Marymount University Fever with Unknown Cause Discussion – Description
Fever with unknown cause, also described as a fever of unknown origin (FUO), can be caused by more than 200 diseases.
FUO is suspected when a patient presents with the following established criteria:
Illness lasting for at least three weeks
Illness accompanied by fever (temperature over 101° F or 38.3° C on several occasions)
No established diagnosis after one week of hospital investigation
Fever of Unknown Origin, Evidence-Based ApproachCommon Etiologic Categories and DiagnosisOther Considerations
Infection
Malignancies
Autoimmune conditions
Miscellaneous
Drug-induced fever (DIF) must be considered in patients who are taking medications.
Factitious Fever
Studies have indicated that factitious fever is responsible for as many as 10% of FUO cases and is most commonly seen in young adults with healthcare experience or knowledge. Evidence of psychiatric problems or a history of multiple hospitalizations at different institutions is also common. Rapid changes of body temperature without associated shivering or sweating, large differences between rectal and oral temperature, and discrepancies between fever, pulse rate, or general appearance are typically observed among patients who manipulate their thermometers, the most common cause of factitious fever.
Reference: Holder, M.A. & Ledbetter, C. (2011). Fever of unknown origin, an evidence-based approach, pp. 48–49.
FUO Treatment and Standard of Practice
Continued observation and evaluation while searching for the underlying cause is thought to be the best strategy. Additionally, it is important to withhold therapy until the cause of the fever has been determined, so it can be tailored to a specific diagnosis.
Most studies recommend empiric therapy for FUO in only four situations:
Antibiotics for culture-negative endocarditis
Low-dose corticosteroids for presumed temporal arteritis
Antituberculosis drugs for suspected miliary tuberculosis
Naproxen for suspected neoplastic fever
Instructions
Read the following articles before working on the case study.
Mourad, Palda, V., & Detsky, A. S. (2003). A Comprehensive Evidence-Based Approach to Fever of Unknown Origin Links to an external site.. Archives of Internal Medicine (1960), 163(5), 545–551. https://doi.org/10.1001/archinte.163.5.545Links to an external site.
Vijayan, Vanimaya, Ravindran, S., Saikant, R., Lakshmi, S., Kartik, R., & G, M. (2017). Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy Links to an external site.. Journal of Intensive Care, 5(1), 51–51. https://doi.org/10.1186/s40560-017-0246-8
Fever with Unknown Cause Case Study
Mr. Taft is a 74-year-old man who was admitted to the Emergency Department (ED) for fatigue and fever of 3-week duration. The patient had a history of chronic obstructive pulmonary disease, ischemic cardiomyopathy, hemorrhagic stroke, which had caused cognitive impairment and difficulties in mobilization, HCV-related hepatopathy, obesity, diverticula, and an aortic abdominal aneurysm treated with an endoprosthesis one year earlier.
Two days before admission, he went to the ED for confusion and was discharged within a few hours with a diagnosis of progressive cognitive impairment.
At the ED, the patient had mild confusion, but the physical examination was otherwise normal. Temperature 102.0° F, HR 103, Resp 28, Blood Pressure 154/88.
A chest X-ray study was negative for acute lesions. On admission to the medical unit, blood tests were ordered & showed signs of inflammation and an elevation of procalcitonin. The physical examination showed abdominal tenderness, but there was only mild abdominal pain with no signs of peritonitis.
Initial Post
Answer the following seven questions:
Explain the purpose of each of the following tests:
Complete blood cell count (CBC) with differential
Basic chemistry profile
Liver function test (LFT), measurement of lactate dehydrogenase level
Erythrocyte sedimentation rate (ESR)
Antinuclear antibody (ANA) rheumatoid factor (RF), c-reactive protein (CRP) level
Procalcitonin
Tuberculosis skin test (PPD skin test)
Two to three sets of blood cultures, urinalysis, urine culture
Chest x-ray
What do you think is going on with Mr. Taft? What are your thoughts?
What additional information do you want and why?
Why is procalcitonin considered a promising diagnostic marker for sepsis and antibiotic therapy?
Should this patient be started on oseltamivir?
Would it be appropriate to start Mr. Taft on linezolid? Why or why not?
Based on the case study:
Write two to three nursing diagnoses
Identify three nursing interventions for each diagnosis
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