The management of febrile symptoms is a significant problem affecting virtually every persons living with AIDS (PLWA). While medical care treats the underlying infection, nursing fever management is directed at symptomatology, regardless of etiology. There are presently no widely held standards for care of symptoms during fever. Common approaches that attempt cool patients to euthermic temperatures are counterproductive and distressful. Cooling during the chill phase provokes warming responses that increase oxygen consumption and cardiorespiratory effort, which are poorly tolerated by PLWAs who are debilitated, anemic or have respiratory problems. Dehydration, a frequent problem for PLWAs, is related to both cause and effect of fever. Yet it is seldom aggressively treated with oral fluids. Interventions are needed, based on dynamics of and responses to febrile activity This experimental study tests a scientifically based protocol for febrile symptom management in PLWAs, centered on the heightened sensitivity and lowered threshold to shivering caused by the elevated hypothalamic set point range in fever. Rehydration increases blood volume, restabilizes circulation to skin and allows heat to be lost from the body surface. The protocol is aimed at preventing rapid heat loss that stimulates shivering and vasoconstriction, maintaining body temperature within a safe range, restoring fluid balance, avoiding fatigue and promoting thermal comfort during fever. A quasi-experimental design compares two cohort groups. Year 01 the first cohort is a control group where routine care is monitored. Year 02, the second cohort is randomly assigned to treatment/control conditions. Subjects are adults (n = 105) PLWAs with temperature """"""""spikes"""""""" of 1 degree C in one hour, seen in the HIV/AIDS unit of a large teaching hospital and followed to its clinic.
Specific aims are to test the efficacy of a structured febrile symptom management protocol during acute fever episodes in PLWAs to: 1) reduce frequency, severity, duration and reactivation of shivering; 2) reduce distress, chill perception and fatigue from chills; 3) influence cardiorespiratory indicators of exertion; 4) influence body temperature patterns and variability; 5) control shivering when aggressive cooling treatments are warranted; and 6) to maintain body hydration. Portable multichannel systems are used to monitor shivering by electromyograph, skin and aural temperature, blood pressure and heart rate. Thermal perception, thermal comfort, fatigue, and chills are measured by Visual Analog Scales (VAS). Body water loss is measured by assessing skin, weight loss, and sweating severity. Interval level physiological data and VAS scores are compared between treatment and control groups by Analysis of Variance. Categories of shivering and sweating severity are compared by chi-square analysis.
| Holtzclaw, B J (1998) Managing fever in HIV disease. J Assoc Nurses AIDS Care 9:97-101 |
