FEVER

FEVER - increased body temperature (over 37 ° C), which appears as a protective-adaptive reaction in infectious and many other diseases, or as a manifestation of thermoregulatory disorders in the pathology of the nervous or endocrine system. Accompanied by a violation of certain body functions, is an additional burden on the respiratory and circulatory systems. With fever, the main metabolism is usually increased, the disintegration of proteins increases (in connection with which the release of nitrogen in the urine increases), the frequency of respiration and cardiac contractions increases; Perhaps the darkening of consciousness. However, abnormalities of functions and metabolism observed during a fever are often determined not by fever itself, but by a major disease.

Depending on the cause of the disease, infectious and non-infectious fever is distinguished. The latter is observed during poisoning with various poisons (plant, animal, industrial, etc.), allergic reactions (for example, with parenteral administration of protein) and diseases (bronchial asthma), malignant tumors, aseptic inflammatory processes, necrosis. As a manifestation of disorders in the regulation of body temperature, noninfectious fever is noted in diseases of the brain, thyrotoxicosis, ovarian dysfunction.

The mechanism of the emergence of infectious and non-infectious fever is similar. It consists in stimulation of the nerve centers of thermoregulation with substances (so-called pyrogens) of exogenous nature (decay products of microbes, toxins) or formed in the body (immune complexes, pyrogens produced in leukocytes).

There are three stages of a febrile reaction. The first stage - the increase in temperature - the result of increased heat production with a decrease in heat transfer, which is due to reflex spasm of the skin vessels. In this case, often paleness of the skin and chills are noted. Then the heat transfer begins to increase due to the expansion of the vessels, and in the second stage of the fever, when the temperature is kept at an elevated level (the height of the fever), both heat production and heat transfer are increased. Pallor of the skin gives way to hyperemia, the skin temperature rises, and the patient has a feeling of heat. The third stage of fever - decrease in body temperature - comes as a result of further increase in heat transfer, including due to profuse sweating and a significant expansion of blood vessels, which can lead to collapse. Such a flow is often observed in the case of a sharp, so-called critical, drop in temperature, or a crisis. If the temperature drops gradually over many hours or a few days (lytic decline, or lysis), then the threat of collapse is usually absent. In some diseases (eg, malaria), fever is of a cyclic nature: the three stages of fever are repeated at some intervals when the temperature remains normal.

By the degree of increase in body temperature, the subfebrile (from 37 to 38 ° C, moderate (from 38 to 39 ° C), high (from 39 to 41 ° C) and excessive, or hyperpyretic, fever (above 41 ° C) are distinguished. Cases in acute infectious diseases, the most favorable form is moderate fever with a daily temperature fluctuation in the range of 1 ° C. Hyperpyrexia is dangerous by a profound disturbance of vital activity, and the absence of fever indicates a decrease in the reactivity of the organism.

In various diseases, febrile reactions can proceed in different ways. This is reflected in the temperature curves - a graphical representation of the temperature fluctuations of the body, measured daily in the morning and in the evening (or at other times of the day). According to the types of temperature curves, the following types of fever are distinguished:

1) constant fever: body temperature is usually high, often more than 39 ° C, held for several days or weeks with daily fluctuations within 1 ° C; Occurs in acute infectious diseases (typhus fever, croupous pneumonia, etc.);

2) laxative, or remitting, fever: significant daily fluctuations in body temperature - from 1 to 2 ° C or more; Occurs in purulent diseases;

3) intermittent, or intermittent, fever: a sharp rise in body temperature to 39 - 40 ° C and higher with a drop in it in a short time to normal or even subnormal and with the repetition of such upsurge after 1-3 days; Is characteristic of malaria;

4) Depleting, or hectic, fever: significant diurnal or with intervals of several hours fluctuations in body temperature (above 3 ° C) with a sharp drop from higher to normal and subnormal values; Is observed in septic states;

5) recurrent fever: increase in body temperature immediately to 39 - 40 ° C and above, the temperature remains high for several days, then decreases to normal or subnormal, and after a few days the fever returns and is replaced by remission; Occurs, for example, in recurrent typhus;

6) wave-like fever: a gradual day-to-day increase in body temperature, which in a few days reaches a maximum, then, in contrast to recurrent fever, also gradually decreases and again gradually increases, which looks on the temperature curve as alternating waves with a period of several days for each Wave; Is observed in brucellosis, lymphogranulomatosis, etc .;

7) wrong fever: does not have certain regularities in diurnal fluctuations; Occurs most often (with rheumatism, pneumonia, dysentery, influenza and many, including cancer, diseases);

8) perverted fever: the morning temperature is higher than evening; Is observed with prolonged sepsis, viral diseases, thermoregulatory disorders.

The temperature curve is reflected in the temperature sheet. The nature of the temperature curve can have important diagnostic and prognostic significance.

Treatment is directed primarily to the underlying disease. In hyperpyrexia and in patients with high body temperature against the background of existing heart diseases, respiratory failure, exhausting diseases, the use of antipyretic agents (acetylsalicylic acid, amidopyrine, etc.) is shown. They should not be prescribed with a moderate fever, well tolerated by the patient, as in infectious diseases, temperature reactions are protective-adaptive.

Patients with high fever, especially the elderly and children, require increased attention and need care. The nurse should monitor the state of consciousness, breathing, heart rate and its rhythm, and if breathing or heart rhythm is disturbed, inform the doctor immediately. It is often necessary to give a patient a drink, in a timely manner. To change the linen after a sweat, wipe the skin consistently with wet and dry towels. The room in which a febrile patient is located should be well ventilated and have a constant supply of fresh air.