Nursing management at a Chinese fever clinic during the COVID-19 pandemic.

BACKGROUND: The rampant spread of the novel coronavirus disease (COVID-19) has assumed pandemic proportions across the world. Attempts to contain its spread have entailed varying early screening and triage strategies implemented in different countries and regions. AIM: To share the experience of scientific and standardized management of fever clinics in China, which provide the first effective checkpoint for the prevention and control of COVID-19. INTRODUCTION: A fever clinic was established at our hospital in Tianjin, China, for initially identifying suspected cases of COVID-19 and controlling the spread of the disease. METHODS: The management system covered the following aspects: spatial layout; partitioning of functional zones; a work management system and associated processes; management of personnel, materials and equipment; and patient education. RESULTS: Within two months of introducing these measures, there was a comprehensive reduction in the number of new COVID-19 cases in Tianjin, and zero infections occurred among medical staff at the fever clinic. DISCUSSION: The fever clinic plays an important role in the early detection, isolation and referral of patients presenting with fevers of unknown origin. Broad screening criteria, an adequate warning mechanism, manpower reserves and staff training at the clinic are essential for the early management of epidemics. CONCLUSION: The spread of COVID-19 has been effectively curbed through the establishment of the fever clinic, which merits widespread promotion and application. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Health managers should be made aware of the important role of fever clinics in the early detection, isolation and referral of patients, and in the treatment of infectious diseases to prevent and control their spread. In the early stage of an epidemic, fever clinics should be established in key areas with concentrated clusters of cases. Simultaneously, the health and safety of health professionals require attention.

Fever of unknown origin: an evidence-based approach.

This article reviews the classification and etiology of fever of unknown origin (FUO) in the adult population. A systematic diagnostic approach is discussed, equipping the NP to follow a careful history and physical, as well as focused diagnostic tests and procedures to determine the underlying cause of FUO.

Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America.

Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.

[Fever in critically ill patients: frequent causes, diagnostic procedures, and therapy]. / Fieber bei kritisch kranken Patienten: häufige Ursachen, diagnostische Massnahmen und Behandlung.

Fever is an adaptive physiological process. In reaction to specific proteins (pyrogens) distributed by the blood the reference temperature increases, thus the organism has to produce heat. In intensive care units approximately 50 percent of fever episodes are caused by hospital acquired infections, while other episodes result from non-infectious diseases or their aetiology remain undetected. A special kind of fever is the hyperthermia following malfunctioning hypothalamic regulation after central nervous diseases or injuries. In patients with severe head injuries any increase of temperature has to be prevented as hyperthermia is associated with more adverse outcomes. If the hyperthermia can be attributed to other aetiological factors, a decrease of temperature is not desirable provided that the consequences of fever do not jeopardize the patient for further health risks. As a basis of therapy, the aetiology of fever episodes should be diagnosed taking recent scientific knowledge and guidelines into consideration. The most reliable temperature values are measured by using invasive sensors, particularly in pulmonary arterial catheters or bladder catheters. Alternatively usual thermometers can be applied, due to unreliable results excepting in the axilla.

Diagnóstico y manejo del niño entre 3 y 36 meses de edad con fiebre sin causa aparente

Objetivo: proporcionar pautas para el diagnóstico y manejo del lactante mayor de 3 meses con fiebre sin causa aparente. Métodos: se hizo una revisión bibliográfica de los principales artículos publicados en los últimos meses, concerniente al manejo del niño con fiebre sin causa aparente. Las conclusiones y pautas de manejo se discuten y se han modificado para que puedan ser aplicados a nuestro medio con los recursos disponibles. Resultados: aunque hay divergencia de opiniones en las diferentes publicaciones revisadas, el criterio clínico de toxicidad, a pesar de ser subjetivo, junto con el grado de fiebre y el conteo de leucocitos, selecciona los pacientes que tiene mayor probabilidad de presentar bacteremia oculta. Las pautas recomendadas por Baraff y colaboradores con respecto al manejo de estos pacientes, las cuales fueron elaboradas por un panel de especialistas en la materia, pensamos son las que brindan mayor seguridad al paciente, son claras y aplicables a nuestro medio. Conclusiones: los niños mayores de 3 meses con fiebre menor de 39 grados centígrados sin causa aparente, no necesitan exámenes de laboratorio ni antibióticos y pueden ser observados ambulatoriamente. Si la fiebre es mayor de 39 grados centígrados y el conteo de leucocitos es de 15.000 o más se les debe tomar un hemocultivo y suministrar antibiótico profiláctico hasta que llegue el resultado de los cultivos. Estas pautas no eliminan todos los riesgos ni limita estrictamente el tratamiento antibiótico para los niños que tienen bacteremia oculta, por lo tanto, el médico debe individualizar su terapia basado en las características clínicas de cada paciente o adoptar variaciones basadas en la interpretación de estas evidencias.

Diagnóstico y manejo del lactante menor de tres meses con fiebre sin causa aparente

Objetivo: proporcionar pautas para el diagnóstico y manejo del lactante menor de 3 meses con fiebre sin causa aparente. Métodos: se hizo una revisión bibliográfica de los principales artículos publicados en los últimos meses, concernientes al manejo del niño con fiebre. Las conclusiones y pautas de manejo se discuten y se han modificado para que puedan ser aplicados a nuestro medio con los recursos disponibles. Resultados: aunque hay divergencia de opiniones en las diferentes publicaciones revisadas, los criterios de Rochester son los más óptimos para descartar infección bacteriana severa y las pautas recomendadas por Baraff y colaboradores, las cuales fueron elaboradas por un panel de especialistas en la materia (Tabla 7). Conclusiones: todos los niños con fiebre menores de 28 días deben ser hospitalizados para tratamiento antibiótico parenteral. Los lactantes febriles entre 28 y 90 días de edad definidos como de bajo riesgo (criterios de Rochester) pueden ser manejados ambulatoriamente si se asegura un seguimiento diario del paciente. Aunque estas pautas no eliminan totalmente el riesgo de desarrollar Infección Bacteriana Severa (IBS), el médico debe individualizar su terapia basado en las características clínicas de cada paciente o adoptar variaciones basadas en la interpretación de estas evidencias.

Critical infections in the pediatric oncologic patient.

Over the past three decades, significant progress has been made in the treatment of childhood cancers. These advances derive not only from the effectiveness of the multimodal approach but also because of advances in supportive measures during the critical induction phase of therapy. The impact of disease and therapy on the immune system significantly compromises the child to a critical state. Astute application of the nursing process in assessing, planning, implementing, and evaluating measures to prevent, detect, and treat infectious processes in the granulocytopenic child is one of the critical challenges of nursing the child with cancer.