[NP-Clinical] Re: question for the list -definition of fever..thank you all

Sat Jan 13 19:42:56 PST 2007

I agree with all, once again it goes back to the individual patient, and that a practitioner cannot be so "literal" in taking one person's opinion, whether it be that of ID expert or not..There are vast differences, and I also agree that sub temperatures, especially in elderly, chemo pts, and other immune compromised are also possibly septic...I just wanted to check if there was some body of evidence that was consistent about the "fever" definition, but regardless of whether there is or not, it is a dangerous practitioner that gets caught on semantics and not viewing the entire picture and using critical thinking skills.Thanks again, Tracy, Diane, others.. Carla /Portland, OR

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Today's Topics:

1. Re: Re: question for the list re: definition of "fever"
(Maggie Garancosky)

----------------------------------------------------------------------

Message: 1
Date: Sat, 13 Jan 2007 21:46:27 -0500
From: Maggie Garancosky 
Subject: Re: [NP-Clinical] Re: question for the list re: definition of
"fever"
To: NP Clinical 
Message-ID: <45A99983.9090808 at mindspring.com>
Content-Type: text/plain; charset="us-ascii"

2 degrees above baseline is accepted as fever, at least in geriatric
patients. This seems the most sensible, taking individual
differences into account.

Maggie

Carla Anderson wrote:

