Page 222 - Encyclopedia of Nursing Research

FEVEr/FEBrILE rESPONSE n 189

level. Body temperatures of about 39°C may in nature, varying from laboratory studies
have added immunostimulant and antimi- of humans and animals to clinical studies in
crobial effects. These features make comfort hospitals and homes. Circadian variations in F
the primary reason for treating low-grade temperature are well documented (Bailey &
fever with antipyretic drugs. Higher set- Heitkemper, 2001), but there are few recent
point levels raise sensitivity to heat loss, studies which confirm that daily temperature
causing even mild cooling to stimulate shiv- screening in hospitals adequately detect fever
ering. Aggressive cooling with conductive in persons with abnormal cytokine expres-
cooling blankets and ice packs evokes vig- sion, such as those with HIV/AIdS. A study
orous shivering, raising energy expenditure of febrile symptom management in patients
three to five times the resting values. As the with cancer tested interventions to suppress
consistent clinical observer of patient body drug-induced febrile shivering (Holtzclaw,
temperatures, nurses find that issues of 1990) showed that insulating thermosensitive
measurement, febrile patterns, physiological skin regions during the chill phase of fever
correlates, and sensory responses are of sig- not only reduced shivering but improved
nificance to practice and research. comfort. This preliminary work provided
Febrile symptoms are nonspecific the basis for a comprehensive febrile symp-
responses to both infectious and host defense toms management protocol, tested in hospi-
activities so that many symptoms and inter- talized and home care HIV-infected persons
ventions are generalizable. Contrasted with with febrile illness (Holtzclaw, 1998a). In a
studies of fever management in other disci- controlled trial, the intervention of insulative
plines that center primarily on pharmacolog- coverings to suppress shivering was shown to
ical control of underlying infection, nursing be an effective intervention. Body water loss
research focuses on symptom management of and dehydration were monitored by body
fever responses regardless of etiology. Nurse weight, serum osmolality, and urine specific
researchers began studying interventions in gravity in hospitalized patients, whereas a
the early 1970s to cool the body during fever fever diary and home visits reported changes
without causing shivering or temperature in patients at home. No patients with insula-
“drift.” By the late 1980s, concern grew about tive wraps shivered, whereas controls expe-
the metabolic and cardiorespiratory effects rienced both shivering and higher peak
of fever on vulnerable patients with cancer temperatures. Systematic oral fluid replace-
or HIV infection (Holtzclaw, 1998b). The “set ment was not effective in replacing loss
point” theory of temperature regulation was despite metabolic, cardiorespiratory, and
central to these intervention studies, but as fever-related fluid expenditures because fever
discoveries of the 1990s identified and clar- suppressed thirst. Findings documented the
ified mechanisms of endogenous pyrogens, negative effects of fever on hydration and
cytokines and other biological messengers febrile shivering on cardiorespiratory effort.
offered new measurable biomarkers of fever Higher fatigue levels, lower thermal comfort,
as a host response. Nurse scientists contrib- higher rate pressure product and respiratory
uted significant scientific information about rate were experienced by those in the control
the febrile response using human and animal group who shivered. A growing awareness
models (McCarthy, Murray, Galagan, Gern, that cooling measures exert distressful and
& Hutson, 1998; richmond, 2001; rowsey, sometimes harmful effects has stimulated
Metzger, Carlson, & Gordon, 2009) inquiry surrounding procedures commonly
responsible nursing research on fever used to “cool” patients. The practice of sponge
draws on principles from physiology, phys- bathing with tepid water to cool down febrile
ics, biochemistry, and psychoneuroimmunol- (38.9°C) children was studied in a group of
ogy. It is often interdisciplinary and diverse 20 children, ages 5 to 68 months, seen in an