Hyperpyrexia is defined as a temperature higher than 105.8°F (41°C) and is associated with severe infection, hypothalamic disorders, or central nervous system hemorrhage. It involves normal thermoregulatory responses responding at a higher level. Hyperpyrexia responds best to central cooling interventions such as antipyretic therapy. Hyperpyrexia requires primary management by a healthcare prescriber because antipyretic therapy will need to be initiated.
Hyperthermia exists when the set point is normal yet the child feels heated and overly warm (e.g., after increased physical exertion) with a higher body temperature. Hyperthermia involves a dysfunction of thermoregulatory responses and responds best to physical cooling methods.
Fever is defined as an elevation in set point such that body temperature is regulated at a higher level (e.g., as a result of a bacterial infection). Fever is considered an adaptive response and is one of many mechanisms to fight infection. There is evidence that various components of the immune system are enhanced at elevated temperatures. Fever is considered present when the child’s temperature is ≥100.4°F (38°C).
Temperatures commonly used as the point at which further evaluation for serious bacterial infection is initiated are as follows:
Younger than 2 months of age: ≥100.4°F (38°C)
Older than 2 months of age: ≥102.2°F (39.0°C)
In the hospital, use of antipyretic medications and hypothermia blanket is implemented by the RN or LPN on the order of a healthcare prescriber.
Basic cooling measures are administered by the RN, LPN, physician, or knowledgeable family member.
Medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, or family member who is knowledgeable about the medication and techniques of administering oral medications to a child.
Principles of pharmacologic management (see Chapter 7) are followed.
Child’s temperature is frequently monitored during cooling measures, the frequency of monitoring is continued until the child’s temperature has returned to within normal parameters.
Tepid baths should not be administered. This method is not supported by research for fever management and is often uncomfortable to children and may produce little if any long-lasting effects to reduce fever.
Temperature measurement device (see Chapter 123 for types of temperature measurement devices)
Cotton sheets (if needed, to replace flannel)
Cotton blanket (if needed, to replace wool)
Medications as ordered, see Chapter 68 for oral medications and Chapter 70 for rectal medications
Electronic cooling blanket
Hypothermia machine preferably with thermometer probe
Protective sheets
Assess child for noninfectious reasons for an elevated temperature. The external environmental temperature and overbundling, recent administration of childhood immunizations, and some prescribed drugs may cause an elevation in temperature.
Assess child’s clinical history and related physical symptoms to determine reasons for an elevated temperature. Cooling measures may also be implemented in specific situations (e.g., after cardiac surgery or neurologic insult) to induce mild hypothermia and reduce metabolic demands.
Explain to the child and family what you will be doing to reduce child’s temperature and to make the child more comfortable.
Encourage family to be present in the room.
Use diversionary techniques if needed for cooperation.
PROCEDUREPreintervention Measures
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High fever and rapid rise in temperature in young children are associated with febrile convulsions.
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