Chapter 5
Fever and Infections
Overview of the Home Care Plan for Fever and Infections
1. Understanding the Problem
Infections and the person with HIV/AIDS
Signs of infection
Fever as one sign of infection
Your goals
2. When To Get Professional Help
Symptoms that indicate an emergency
Symptoms that do not indicate an emergency but should be reported
Information to have ready when you call
What to say when you call
3. What You Can Do To Help
Reduce fever after reporting it
Prevent infections
4. Possible Obstacles to Caregiving
5. Carrying Out and Adjusting Your Plan
Checking on results
What to do if your plan does not work
Topics with an arrow (
) in front of them are actions you can take or symptoms you can look for.
Fever, defined as a temperature higher than normal, is the most common sign of an infection. Other common signs of infection include fatigue, swelling, shaking chills, cough, pain, and headache. Chronic fevers are common with HIV/AIDS, but when a new fever is noticed in a person with HIV/AIDS, it should be checked out by a doctor. Thereafter, chronic fevers should be watched carefully. Fevers may become persistent as the disease progresses, and such fevers are very physically taxing. A new fever that is higher than usual (greater than 101 °F [38.3 °C]) can be a sign of a new infection requiring treatment with new or different antibiotics. Untreated fevers also add to weakness and fatigue.
Infections are caused by organisms or germs, such as bacteria, viruses, and fungi, that invade the body and begin to grow. Persons who are HIV-positive or who have developed AIDS are more likely to get infections because their immune systems are not working to protect them. The AIDS virus attacks the immune system and destroys it. When the CD4 count (T4 lymphocyte count) is 200 or less, the person is especially susceptible to infections.
The information in this home care plan fits most situations, but yours may be different.
If the doctor or nurse tells you to do something else, follow what he or she says.
If you think there may be a medical emergency, see the section "When To Get Professional Help" on pp 52-55.
Your Goals
Know when to get professional help
Reduce fever after reporting it
Prevent infections
2. When To Get Professional Help
Symptoms that indicate an emergency
Call the doctor, nurse, or the "after hours" phone number immediately if any of the following occurs:
A temperature that is 2 degrees higher than the person's normal temperature (after you have checked the temperature twice over a 2-hour period).
Most normal oral temperatures are around 98.6 °F (37 °C) and can rise to 100.4 °F (38 °C) in the evening, but some people can have "normal" temperatures that are higher or lower than these. Consult with the doctor or nurse to learn beforehand (before an emergency occurs) what the normal temperature is of the person you are caring for. Bear in mind that a person with HIV/AIDS may have a chronic or persistent fever of 99 °F to 101 °F most of the time and that a normal temperature will usually rise in the late afternoon hours.
Check the temperature twice over a 2-hour period to be sure that there is a fever. You may want to buy a new thermometer if you have one that you do not trust or cannot read. A digital thermometer is the easiest to use and takes the guesswork out of taking a temperature: It lights up and shows you the exact temperature in digital numbers. Ask your pharmacist or a store clerk to help you select one.
A new fever when accompanied by any of the following symptoms:
Headache
Stiff neck
Shortness of breath
Abdominal pain
Low back pain
Nausea/vomiting/diarrhea
Mental changes or confusion
Lightheadedness or dizziness with standing or sitting
Skin rash
Severe shaking chills that last 20 minutes or that come and go over a 1-hour period.
Chills occur before a temperature goes up. Take the temperature after the chills and shaking have stopped unless they continue for more than 1 hour. Take a temperature during the chills if they last for more than 1 hour.
Frequent, painful urination.
Painful urination indicates a urinary tract infection. Usually the person with this type of infection urinates in very small amounts. A person with a urinary tract infection feels a constant urge to pass urine even if little urine is in the bladder.
No urine output for 24 hours.
It is very important to report if the person you are caring for has not urinated in the last day or has urinated very little. This condition has a variety of causes and needs to be investigated. It may be a sign of dehydration and may indicate the need for increased fluids, even intravenous (IV) fluids. It may also be a sign that the kidneys are not functioning properly.
New cough, shortness of breath, or rapid breathing.
Report any problems with the respiratory tract, especially the feeling that it is hard to draw air into the lungs or release it. Labored or difficult breathing, with or without a fever, is important to report.
When symptoms are not an emergency but should be reported
Some symptoms that should be reported during regular office or clinic hours, even though they do not indicate an emergency, include the following:
The person you are caring for has a fever and is too weak to drink fluids.
