Learning Objective #1: Compare and contrast published fever management protocols in light of current basic and clinical science

Learning Objective #2: Evaluate effectiveness of fever management on thermoregulatory responses of shivering, body temperature level, and perception of chill

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Introduction of clinical problem: Nursing management of the febrile response has changed little throughout history aimed mainly at reducing body temperature. Unfortunately, this approach fails to acknowledge newer knowledge that febrile temperatures are a response to endogenous proinflammatory mediators. Circulating cytokines raise the hypothalamic thermoregulatory set-point range to higher levels as part of the acute phase response. Warmer body temperatures hold some documented host benefits to ill patients. Shivering, by contrast, consumes oxygen and exerts a cardiorespiratory burden. Attempts to cool the body simply stimulate shivering and promote warming responses that raise body temperatures even higher. The clinical question: “What thermoregulatory responses accompany existing nursing approaches for fever management?” Of interest are three outcomes commonly associated with fever: 1) shivering, 2) perceptions of chill, and 3) elevated body temperature. Search for evidence included review of nursing, medicine, and biologic science literature from computerized bibliographic databases of Index Medicus®, CINAHL®, and Cancerlit®. Key sources of literature on fever came from published reports of two important international conferences in thermal physiology. Summary and critical appraisal of evidence: The outcome of interest in most studies of fever management was core body temperature. Published guidelines tended to focus on managing the presumed underlying infection. Few studies measured shivering activity or acknowledged its associated distress. At least 4 studies provided scientific rationale for measures used to prevent shivering during fever or during cooling measures. Three studies showed an intervention to prevent febrile shivering, reduce perception of chills, and maintain safe temperatures. One study showed the intervention effective in keeping core temperatures lower. Evidence review shows need for translational research in fever care to move scientific knowledge from basic discovery into clinically based application. Evidence shows that interventions to prevent febrile shivering reduce distress and metabolic burden during fever but keep core temperatures at lower levels