Chills
Also known as rigors, chills are extreme, involuntary muscle contractions with characteristic paroxysms of violent shivering and teeth chattering. Commonly accompanied by fever, chills tend to arise suddenly, usually heralding the onset of infection. Certain diseases, such as pneumococcal pneumonia, produce only a single, shaking chill. Other diseases, such as malaria, produce intermittent chills with recurring high fever. Still others produce continuous chills for up to 1 hour, precipitating a high fever. (See Why chills accompany fever, page 144.)
CULTURAL CUE:Malaria infects as many as 500 million people annually in Africa, India, Southeast Asia, the Middle East, Oceania, and Central and South America. If a patient exhibits chills, be sure to ask if he has recently traveled to a foreign country.
Chills can also result from lymphomas, blood transfusion reactions, and certain drugs. Chills without fever occur as a normal response to exposure to cold.
History
Ask the patient when the chills began and whether they’re continuous or intermittent. Because fever commonly accompanies or follows chills, take his rectal temperature to obtain a baseline reading. Then check his temperature often to monitor fluctuations and to determine his temperature curve. Typically, a localized infection produces a sudden onset of shaking chills, sweats, and high fever. A systemic infection produces intermittent chills with recurring episodes of high fever or continuous chills that may last up to 1 hour and precipitate a high fever.
Ask about related signs and symptoms, such as headache, dysuria, diarrhea, confusion, abdominal pain, cough, sore throat, or nausea. Does the patient have known allergies, an infection, or a recent history of an infectious disorder? Find out which medications he’s taking and whether any drug has improved or worsened his symptoms. Has he received treatment that may predispose him to an infection (such as chemotherapy)? Ask about recent exposure to farm animals, guinea pigs, hamsters, dogs, and such birds as pigeons, parrots, and parakeets. Also ask about recent insect or animal bites, travel to foreign countries, and contact with persons who have an active infection.
Physical assessment
Take the patient’s other vital signs. Note and record the pattern of the patient’s temperature changes. Check his pulse rate. Infection commonly increases the pulse rate, but some infections, notably, typhoid fever and psittacosis, may decrease it. Assess the skin, mucous membranes, liver, spleen, and lymph nodes. Check for drainage from skin lesions. Note skin color, temperature, and turgor. Percuss for costovertebral angle tenderness to determine if cystitis is present. In addition, assess level of consciousness (LOC).
Medical causes
Acquired immunodeficiency syndrome
With acquired immunodeficiency syndrome (AIDS), the patient usually develops lymphadenopathy. He may also experience fatigue, fever and chills, anorexia and weight loss, diarrhea, diaphoresis, skin disorders, and signs of upper respiratory tract infection.
Anthrax (inhalation)
Inhalation anthrax is caused by inhalation of aerosolized spores of the bacterium Bacillus anthracis. Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial signs and symptoms. The second stage develops abruptly with rapid deterioration marked by fever, dyspnea, stridor, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.
Cholangitis
Charcot’s triad — chills with spiking fever, abdominal pain, and jaundice — characterizes cholangitis (the sudden obstruction of the common bile duct). The patient may have associated pruritus, weakness, and fatigue. Dark urine and light-colored stools may also be present.
Gram-negative bacteremia
This infection causes sudden chills and fever, nausea, vomiting, diarrhea, and prostration. The patient may also have tachypnea, hypotension, warm skin, decreased urine output, and an altered LOC.
Hemolytic anemia
With acute hemolytic anemia, fulminating chills occur with fever and abdominal pain. The patient rapidly develops jaundice and hepatomegaly; he may develop splenomegaly. Urine may be brown or red.
Hepatic abscess
Hepatic abscess usually arises abruptly, with chills, fever, nausea, vomiting, diarrhea, anorexia, and severe upper abdominal tenderness and pain that may radiate to the right shoulder. The patient may also report weight loss.
Hodgkin’s disease
With Hodgkin’s disease, the patient characteristically experiences several days or weeks of fever and chills alternating with periods of no fever and no chills. This disorder commonly produces regional lymphadenopathy that may progress to hepatosplenomegaly. Other findings include diaphoresis, fatigue, and pruritus.
