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Ask the patient about the onset and duration of the fever. Ask the patient to describe the pattern of the fever. Did the temperature rise progressively or did it rise, disappear, and then reappear? Does he have accompanying symptoms, such as chills, headache, fatigue, diarrhea, or pain? Has the patient recently had an infection or exposure to an organism or someone else who was ill? Ask the patient whether he was exposed to high temperatures for a prolonged period of time. Ask about his work environment and water consumption while working. Has the patient experienced unusual physical or emotional stress recently? Ask if he has had any burns or trauma, undergone surgery under general anesthesia, or received a blood transfusion. Does the patient have a history of endocrine dysfunction or malignant hyperthermia? Is he taking thyroid medication? Ask the patient about other medications that disrupt thermoregulatory function such as salicylates as well as drugs that impair sweating, such as antibiotics, anticholinergics, monoamine oxidase inhibitors, or phenytoin.
Perform a physical examination based on the patient’s health history. Note the rate and depth of the patient’s breathing and any changes from normal respiratory patterns. Inspect the skin color and temperature. Check the skin turgor and monitor for diaphoresis. Assess for signs of trauma or needle marks on the arms or legs. Inspect for shivering of the body or flushing of the face. Assess his oral mucosa for lesions or signs of dehydration. Assess the patient’s mental status and be alert for signs of malaise, fatigue, restlessness, or anxiety. Auscultate lung fields and the abdomen. Monitor vital signs and the cardiac rate, rhythm, and intensity. Keep in mind that palpating the thyroid gland of a patient with hyperthyroidism can induce thyrotoxicosis.
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
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