Assessment of Fever - Central Nervous System Infections

Relevant Evaluation Criteria		Scenario/Model Outcome
Information Gathering
1. Gather essential information about the patient’s symptoms, including:
a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms)	Child daycare provider reported to parents that their daughter has felt warm and is not eating well, although she continues to play with the other children. They took an oral temperature, which was 101.4°F. They did not notice any other symptoms other than a slight runny nose.
b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s)	The parents have not tried anything up to this point.
c. description of the patient’s efforts to relieve the symptoms	None reported by Julianna or her parents
2. Gather essential patient history information:
a. patient’s identity	Julianna Smith
b. patient’s age, sex, height, and weight	3-year-old female, 3 ft 0 in, 28 lb
c. patient’s occupation	None
d. patient’s dietary habits	Normal healthy toddler diet. She has not eaten much today, but she is drinking.
e. patient’s sleep habits	Normal sleep pattern
f. concurrent medical conditions, prescription and nonprescription medications, and dietary supplements	Flintstone’s vitamins
g. allergies	Penicillin
h. history of other adverse reactions to medications	None
i. other (describe)	Julianna seems slightly cranky and tired. She was not herself in daycare today, and she has a runny nose. The oral temperature remeasured in the pharmacy is 101.6°F.
Assessment and Triage
3. Differentiate the patient’s signs/symptoms and correctly identify the patient’s primary problem(s).	Julianna has a low-grade fever that is causing her some discomfort. It is most likely related to a virus being transmitted through the daycare.
4. Identify exclusions for self-treatment.	None
5. Formulate a comprehensive list of therapeutic alternatives for the primary problem to determine if triage to a health care provider is required, and share this information with the caregivers.	Options include: (1) Refer Julianna for medical attention. (2) Monitor her symptoms and fever and recommend nondrug measures only. (3) Recommend a medication alone or combined with nondrug measures. (4) Make no recommendations.
Plan
6. Select an optimal therapeutic alternative to address the patient’s problem, taking into account patient preferences.	Julianna has no symptoms of a bacterial infection and she has no exclusions for self-care; therefore, therapy with either acetaminophen or ibupro-fen is appropriate combined with nondrug measures. Julianna’s parents would also like a chewable tablet, if possible, to ease administration. She should not receive any aspirin-containing products.
7. Describe the recommended therapeutic approach to the caregivers.	If fever persists for 72 hours, take Julianna to her clinician for follow-up.
8. Explain to the patient the rationale for selecting the recommended therapeutic approach from the considered therapeutic alternatives.	Julianna has a low-grade fever that is causing her discomfort, so minimizing the fever with the medications and nondrug measures should help her. She does not need to see her clinician, because she is otherwise healthy and does not exhibit any signs of a bacterial infection for which she might need an antibiotic.
Patient Education
9. When recommending self-care with nonprescription medications and/or nondrug therapy, convey accurate information to the caregivers:
a. appropriate dose and frequency of administration	Acetaminophen 160 mg (two 80 mg chewable tablets) orally every 4-6 hours. Do not exceed 5 doses per 24 hours.
b. maximum number of days the therapy should be employed	3 days
c. product administration procedures	Chew tablets and swallow.
d. expected time to onset of relief	1-2 hours
e. degree of relief that can be reasonably expected	Complete resolution of symptoms may take anywhere from 2 days to 3 weeks, depending on the underlying cause of the fever.
f. most common side effects	Rare; possible gastrointestinal effects or rash
g. side effects that warrant medical intervention should they occur	Can take with food if gastrointestinal effects occur
h. patient’s options in the event that condition worsens or persists	Contact health care provider if symptoms worsen or persist after 72 hours of pharmacologic therapy.
i. product storage requirements	Keep medication in a tightly secured container away from any extreme temperatures.
j. specific nondrug measures	Maintain room temperature at 78°F. Maintain fluid intake and wear lightweight clothing.
10. Solicit follow-up questions from caregivers.	May I give Julianna ibuprofen as well?
11. Answer caregivers’ questions.	You should not. The American Academy of Pediatrics does not recommend alternating ibuprofen and acetaminophen because of the increased risk of medication errors and side effects.