The mean oral temperature is 36.8+/- 0.4C (98.2+/- 0.7_F), with low levels at 6 A.M.& higher levels at 4 to 6 P.M.
In women who menstruate, the A.M. temperature is generally lower in the 2 weeks before ovulation; it then rises by about 0.6 C ( 1 F) with ovulation& remains at that level until menses occur.
Body temperature is elevated in the postprandial state.
Elderly individuals have a reduced ability to develop fever, even in severe infections.
Common Sites for Temperature Measurement WWW.SMSO.NET Uses Cons Pros Site Most common site in adults and children over 5. Affected by eating, drinking, etc. Temperature varies within oral cavity. Hard to keep thermometer in place, esp. if edentulous. Easy access Familiar Minimally invasive Oral cavity Often requested by MDs as the 'most accurate' site for core temperature. Site records highest temp in body. Lags behind other core sites when temp is changing rapidly. Preferred by MDs. Rectum Most common site in children under 5. Sometimes used during surgery. Reflects skin temperature. Not always a good indicator of core temperature. Must be held in place. Takes long time to reach equilibrium. Easy access Familiar Minimally invasive. Preferred by American Academy of Pediatrics for use in infants. Axilla Commonly used in hospitals and clinics. Requires thorough training and attention to technique. Easy access Familiar Minimally invasive. Two sites available. Reflective of brain temperature. Ear
Body Normal Temperature WWW.SMSO.NET 36.8 c Mouth 36.4 c Axilla 37.7 c Rectum 36.8 c Ear
Electronic/Disposable Thermometer Skill 31-1: Step 6C(7). Thermometer tip in axilla. View
Elevation of body temperature that exceeds the normal daily variation& occurs in conjunction with an increase in the hypothalamic set point
The processes of heat conservation (vasoconstriction)& heat production (shivering / increased metabolic activity) continue until the temperature of the blood bathing the hypothalamic neurons matches the new thermostat setting.
Types WWW.SMSO.NET examples character type Typhoid fever, typhus, drug fever, malignant hyperthermia. Does not remit Continued Pyogenic infection, lymphoma, military T.B. Temperature falls to normal everyday Intermittent Not characteristic for any particular disease. Daily fluctuation >2c .temperature dos not return to normal Remittent Malaria: tertian-3days pattern, fever peaks every other day (plas. Vivax, plas.ovale), quatrain-4day pattern . fever peaks every third day (p.malaria) lymphoma: HODJKIN lymphoma Pyogenic infection Temperature returns to normal for days before rising again Relapsing
Hyperthermia is characterized by an unchanged (normothermic) setting of the thermoregulatory center in conjunction with an uncontrolled increase in body temperature that exceeds the body’ ability to lose heat.
Drug-induced hyperthermia by MAOIs, tricyclic antidepressants, & amphetamines,phencyclidine (PCP), LSD, or cocaine.
Malignant hyperthermia occurs in individuals with an inherited abnormality of skeletal-muscle sarcoplasmic reticulum that causes a rapid increase in intracellular calcium levels in response to halothane& other inhalational anesthetics or to succinylcholine.
The neuroleptic malignant syndrome (NMS) with neuroleptic use (antipsychotic phenothiazines, haloperidol, prochlorperazine, metoclopramide) or the withdrawal of dopaminergic drugs characterized by “lead-pipe” muscle rigidity, extrapyramidal side effects, autonomic dysregulation& hyperthermia.
The serotonin syndrome , seen with (SSRIs), MAOIs& other serotonergic medications, has many overlapping features, including hyperthermia, distinguished by diarrhea, tremor, myoclonus rather than the leadpipe rigidity of NMS.
Thyrotoxicosis&pheochromocytoma can also cause increased thermogenesis.
Treatment of fever in some groups of patients is specially recommended.
Fever increases the demand for oxygen (i.e., for every increase of 1C over 37C, there is a 13% increase in oxygen consumption) aggravating preexisting cardiac, cerebrovascular, or pulmonary insufficiency.
Elevated temperature can induce mental changes/hallucinations in patients with or without organic brain disease.
Children with a history of febrile or nonfebrile seizure should be aggressively treated to reduce fever.
In hyperpyrexia, the use of cooling blankets facilitates the reduction of temperature; but should not be used without oral antipyretics.
In hyperpyretic patients with CNS disease or trauma, reducing core temperature reduces the ill effects of high temperature on the brain