> Hi, I have a question about the definition of fever. In my opinion, a 
> patient may have a constellation of symptoms, and an elevated body 
> temperature is something to evaluate. I believe that one must look at 
> the individual patient, and not just categorize generally. However, a 
> question has come up with a physician who states that a fever is "over 
> 101" per Infectious Disease definition. I have read several 
> references, including a couple dictionary definitions where the term 
> "fever" refers to "elevation in body temperature". This is how I have 
> also viewed it. But I also found on the website for American Academy 
> of Family Physicians, the American Family Physician 
> (http://www.aafp.org/aft/20031201/2223.html) that the definition for 
> "fever of unknown origin", which is not just "fever" is defined as 
> "temperature > 38.3 degrees Celsius, or 100.9 degrees F, and lasting > 
> 3 weeks. (FUO). I am just wishing to know your opinions/knowledge 
> regarding this, as a physican corrected me when I was stating that a 
> patient had a "fever" of 99.6F...he said it was not a fever according 
> to "Infectious Disease".. I admit, this must be taken into context, 
> and the patient's overall health needs are the priority, but I was 
> just curious if any of you had different views. Thank you, Carla 
> Anderson FNP/Portland, OR
>
> np-clinical-request at nurse.net wrote:
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> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of NP-Clinical digest..."
>
>
> Today's Topics:
>
> 1. Zithro for Sinus Infections... (Christine Smith)
> 2. Re: It's that time again (Kimberly Spering)
> 3. Re: It's that time again (Kimberly Spering)
> 4. MRSA UTI (Pat Camillo)
> 5. palpating spleens in suspected mono-reliable? (Lorraine Loretz)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Sat, 13 Jan 2007 05:44:02 -0800
> From: "Christine Smith"
> Subject: [NP-Clinical] Zithro for Sinus Infections...
> To: "NP Clinical"
> Message-ID: <021701c73718$e433eee0$6401a8c0 at ChristineNB>
> Content-Type: text/plain; charset="iso-8859-1"
>
> I have actually seen Zithro dosed twice for Acute Bacterial
> Sinusitis. The ENT MD who is on call to our ER told me that true
> bacterial sinus infections often take more than one abx course as
> they are hard to penetrate. He suggested to me that exact regimen
> (since Zither is a 5 day abx but really continues to work for 10
> days - so 5 days on, hold 5 days and then repeat). I since have
> rx'd standard Amox 500 TID x 10 days, then repeated if some
> improvement but not resolved with good success. If Amox is not
> improving them some by day 9 or 10 I switch to Bactrim DS for 10
> days. I don't usually ever do Augmentin because of the cost but if
> they have insurance I consider it. I know there is alot of
> resistance to Amox but if a patient has not had many abx in the
> past it seems to work well for many of my patients. I think the
> assumption is that it is likely a chronic sinusitis and not acute.
> If you do a literature search you should be able to find that a 20
> day course of abx is requ!
> ired for those patients.
>
> My vote for the etiology of the hives goes to the PCN portion of
> the Augmentin. There is nothing to make me think Mono - Sinusitis
> would not present like a strep throat infection. I doubt this is
> cold induced urticaria. It began right after she finished her
> Augmentin - not uncommon for PCN allergies to occur this way.
>
> As for Zrytec - love the drug for Seasonal allergies, better than
> Claritin or Allegra in my highly allergic daughter but I
> personally have never thought it was near as good for Urticaria as
> good old Benedryl even though it is approved. I would never give a
> Zyrtec as an emergent treatment for Urticaria, but I give Benedryl
> all the time as it works so quickly. Too pricey and not covered on
> lots of plans too. That said, I sure wish I could get some samples
> for my kid.
>
> Kathleen - abdominal exam to check for splenomegaly seen with
> Mono. Your daughter is classic age for mono but assuming she has a
> good PCP, he must have not seen anything to make him consider Mono.
>
> Christine Smith, NP
>
> ----- Original Message -----
> From: Kathleen
> To: NP Clinical
> Sent: Friday, January 12, 2007 7:39 AM
> Subject: Re: [NP-Clinical] Help with Hives......Just some
> thoughts.....
>
>
> No mono testing done and why an abdominal exam? Her doc seems to
> think that her sinus infection is not resolved and that's why the
> Zith paks. The doc is calling me back this PM and I will ask about
> the mono test. Thanks.
> Kathleen
>
> mmhelgert46 at comcast.net wrote:
> I wonder if.......this 15 year old didn't actually have Mono and
> the "hives" weren't actually an Amoxicillin rash secondary to
> Augmentin 875?
> I know psych folks don't treat alot of medical
> problems...but...was a mono spot done? or an abdominal exam?
> just my thoughts.......
>
> Adolescent 15 yo female on Amoxicillin 875 bid for sinus infection
> for ten
> days. On 11th day with no antibiotic given developed hives,
> benadryl gave some
> relief but not entirely, still breaking out. No wheezing or SOB.
> Off antibiotic
> for four days, put on azythromycin for 10 days yesterday (5 days
> on and wait 5
> days, then do the next pack for five days), and Alavert
> (loratadine 10mg qd),
> still hives but not as much. What next? Continue with same
> treatment? (This is
> my daughter, by the way). Thoughts?
>
> Kathleen Allen, Psych. NP
>
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> ------------------------------
>
> Message: 2
> Date: Sat, 13 Jan 2007 08:55:33 -0500
> From: "Kimberly Spering"
> Subject: Re: [NP-Clinical] It's that time again
> To: "NP Clinical"
> Message-ID: <004201c7371a$7ee47fd0$2e01a8c0 at Kim2>
> Content-Type: text/plain; charset="iso-8859-1"
>
> Julie~
>
> My thoughts and prayers have continued for you along this
> journey...now there is more "light at the end of the tunnel." So,
> extra hugs sent your way for the 17th~
>
> Kim Spering
> OB-GYN
> ----- Original Message -----
> From: Julie Orfirer