Report if the person you are caring for has a fever and is drinking very little. Drinking fluids is very important in a person with a fever because the body loses water when the body temperature rises. Dehydration may occur if the fever causes severe sweating and fluids are not being replaced.
Any redness or swelling near the site of a venous access device (for example, an IV, a Mediport, Hickman, Groshong, port-a-cath, or PICC Line).
Venous access devices can become infected at any time after placement. This can happen even when great care has been taken to keep the site clean and free of contamination.
Any change in appearance of an open wound on the skin.
Any open wound on the skin can become infected when the immune system is not working normally. The area may become more red and more tender. The wound may look deeper or the drainage from it may have changed color.
Cold symptoms, sore throat, or sinus pain or drainage.
Infections can develop quickly in the mouth or throat. Report these symptoms even if they are not accompanied by fever.
Any change in menstrual pattern, such as a missed menstrual period or bleeding between periods.
Menstrual abnormalities or irregularities have a variety of causes, including pregnancy, infection, tumors, and hormonal imbalances. Because the immune system of HIV-positive women is compromised, any potential sign of infection or cancer, such as a change in the menstrual pattern, should be reported.
Vaginal itching, irritation, or discharge.
Women with HIV/AIDS women tend to have more gynecologic infections than other women. Vaginal candidiasis, also known as a yeast infection, is the most common. Symptoms included vaginal itching and a white curdlike discharge. This infection often persists in women with HIV/AIDS, despite the use of over-the-counter medicine, so report the symptoms.
Lower abdominal pain.
In women with HIV/AIDS, lower abdominal pain may be a symptom of pelvic inflammatory disease (PID), a serious infection. This infection is equally likely in women with or without HIV/AIDS.
When you call, have the answers ready to the following questions:
1. For how many hours has the fever persisted (greater than 101 °F [38.3 °C] by mouth)?
2. Are the fevers sometimes less than 101 °F (38.3 °C)? If so, at what time of day?
3. How much liquid was taken over the last 8 hours?
4. Does the person you are caring for have an intravenous device, such as a Mediport, Hickman, Groshong, port-a-cath, or PICC Line?
5. Have any medicines been given to reduce fever or fight an infection (for example, acetaminophen, ibuprofen [Advil], or antibiotics)? If so, when?
6. Have you tried any other methods of reducing fever (i.e., not medication), such as sponge baths, fans, or cooling blankets?
7. Has the person you are caring for recently started taking any new medications? If so, what are they?
8. Were any blood counts measured recently, and if so, what were the test results?
9. For women, have there been any vaginal symptoms, lower abdominal pain, changes in menstrual flow or pattern of menstrual period?
Here is an example of what you might say when calling for professional help:
"I am Joan Smith, Alice Jones' caregiver. Joan is Dr. Black's patient. An hour ago, she had shaking chills that lasted for more than 20 minutes, and she had a temperature of 102.5 °F. Alice is also saying that she has a bad headache. What should I do? Do you think she has a new infection?"
Reduce fever after reporting it
Give acetaminophen.
Certain medicines (antipyretics), such as acetaminophen (e.g., Tylenol) or aspirin, reduce fevers. These drugs will not eliminate the cause of the fever, but they will make the person who is ill feel more comfortable. Give acetaminophen (2 tablets every 4 hours) for 24 hours, then stop. Check the temperature every 4 hours after this.
Make certain that all medications are taken that have been prescribed by the doctor for fever or infection.
Apply cool washcloths to the forehead of the person you are caring for if he or she is uncomfortably hot.
Cooling the forehead brings some relief from the discomfort of fever by cooling the blood that flows through the head close to the surface of the skin.
Change damp clothing and bed linens.
If fever is accompanied by profuse sweating, the person you are caring for can get chills from the moisture. This adds to the discomfort brought on by the fever.
Encourage drinking plenty of fluids during a fever.
Unless the doctor has instructed that fluids be restricted, encourage the person who has a fever to drink 2 to 3 quarts of cool fluids over a 12-hour period. During a fever, more fluids than usual are being lost through the skin and lungs, which may lead to dehydration. Drinking 2 to 3 quarts of fluids reduces this risk.
Prevent infections
If you have a cold, sore throat, or the flu, arrange for someone else to care for the person with HIV/AIDS until you are well.
If you cannot find anyone to fill in for you, make certain that you wash your hands carefully before caring for the ill person.
