CBC), blood cultures, urinalysis, and imaging may be needed to identify underlying infections or other causes.
• Special considerations: In pediatric patients, especially infants under 3 months, fever can be a sign of serious infections and should be evaluated promptly. 

Management 

The treatment of fever focuses on relieving discomfort and treating the underlying cause. Fever itself may not always require intervention unless it leads to distress or complications. 

Non-pharmacological management: 

• Hydration: Encourage oral fluids to prevent dehydration.
• Comfort measures: Lukewarm sponge baths and lightweight clothing can help reduce body temperature.
• Rest: Promote bed rest to conserve energy for immune response. 

Pharmacological treatment: 

• Antipyretics: Acetaminophen and ibuprofen are commonly used to reduce fever and alleviate discomfort.
• Treatment of underlying causes: Antibiotics, antivirals, or antifungals may be indicated depending on the identified cause (e.g., bacterial infection). 

When to seek medical intervention: 

• Prolonged fever (lasting more than three days) or very high fever (>104°F or 40°C)should prompt further medical evaluation.
• Fever in immunocompromised patients or those with chronic illnesses may require urgent care Patients should contact their physician immediately.
• Fever in children under three months of age or in older adults should prompt medical evaluation. 

Fever nursing care plan 

Nursing considerations 

Nurses must monitor vital signs, assess for potential causes of fever, and evaluate for signs of dehydration or other complications. Patient education on fever management, especially in home care settings, is crucial. 

Assessment 

• Vital signs: Regular monitoring of temperature, heart rate, and respiratory rate is essential. 
• Signs of infection: Assess for symptoms like cough, sore throat, diarrhea, or urinary frequency. 
• Hydration status: Monitor for signs of dehydration (e.g., dry mucous membranes, reduced urine output). 
• Behavioral changes: Look for confusion, irritability, or lethargy, especially in children and older adults. 

Nursing diagnosis/risk for 

• Hyperthermia related to infectious process as evidenced by increased body temperature and chills. 
• Risk for fluid volume deficit related to increased insensible fluid loss through fever and sweating. 

Interventions 

• Administer antipyretics as prescribed, monitoring for effectiveness and side effects. 
• Ensure adequate hydration by encouraging fluid intake or administering intravenous fluids if necessary. 
• Provide non-pharmacological cooling measures such as tepid sponging, light clothing, and adjusting room temperature. 
• Monitor for complications like dehydration, febrile seizures, or confusion in at-risk populations (children, elderly, and immunocompromised patients). 
• Educate caregivers about fever management at home, including appropriate use of medications and when to seek medical care. 

Expected outcomes 

• The patient's temperature returns to normal limits within 24 to 48 hours with appropriate treatment. 
• The patient remains well-hydrated, with no signs of dehydration. 
• The patient or caregiver demonstrates understanding of fever management and can identify signs that require further medical evaluation. 

Individual/caregiver education 

• Hydration: Ensure the patient stays well hydrated, especially in cases of prolonged fever. 
• Antipyretic use: Teach the appropriate dosage and timing of fever-reducing medications, such as acetaminophen or ibuprofen. 
• Signs of complications: Educate on when to seek medical attention, particularly for very high fever, prolonged fever, or associated symptoms like confusion or difficulty breathing. 
• Comfort measures: Discuss home strategies to keep the patient comfortable, such as adjusting clothing, bathing, and maintaining a cool environment. 

Additional Information

Course Contributor

Ann M. Dietrich, MD, FAAP, FACEP, Professor of Pediatrics and Emergency Medicine for the University of South Carolina School of Medicine Greenville, has over 30 years of experience in pediatric emergency medicine. Throughout her career, Dietrich has helped educate medical students, residents, fellows, and junior attendings, including as an educator at Ohio State University and the American College of Emergency Physicians. She also collaborated on several research projects, including one on concussions and one on improving mental healthcare for children. Dietrich helped develop guidelines on the impact of concussions on children and worked with trauma surgeons to enhance care for pediatric trauma patients.

Resources 

• Centers for Disease Control and Prevention (CDC): This agency offers guidelines on fever management, especially for infectious diseases. 
• World Health Organization (WHO): This organization provides global recommendations for managing fever, especially in resource-limited settings. 
• American Academy of Pediatrics (AAP): This organization offers resources for managing pediatric fever, including recommendations on fever in children. 

References 

• ICD10data.com. (n.d.). ICD-10-CM code R50.9 fever, unspecified. 
• Balli S, Shumway KR, Sharan S. Physiology, Fever. [Updated September 2023]. In: StatPearls.