Infective endocarditis
Infective endocarditis produces abrupt onset of intermittent, shaking chills with fever. Petechiae commonly develop. The patient may also have Janeway lesions on his hands and feet and Osler’s nodes on his palms and soles. Associated findings include murmur, hematuria, eye hemorrhage, Roth’s spots, and signs of cardiac failure (dyspnea, peripheral edema).
Influenza
Initially, influenza causes an abrupt onset of chills, high fever, malaise, headache, myalgia, and nonproductive cough. Some patients may also suddenly develop rhinitis, rhinorrhea, laryngitis, conjunctivitis, hoarseness, and sore throat. Chills generally subside after the first few days, but intermittent fever, weakness, and cough may persist for up to 1 week.
Legionnaires’ disease
Within 12 to 48 hours after the onset of legionnaires’ disease, the patient suddenly develops chills and a high fever. Prodromal signs and symptoms characteristically include malaise, headache and, possibly, diarrhea, anorexia, diffuse myalgia, and general weakness. An initially nonproductive cough progresses to a productive cough with mucoid or mucopurulent sputum and possibly hemoptysis. Most patients also develop nausea and vomiting, confusion, mild temporary amnesia, pleuritic chest pain, dyspnea, tachypnea, crackles, tachycardia, and flushed and mildly diaphoretic skin.
Lymphangitis
Acute lymphangitis produces chills and other systemic signs and symptoms, such as fever, malaise, and headache. Its characteristic signs are red streaks radiating from a wound and cellulitis draining toward tender, regional lymph nodes. The lymph nodes along the course of drainage may be enlarged, red, and tender.
Malaria
The paroxysmal cycle of malaria begins with a period of chills lasting 1 to 2 hours. This is followed by a high fever lasting 3 to 4 hours and then 2 to 4 hours of profuse diaphoresis. Paroxysms occur every 48 to 72 hours when caused by Plasmodium malariae and every 42 to 50 hours when caused by P. vivax or P. ovale. With benign malaria, the paroxysms may be interspersed with periods of well-being. The patient also has a headache, muscle pain and, possibly, hepatosplenomegaly.
Miliary tuberculosis
With the acute form of miliary tuberculosis, the patient suffers intermittent chills, high fever, and night sweats. Epididymal or testicular nodules and splenomegaly may also occur. Other signs and symptoms may include fatigue, malaise, joint pain, and swollen lymph nodes.
Otitis media
Acute suppurative otitis media produces chills with fever and severe deep, throbbing ear pain. The patient usually displays a mild conductive hearing loss and a bulging, hyperemic tympanic membrane. He may also have dizziness, nausea, and vomiting. When the tympanic membrane ruptures, pus drains externally through the ear canal and the patient feels relief.
Plague
Signs and symptoms of plague, a disease caused by the bacterium Yersinia pestis, include fever, chills, and swollen, inflamed, and tender lymph nodes near the site of the flea bite. Septicemic plague develops as a fulminant illness generally with the bubonic form. The pneumonic form may be contracted through direct person-to-person contact via the respiratory system or through biological warfare from aerosolization and inhalation of the organism. The onset is usually sudden with chills, fever, headache, and myalgia. Pulmonary signs and symptoms include productive cough, chest pain, tachypnea, dyspnea, hemoptysis, increasing respiratory distress, and cardiopulmonary insufficiency.
Pneumonia
A single shaking chill usually heralds the sudden onset of pneumococcal pneumonia; other pneumonias characteristically cause intermittent chills. With any type of pneumonia, related findings may include fever, productive cough with bloody sputum, pleuritic chest pain, dyspnea, tachypnea, and tachycardia. The patient may be cyanotic and diaphoretic, with bronchial breath sounds and crackles, rhonchi, increased tactile fremitus, and grunting respirations. He may also experience achiness, anorexia, fatigue, and headache.
Pyelonephritis
With acute pyelonephritis, the patient develops chills, high fever and, possibly, nausea and vomiting over several hours to days. He generally also has anorexia, fatigue, myalgia, flank pain, costovertebral angle tenderness, hematuria or cloudy urine, and urinary frequency, urgency, and burning.
