Can you do something about fevers? Like their progression, causes, and symptoms as they get worse?
*sighs* you know you’re a nursing major when the index directs you to page 1,941 to answer a question…. anyway….
Also this is a super ass-long post that I’m ridiculously happy about. Be prepared.
And if anyone can find a good picture for this post, I’m coming up empty.
The human body is basically a protein, fat, and mineral vessel made up of symbiotic chemical processes that have come together for the purpose of… well, as far as we can figure, continuing to run those chemical processes. Meaning of life. You’re welcome. Now, somewhere along the line, evolution figured out that the best temperature for the majority of those particular human chemical processes to take place was between 36.5C and 37.5C, because those within that parameter tended to live and reproduce more often than those who didn’t. Most of the rest of the gene pool died off.
Somewhere along the same line, evolution also figured out that the ability to temporarily raise that temperature in response to certain stimuli (pyrogens) gave us a better chance of fighting bacteria, viruses, and other microorganisms that might seek to do us harm (called pathogens), thus also allowing us to live longer and make more little chemical reaction vessels.
Current thought is that the increased survival is because some of those human chemical processes (like the kind necessary to fight infections) actually work better at slightly higher temperatures, and at those same temperatures, toxins produced by those pathogens aren’t as effective at causing us problems.
Fever occurs when the body detects something called a pyrogen. Pyrogens are chemical messengers that, when present, tell the body that something is wrong that might be helped by turning up the heat. Sometimes this is purposeful (we evolved to recognize the coatings on some pathogens as pyrogens) and sometimes accidental (medications and poisons can also act as pyrogens by coincidence (turning up the heat probably won’t help, but worth a shot)).
Other pyrogens come from inside the body as a result of inflammation. This can be because of tumors, a prolonged diet of white sugar/flour, damage to blood vessels, bad sunburn or other tissue damage.
Whatever the trigger, the part of the brain that sets temperature (the hypothalamus) reacts to the pyrogen by “setting” that temperature higher.
Now, with that temperature set higher, your body goes “oh $#*%, I’m too cold!” And promptly does everything it would do if you were actually hypothermic (see this post for info on hypothermia). First, it makes the blood vessels near the surface of your skin smaller so they lose less heat (and make you feel really cold so you pile on clothes/blankets and curl up). If that doesn’t work, and you’re still “too cold,” you begin to shiver, which further raises the temperature. Between these two processes, the body can pretty efficiently reach the new “set point.”
Now, only in super duper limited circumstances are true fevers actually dangerous. Uncomfortable, maybe, and the body ends up burning more calories and using more water to maintain them, so hunger and dehydration become a problem more quickly, but because they’re entirely controlled by the “set point,” they’re typically not going to get so high on their own that they start being detrimental to life.
Hyperthermia, on the other hand, is pretty awful and definitely needs treated ASAP. Hyperthermia is not a fever. Where a fever is a higher temperature because the brain’s temperature set point is higher (brain is in control), Hyperthermia is where the body’s cooling systems have failed and body temperature gets too high despite a “normal” set point (external forces (hot tubs, dehydration on a really hot day, stroke, certain medications different from those above) are in control).
Now, The Part That Might Actually Help You Write About Fevers:
Fevers come in cycles. A body develops a fever, has the fever, gets rid of the fever. One “fever cycle” is known as a febrile episode. Certain fever-inducing problems may have one long febrile episode, several febrile episodes, or may have a specific pattern of febrile episodes (different disease processes have different fever patterns).
The Chill Phase: The first phase of a fever is called the “Chill Phase.” In the chill phase, the person feels very cold, their skin is pale and they may or may not be shivering (baseline temperature –> peak temperature)
The Fever Phase: The fever phase is when the person’s temperature has reached the new set point. At this point, the person feels neither hot nor cold, but may feel thirsty, weak, achy and generally sick. Their skin is hot and flushed (peak temperature –> peak temperature). If the fever hits about 40C during the fever phase, neurological symptoms start to occur- most commonly because of dehydration and electrolyte imbalances (this is seriously the main reason. Not kidding. Drink fluids when you’re sick). These include drowsiness, restlessness, delirium (difficulty concentrating, mood swings, anxiety, euphoria, behavioral changes like becoming combative or particularly withdrawn, irritability, nightmares, hallucinations). Seizures may also occur, especially in children. Cerebral nerve cell irritation due to temperature can cause similar problems, but not as commonly.
The Crisis Phase: During this phase, the person feels warm and flushed and becomes extremely diaphoretic (sweaty). This is another period where the person may experience severe dehydration (peak temperature –> baseline temperature).
The interesting thing about fevers is that the general population assumes that they are super dangerous and need to be treated super aggressively. This is great for you as a writer, because it is yet another way you can freak your characters (and audience) out without putting them in serious medical danger. Honestly, if the fever is under 39C, it doesn’t need treated. If its over that, the goal is to get it under that. Completely eliminating a fever isn’t going to do much good, and if your story is in a lower resource environment, it will just deplete supplies much faster.
The first thing a character needs is comfort/prevention of further symptoms. If the fever is below 39C, give them lots of water. It will make them more comfortable and reduce their chances of having worse neuro symptoms if their fever gets higher. If they’re hungry give them food, and if they’re not, get some kind of drink with calories and electrolytes (sports drinks or clear supplement drink (especially if the fever has been going on for a few days and they still haven’t eaten)).
But say the fever gets higher than that? Here’s what your supporting characters can give/do:
Antipyretic medications: These medications help move the set point back down. They work for fever, but not for hyperthermia. They also may make a person more comfortable, because they’re painkillers (aspirin and ibuprofen will reduce inflammation as well). Examples:
Acetaminophen and ibuprofen can be given at the same time.
Mechanical cooling: These are more effective for hyperthermia, but are only very temporary measures for fever.
Bathing a character in slightly warm or tepid water
Dressing a character only in very light clothing/blankets
Placing a fan in or cooling the character’s room
Cold or ice water baths will actually make things worse, because while they lower external temperature, they encourage shivering, which raises core temperature and is just really, horribly uncomfortable for someone with a fever (Winchester the Younger can’t get a break, can he?).
Antipyretics are a good starting point because they are treating the biological cause of the fever. Mechanical methods will only work for very short periods of time, and like I said, they’re usually uncomfortable for the character (unless this is what you’re going for, then be my guest).
Craven, R. (2009). Fundamentals of nursing: Human health and function (6th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Lippincott, W. (2013). Brunner and suddarth’s textbook of medical-surgical nursing (12th ed.). Wolters Kluwer Health.
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