Do not share personal items.
It is especially important that anything that is used orally (for example, a thermometer or toothbrush) not be shared.
Ask people who have colds or who are ill to wait until they are better to visit.
Maintain good personal hygiene.
Hand washing is the best way to limit the spread of germs. Both the person with HIV/AIDS and those who come in contact with him or her should wash their hands frequently and brush their teeth at least twice daily to help kill the germs that cause infections. If this is a problem because areas of the skin or mouth are sore, read the home care plan "Problems with the Mouth" (Chapter 7).
Prevent infection caused by certain foods.
Infections can be caused by unwashed raw fruits and vegetables; raw or poorly cooked eggs, fish, meat, and poultry; and unpasteurized milk. This is because of the bacteria and parasites that these foods carry. Proper washing and cooking will destroy sources of infection in food. Proper food storage is also important.
Encourage drinking plenty of fluids.
Increased fluid intake will help prevent urinary infections. Urinary infections are less likely to occur when the kidneys, bladder, and urinary system are well flushed with plenty of fluids, especially water.
Encourage cleaning the rectal area thoroughly after bowel movements, especially if he or she has diarrhea.
Women especially should cleanse the rectal area from front to back to reduce the likelihood of a urinary tract infection. Also, keeping the rectal area clean, particularly when diarrhea is a problem, will help keep the rectal area from getting raw or sore.
Consult with the health professional if you are planning to travel.
You may need special immunizations and medicines to take with you.
Encourage wearing shoes or some other form of footwear to prevent cuts or sores on the feet.
Make sure that shoes fit well and do not rub or cause blisters. Wash cuts or sores immediately with soap and water. Even small cuts or sore areas on the feet can let bacteria into the body.
Encourage using lotions and moisturizers on the skin to prevent drying, chapping, or cracking.
Lotions boost the ability of the skin to stay intact by keeping the skin moist. Bacteria can enter dry skin cracks, leading to infection.
Encourage wearing gloves when working in soil.
Soil has bacteria that can cause infection when in contact with skin cuts.
Arrange for someone other than the person with HIV/AIDS to groom the pet, empty cat litter boxes, and clean pet cages or fish tanks.
Pet feces (stools) contain bacteria and fungi that can cause an infection in a person whose immune system is not functioning normally. If the person you are caring for is scratched or bitten by a pet, wash the site well and call the doctor or nurse if it begins to look infected. Stay up to date on routine vaccinations for your pets and tetanus boosters for yourself. Always wash your hands after handling pets, their toys, their hygiene items, their food and water, and their rugs and blankets. Be sure to have someone other than the person with HIV/AIDS wash fish tanks or reptile tanks.
4. Possible Obstacles to Caregiving
Here are some common attitudes, fears, and misconceptions that may prevent you from carrying out your plan:
"High fevers can be controlled by Tylenol. I'll just take a few and not worry."
> Response: High fevers, especially if they are new fevers, may indicate an infection. Taking a few acetaminophen tablets is not the only action needed. Careful monitoring of the fever and associated symptoms and reporting the temperature to the doctor or nurse is very important. This will ensure that treatment is started early, before the condition worsens.
"I've had fevers before, and they didn't last long. This one will go away like the others."
Response: Fevers can be the sign of a serious infection in the body. Remind the person you are caring for that fever needs to be reported, especially if it is new, so the infection can be treated.
Think of other obstacles
Identify additional roadblocks that could keep you from following the recommendations in this home care plan:
- Will the person with HIV/AIDS cooperate?
- Will other people help?
- How should I explain my needs to other people?
- Do I have the time and energy to carry out my plan?
You need to develop plans for getting around these roadblocks. Use the four COPE ideas (Creativity, Optimism, Planning, and Expert information) in developing your plans. See pp 4-8 for a discussion on how to use the four COPE ideas in overcoming your obstacles.
5. Carrying Out and Adjusting Your Plan
Checking on results
Check on how effectively you are controlling fevers and preventing infections. Are fevers and infections occurring less often? Pay attention to which recommendations are working for you and which ones the person with HIV/AIDS is following. (For example, is the person with HIV/AIDS avoiding situations that increase the risk of his or her getting an infection?) Keep a "diary" of your progress.
What to do if your plan does not work
1. Review this chapter.
2. If you find that you've skipped something, try it now.
3. If you find that you've done all that you can, call the doctor for further guidance.
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