Clinical Fever Management and Sitz Bath Protocols
Definition and Causes of Fever
Definition: A body temperature rise above 99°F (37° Celsius) is clinically defined as a fever.
Common Causes of Fever
- Infections: Bacterial, viral, fungal, and other pathogens.
- Tissue Damage: Trauma, surgery, or myocardial infarction.
- Dehydration or Heat Exposure: Heatstroke and hyperthermia.
- Malignancy: Conditions such as leukemia and lymphoma.
- Allergic Reactions: Adverse drug or serum reactions.
- Hormonal Causes: Ovulation or hyperthyroidism.
- Drugs and Medications: Antibiotics, vaccines, and other pharmacological agents.
The Three Stages of Fever
1. First Stage or Cold Stage
- Symptoms: The client shivers uncontrollably. The skin feels cold, and the face appears pinched and pale. The pulse is feeble and rapid. Temperature rises rapidly to 103-104°F or higher.
- Nursing Care: Cover the patient with a blanket, apply warmth using a hot water bag, provide warm drinks, and protect the client from falling.
2. Second Stage
- Symptoms: The skin feels hot and dry, and the client experiences intense thirst. Shivering ceases, though the temperature may continue to rise.
- Nursing Care: Remove all heavy blankets and hot appliances; cover the patient only with a light blanket or thin sheet. Provide cool drinks and apply cold compresses to the head to relieve congestion or headache. Record the temperature every 10-15 minutes. Initiate cold sponging if the temperature reaches 40.5°C. Monitor for early signs of sweating.
3. Third Stage
- Symptoms: The client sweats profusely. The body temperature falls, the pulse improves, and acute discomfort diminishes. There is a significant risk of shock and collapse if the patient is not monitored properly.
- Nursing Care: Change wet clothes and remove cold applications. Provide a quick sponge bath and dry the client thoroughly. Dress them in clean, dry clothes and cover with a light cotton blanket. Monitor TPR (Temperature, Pulse, and Respiration) every 15 minutes.
Types of Fever Based on Pattern and Level
- Onset/Invasion: The period when body temperature begins to rise continuously.
- Fastigium/Stadium: The stage where the temperature reaches its maximum and remains at a constant high level.
- Decline: The stage when the temperature begins to decrease toward a normal range.
- Crisis: The temperature returns to normal suddenly.
- True Crisis: Temperature drops suddenly with an improvement in the patient’s general condition.
- False Crisis: Temperature drops suddenly without improvement in the patient’s general condition.
- Lysis: The body temperature returns to normal slowly in a zigzag manner over 2-3 days.
- Constant Fever: Temperature fluctuates no more than 2° between morning and evening but does not return to normal.
- Remittent Fever: Temperature fluctuates more than 2° between morning and evening but does not return to normal.
- Intermittent Fever: Temperature rises from normal to high and returns to normal at regular intervals.
- Inverse Fever: Temperature is highest in the morning and lowest in the evening.
- Hectic Fever: A very high difference between the peak and lowest points of body temperature.
- Relapsing Fever: Temperature remains normal for 2-3 days, then suddenly increases again.
Classification of Fever by Degree
- Low Pyrexia: Temperature does not rise to 100° Fahrenheit.
- Moderate Pyrexia: Temperature remains between 100-103° Fahrenheit.
- High Pyrexia: Temperature rises between 103-105° Fahrenheit.
- Hyperpyrexia: Temperature rises above 105°F.
- Hypothermia: Temperature falls below 95° Fahrenheit.
Sitz Bath: Definition and Clinical Purpose
Definition:
- A warm, shallow bath providing a local application of moist heat to the pelvic organs.
- A bath taken in a sitting position, typically immersing the patient from the mid-thigh to the hips.
- Bathing the perineal area in a sitting position, where the buttocks, thighs, and lower trunk are immersed in water.
Purpose of a Sitz Bath
- To relieve pelvic congestion.
- To treat dysmenorrhea.
- To relieve pain following operations affecting the perineal area.
- To promote drainage of rectal abscesses and hemorrhoids.
- To relieve pain following a cystoscopy.
Indications
- Swollen or painful hemorrhoids (piles).
- Recovery following surgery in the ano-rectal region.
- Episiotomy recovery.
- Uterine cramps.
Contraindications
- Diabetes.
- Peripheral vascular diseases.
- Impaired peripheral sensory function.
- Immediate post-hemorrhoidectomy period.
- Menstruating or pregnant women.
Fever and Sitz Bath Quick Reference Notes
Fever / Pyrexia Summary
- Definition: Body Temp > 99°F (37°C).
- Causes: Infections (Bacterial, Viral, Fungal), Tissue Damage (Trauma, Surgery, MI), Dehydration/Heat, Malignancy (Leukemia, Lymphoma), Allergic Reactions, Hormonal (Ovulation, Hyperthyroidism), Drugs (Antibiotics, Vaccines).
Stages of Fever Reference
- 1. Cold Stage: Shivers, cold/pale skin, rapid/feeble pulse, Temp rises rapidly (103-104°F+).
- Care: Blanket, warmth (Hot Water Bag), warm drinks, prevent falls.
- 2. Second Stage: Hot/dry skin, very thirsty, shivering stops, Temp may continue to rise.
- Care: Remove blankets/hot appliances, light sheet, cool drinks, cold compresses to head, Temp check every 10-15 min, cold sponging (>40.5°C), watch for sweating.
- 3. Third Stage: Profuse sweating, Temp falls, pulse improves, discomforts decrease, risk of shock/collapse.
- Care: Change wet clothes, quick sponge/dry, clean/dry clothes, light cotton blanket, take TPR every 15 min.
Fever Types and Patterns
- Onset/Invasion: Temp starts rising continuously.
- Fastigium/Stadium: Temp reaches max, stays constant/high.
- Decline: Temp starts declining to normal.
- Crisis: Temp returns to normal (True: sudden with improvement; False: sudden without improvement).
- Lysis: Temp returns to normal slowly (zigzag over 2-3 days).
- Constant: Fluctuation ≤ 2°F, never returns to normal.
- Remittent: Fluctuation > 2°F, never returns to normal.
- Intermittent: Normal to high to normal at regular intervals.
- Inverse: Highest in AM, lowest in PM.
- Hectic: Very high difference between high/low points.
- Relapsing: Normal for 2-3 days, then suddenly rises again.
Degree Classification
- Low Pyrexia: < 100°F
- Moderate Pyrexia: 100-103°F
- High Pyrexia: 103-105°F
- Hyperpyrexia: > 105°F
- Hypothermia: < 95°F
Sitz Bath Quick Summary
- Definition: Warm, shallow bath (sitting position) for local moist heat to pelvic organ/perineal area.
- Purpose: Relieve pelvic congestion, treat dysmenorrhea, relieve post-op pain (perineal), promote drainage (rectal abscess/hemorrhoids), relieve pain after cystoscopy.
- Indication: Swollen/painful hemorrhoids (piles), post ano-rectal surgery, Episiotomy, Uterine cramps.
- Contraindication: Diabetes, Peripheral Vascular Diseases, Impaired Peripheral Sensory Function, Immediate Post-Hemorrhoidectomy, Menstruating/Pregnant Women.