CARE PLANNING

Fever
Setting: Inpatient Population: Pediatric

Last Updated: 09/06/2018. Copyright Elsevier BV. All rights reserved.

Clinical Description
Care of the hospitalized child experiencing elevated body temperature.

Key Information
• Core temperature monitoring (intravascular, esophageal, bladder) is most accurate. If noncore monitoring is
used, only oral and rectal electronic measurement should be used to support clinical decision-making, based on
current evidence.
• Fever has a protective role with infection, however, it has been proven harmful in the presence of septic shock
or cerebral damage. It may be harmful for children with heart failure, respiratory comorbidity, hemodynamic
instability or neuropsychiatric disorder.
• Recommendations vary regarding temperature value at which antipyretic pharmacologic therapy or active
cooling method should be initiated. Management should be individualized by baseline temperature and
symptoms.
• Febrile seizures are felt to be caused by genetic susceptibility. Use of antipyretic medication does not prevent
seizures.

Clinical Goals
By transition of care
A. The patient will demonstrate achievement B. Patient, family or significant other will teach
of the following goals: back or demonstrate education topics and points:

• Body Temperature in Desired Range • Education: Overview

• Education: Self Management
• Education: When to Seek Medical
Attention

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 CARE PLANNING CPG IP Fever Peds Setting: Inpatient Population: Pediatric

Correlate Health Status

Correlate health status to:

• history, comorbidity, congenital anomaly

• age, developmental level
• sex, gender identity
• baseline assessment data
• physiologic status
• response to medication and interventions
• psychosocial status, social determinants of health
• barriers to accessing care and services
• child and family/caregiver:
• health literacy
• cultural and spiritual preferences
• safety risks
• family interaction
• plan for transition of care

Fever
Signs/Symptoms/Presentation

• agitation
• diaphoresis
• irritability
• lethargic
• level of consciousness decreased
• seizure activity
• skin flushed
• skin warm to touch

Vital Signs
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 CARE PLANNING CPG IP Fever Peds Setting: Inpatient Population: Pediatric

• blood pressure increased or decreased

• core body temperature elevated
• heart rate increased
• respiratory rate increased

Laboratory Results

• blood culture positive

• WBC (white blood cell) count elevated

Hemodynamic Values

• CVP (central venous pressure) decreased

• MAP (mean arterial pressure) change

Problem Intervention(s)
Promote Normothermia

• Identify and address underlying cause.

• Monitor body temperature and trend; manage variability.
• Provide optimal hydration; consider increased need due to insensible loss.
• Administer antipyretic medication to reduce temperature and discomfort.
• Encourage sleep/rest to minimize oxygen and metabolic demand.
• Provide oxygen therapy if hypoxemia is present.
• Provide comfort measures; adjust environment to minimize body temperature (e.g., offer cool cloths, encourage
lightweight clothing and covers, reduce room temperature, increase air circulation, decrease stimulation).
• Consider active cooling measures (e.g., external-cooling device, tepid sponge or tub bath, internal-cooling
method); cool gradually to avoid shivering.

Associated Documentation

• Thermoregulation Maintenance
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 CARE PLANNING CPG IP Fever Peds Setting: Inpatient Population: Pediatric

General Education
• admission, transition of care
• orientation to care setting, routine
• advance care planning
• diagnostic tests/procedures
• opioid medication management
• oral health
• medication management
• pain assessment process
• safe medication disposal
• tobacco use, smoke exposure
• treatment plan

Safety Education
• call light use
• equipment/home supplies
• fall prevention
• harm prevention
• infection prevention
• MDRO (multidrug-resistant organism) care
• personal health information
• resources for support

Education: Overview
• description

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 CARE PLANNING CPG IP Fever Peds Setting: Inpatient Population: Pediatric

Education: Self Management

• fever reduction measures
• fluid intake
• provider follow-up

Education: When to Seek Medical Attention

• unresolved/worsening symptoms

References
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