Q fever
Signs and symptoms of Q fever, a rickettsial disease caused by the bacterium Coxiella burnetii, include fever, chills, severe headache, malaise, chest pain, nausea, vomiting, and diarrhea. The fever may last up to 2 weeks. In severe cases, the patient may develop hepatitis or pneumonia.
Rocky Mountain spotted fever
Rocky Mountain spotted fever begins with a sudden onset of chills, fever, malaise, excruciating headache, and muscle, bone, and joint pain. Typically, the patient’s tongue is covered with a thick white coating that gradually turns brown. After 2 to 6 days of fever and occasional chills, a macular or maculopapular rash appears on the hands and feet and then becomes generalized; after a few days, the rash becomes petechial.
Septic shock
Initially, septic shock produces chills, fever and, possibly, nausea, vomiting, and diarrhea. The patient’s skin is typically flushed, warm, and dry; his blood pressure is normal or slightly low; and he has tachycardia and tachypnea. As septic shock progresses, the patient’s arms and legs become cool and cyanotic, and he develops oliguria, thirst, anxiety, restlessness, confusion, and hypotension. Later, his skin becomes cold and clammy; his pulse, rapid and thready. He further develops severe hypotension, persistent oliguria or anuria, signs of respiratory failure, and coma.
Tularemia
Signs and symptoms following inhalation of the gram-negative non-spore-forming bacterium Francisella tularensis include the abrupt onset of fever, chills, headache, generalized myalgia, nonproductive cough, dyspnea, pleuritic chest pain, and empyema. Other signs and symptoms of tularemia include a red spot on the skin that ultimately enlarges to an ulcer, enlarged lymph nodes, conjunctivitis, diaphoresis, and joint stiffness.
Other causes
Drugs
Amphotericin B is a drug associated with chills. Phenytoin is also a common cause of drug-induced fever that can produce chills. I.V. bleomycin and intermittent administration of an oral antipyretic can also cause chills.
I.V. therapy
Infection at the I.V. insertion site (superficial phlebitis) can cause chills, high fever, and local redness, warmth, induration, and tenderness.
Transfusion reaction
A hemolytic reaction may cause chills during the transfusion or immediately afterward. A nonhemolytic febrile reaction may also cause chills.
Special considerations
Check the patient’s vital signs often, especially if his chills result from a known or suspected infection. Be alert for such signs of progressive septic shock as hypotension, tachycardia, and tachypnea. If appropriate, obtain samples of blood, sputum, or wound drainage for culture to determine the causative organism. Give the appropriate antibiotic. Radiographic studies and serum samples and urine specimens may be required.
Because chills are an involuntary response to an increased body temperature set by the hypothalamic thermostat, blankets won’t stop a patient’s chills or shivering. Despite this, keep his room temperature as even as possible. Provide adequate hydration and nutrients, and give an antipyretic to help control fever. Irregular use of an antipyretic can trigger compensatory chills.
Pediatric pointers
Infants don’t get chills because they have poorly developed shivering mechanisms. In addition, most classic febrile childhood infections, such as measles and mumps, don’t typically produce chills. However, older children and teenagers may have chills with mycoplasma pneumonia and acute pyogenic osteomyelitis.
Geriatric pointers
Chills in an elderly patient usually indicate an underlying infection, such as a urinary tract infection, pneumonia (commonly associated with aspiration of gastric contents), diverticulitis, or skin breakdown in pressure areas. Also, consider an ischemic bowel in an elderly patient who comes into your facility with fever, chills, and abdominal pain.
Patient counseling
Advise the patient to measure his temperature with a thermometer when he experiences chills and to document the exact readings and times. This will help reveal patterns that may point to a specific diagnosis. Make sure he understands how to follow his treatment regimen, including taking the full course of antibiotics. Explain signs and symptoms that signal worsening of his condition as well as when to seek medical attention.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Chills
Read excerpts from these other book chapters related to Chills:
Medical Books Excerpts
- CHILLS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- CHILLS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Common cold
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Skin, clammy
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, clammy
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Chills
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- CHILLS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Chills
» Next page: Skin, clammy (Nursing: Interpreting Signs and Symptoms)
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