> To: np-clinical at nurse.net
> Sent: Thursday, January 11, 2007 3:17 PM
> Subject: [NP-Clinical] It's that time again
>
>
> Hey all. I can't believe it but I'm getting ready for surgery
> again! At least this time it has nothing to do with nodes and
> margins and treatment decisions. Just replacing the tissue
> expander with an implant. Hopefully this'll be an easy recovery -
> no drain!, small incision even tho it is into the muscle.....
>
> So, I'm asking again for good thoughts, energies, prayers as I
> wait in the holding area preparing to go into the OR. It's
> scheduled for 10:30 eastern time on the 17th (next Wednesday). You
> guys did me good in the past. I hope this is the last time I have
> to ask!
>
> Thanks for your love and support!
>
> Julie
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> ------------------------------
>
> Message: 3
> Date: Sat, 13 Jan 2007 08:58:30 -0500
> From: "Kimberly Spering"
> Subject: Re: [NP-Clinical] It's that time again
> To: , "NP Clinical"
>
> Message-ID: <004701c7371a$e84805a0$2e01a8c0 at Kim2>
> Content-Type: text/plain; format=flowed; charset=iso-8859-1;
> reply-type=original
>
> Priscilla~
>
> Gee, waiting is the hardest part for many of us--myself included.
> You and
> your hubby are in my thoughts and prayers this week, too. Take care~
>
> Kim Spering
> OB-GYN
>
> ----- Original Message -----
> From:
> To:
> Sent: Thursday, January 11, 2007 3:35 PM
> Subject: RE: [NP-Clinical] It's that time again
>
> > So, on a similar note, my hubby and I go for his neck mass
> biopsy results
> > today. I was expecting the worse, hoping for the best, but not in my
> > wildest dreams expecting NO news! So no results after one week.
> We are
> > to
> > call tomorrow around 1 pm. I must admit to being a bit more
> nervous since
> > he said, if all was well, we'd know in a couple of days and if
> suspicious,
> > it goes through a longer process. The endoscopy was clear and he
> just saw
> > "a bunch of matted nodes with one large one adherent to the
> > sternocleidomastoid." He said he truly didn't know what it was
> so that
> > gives me some hope. Since he knows I'm a NP, I think he would've
> come out
> > and said it WAS lymphoma/cancer. Whatever will be, I know we'll
> be OK but
> > the waiting is the toughest. I will keep you updated since
> you're a great
> > source of support.
> >
> > Priscilla Merrill FNP
>
>
>
>
> ------------------------------
>
> Message: 4
> Date: Sat, 13 Jan 2007 09:53:34 -0500
> From: "Pat Camillo"
> Subject: [NP-Clinical] MRSA UTI
> To: "NP Clinical"
> Message-ID: <005301c73722$9a72a990$40864b0c at IBME6A21918636>
> Content-Type: text/plain; charset="iso-8859-1"
>
> Recently saw a woman who had been having 2-3 UTI's a year, ran a
> culture - came back MRSA.......tx with cipro which was found to be
> sensitive.......she also complains of vulvar burning .....tx with
> terazole thinking it was yeast following multiple antibiotic
> therapies......some relief but not gone. I'm beginning to wonder
> if perhaps the vulvar complaint might be related to the MRSA.....
>
> Any thoughts would be appreciated :)
>
> Pat
>
> Pat Camillo PhD,RN,APN,C
> Certified Nurse Practitioner in Women's Health,
> Gerontology and Menopause
> Carmenta Health
> 1 Kalisa Way Suite 103
> Paramus, New Jersey 07652
> (201) 265-9042
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> ------------------------------
>
> Message: 5
> Date: Sat, 13 Jan 2007 17:22:33 GMT
> From: "Lorraine Loretz"
> Subject: [NP-Clinical] palpating spleens in suspected mono-reliable?
> To: np-clinical at nurse.net
> Message-ID: <20070113.092245.3483.1909600 at webmail12.lax.untd.com>
> Content-Type: text/plain; charset="us-ascii"
>
> Following the thread on sinusitis with the mention of r/o mono:
>
> <<-- "Christine Smith" wrote:
>
> Kathleen - abdominal exam to check for splenomegaly seen with
> Mono. Your daughter is classic age for mono but assuming she has a
> good PCP, he must have not seen anything to make him consider
> Mono. Christine Smith, NP>>
> I'll always try to palpate the spleen, but based on my reading I'm
> not very secure in trusting the exam. Splenomegaly trivia from one
> of my sports med lectures:
>
> Spleen size is not a reliable guide to splenic function, and
> palpable spleens are not always abnormal.
> Patients with COPD and low diaphragms commonly have palpable
> spleens. In one study, 3% of college freshmen had palpable
> spleens; an additional study showed that 5% of hospitalized
> patients with normal spleens based on scan results were thought to
> have palpable spleens by their physicians. Experienced MD's had
> 27-58% accuracy in detecting an enlarged spleen in one study.
> Although most patients do not have a palpable spleen on physical
> examination, a study of 29 patients who were hospitalized with
> infectious mononucleosis (and who therefore may have had more
> severe disease) found that all patients had splenomegaly on
> ultrasound examination and that one half of them had hepatomegaly.
> Only 17 percent of the enlarged spleens and 8 percent of the
> enlarged livers were palpable on physical examination, a finding
> that is consistent with other studies. (Ebell, 2004)
> Examination should include palpation with the patient in the
> supine and right lateral decubitus position, with knees up and
> hips flexed. Apply light fingertip pressure as the patient slowly
> inspires. The use of the reverse Trendelenburg position may aid in
> bringing the spleen into contact with the examiner's fingers. This
> is especially helpful in patients with morbid obesity.
> American Academy of Pediatrics, American Academy of Family
> Physicians, American Academy of Pediatrics, American Medical
> Society for Sports Medicine, American Orthopedic Society for
> Sports Medicine, American Osteopathic Society for Sports Medicine.
> 2005. Preparticipation physical evaluation, ed 3. Minneapolis, MN:
> McGraw Hill, 98pp.
> Ebell, MH. 2004. Epstein-Barr virus infectious mononucleosis. AFP
> 70(7):1289-90.
> Lorraine Loretz, DPM, NP (and bucking for Queen of Trivia award)
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