Symptom: Fever

Initial Grading Reminder

CTCAE grading of fever (note this is different than pyrexia associated with targeted therapies):

Grade 1: 38.0 – 39.0 °C (100.4 – 102.2 ° F)
Grade 2: >39.0 – 40.0 °C (102.3 – 104.0 ° F)
Grade 3: >40.0 °C (>104.0 ° F) for ≤24 hrs
Grade 4: >40.0 °C (>104.0 °F) for >24 hrs

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? Has it developed gradually or suddenly? Have you had any exposure to sick individuals? Do you have other symptoms suggesting an infection (e.g., sore throat, cough, runny noise)? Any associated flu-like symptoms (fatigue, chills, decreased appetite)?

Grade the symptom

Ask the patient:

How high is your temperature? How long have you had the fever? Have you taken any medications to reduce the fever?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any diarrhea and severe abdominal (belly) pain or bloating? Are you feeling faint? Do you have yellowing of the skin? Do you have a headache or any vision problems? Any chills or flu-like symptoms?  Are you able to hydrate?

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?

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    Suggested Intervention

    Patients with new onset moderate or worse (or worsening) fever should be seen.  Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    Infusion Reaction

    Itching, flushing, difficulty breathing? Is he/she feeling faint?

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    Differential Diagnosis

    What do you suspect is the cause of the fever?