Pain and Fever Fall 2012 (1)

Anti inflammatory effects adults usually not used for

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anti-inflammatory effects (adults) Usually not used for this purpose unless under the guidance of health care provider  risk of bleeding Salicylate toxicity is possible Tinnitus, headache, dizziness, confusion, N/V
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Salicylates Adverse effects Gastric ulceration/bleeding Dyspepsia Bleeding Aspirin allergy Urticaria, angioedema, dyspnea, bronchospasm  risk in patients with asthma or nasal polyps If TRUE aspirin allergy, may have cross-reaction to NSAIDs Can use acetaminophen as alternative Does NOT include history of GI intolerance
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Salicylates Drug interactions Patients on warfarin should not use aspirin unless recommended by health care provider ( risk of bleeding) Avoid alcohol ( risk of bleeding) May  effects of antihypertensive agents Counseling points Maximum daily dose (numerical AND tablets) Take with a full glass of water Do NOT crush or chew enteric-coated products Avoid alcohol Increases risk of GI bleeding
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Combination Products Headache products Some contain analgesic(s) + caffeine Produce synergistic analgesic effect Excedrin Migraine Extra Strength Bayer Back and Body
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Fever
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Fever: Pathophysiology Core temperature regulated by thermoregulatory center in hypothalamus and thermosensitive neurons in skin and CNS Regulated by physiologic and behavioral mechanisms Physiologic Sweating, vasodilation Behavioral Additional clothing, rubbing hands, seeking shade,
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Fever: Sites of Temperature Measurement Oral Rectal Typically 0.5°-1°F higher than oral Axillary Typically 0.5°-1°F lower than oral Tympanic Typically 0.5°-1°F higher than oral
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Fever: Definition Normal oral temperature = 95.9°-99.5°F Typically 98.6°F Fever Oral temperature > 99.7°F (37.6°C) Rectal or tympanic temperature: >100.4°F (38.0°C) Axillary temperature: >99.3°F (37.4°C)
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Fever Temperature conversions °F = (9/5 x °C) + 32 °C = 5/9 (°F – 32)
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Fever: Causes Infection Cancer Dehydration Tissue damage Surgery Stroke Medications
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Fever: Clinical Presentation Fever is a symptom of an underlying process Only definitive sign is elevated temperature Other signs and symptoms usually accompanied by fever: Headache, diaphoresis, generalized malaise, chills, tachycardia, arthralgia, myalgia, irritability, anorexia
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Fever: Treatment Fever is due to an underlying process; therefore treatment should be directed on the cause and not the actual fever itself Patient discomfort associated with fever is the main indication for treatment Fever, in general, is not associated with harmful effects until >106°F (41.1°C)
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Fever: Treatment Fevers > 101°F (38.3°C) Use antipyretics Fevers < 101°F (38.3°C) Consider treatment in advanced age
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Exclusions for Self-Treatment
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Exclusions for Self-Treatment >6 months of age with rectal temp ≥104°F (40°C) or equivalent <6 months of age with rectal temp ≥ 101°F (38.3°C) Severe symptoms of infection Risk of hyperthermia Impaired oxygen utilization (i.e. COPD, heart failure)
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