Symptom: Chills/Shaking

Initial Grading Reminder

CTCAE grading of chills/shaking:

Grade 1 (Mild): Mild sensation of cold; shivering; chattering of teeth
Grade 2 (Moderate): Moderate tremor of the entire body; narcotics indicated
Grade 3 (Severe): Severe or prolonged, not responsive to narcotics

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Have you had chills/shaking in the past? How much worse is it now? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How bad are your shakes? What part of your body is involved?  Do you have a fever?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any back pain, itching, flushing, or difficulty breathing? Are you feeling faint?

Note: These symptoms are consistent with an allergic reaction.

Did you black out or become incontinent?

Note: It is important to rule out a seizure.

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?