Campus News

Fever: it’s more than a number

As fever checks get more and more common, what do we need to know?  A Carolina emergency nurse practitioner explains.

Hand holding thermometer after taking a child's temperature.
(Shutterstock image)

Fever can act as a signal that your body is fighting to prevent infection or other threats to well-being, but it can also set off alarms that need quick attention.

To better understand fever, The Well posed some questions to Margaret (Meg) Carman, a clinical associate professor at Carolina’s School of Nursing and certified acute care and emergency nurse practitioner in the School of Medicine’s emergency department.

What’s the definition of fever?

Fever is defined as an elevation of body temperature above normal. Fever in general is an indication that the body is mounting an immune response to something that shouldn’t be there, such as infection.

It’s not really about the number, although the traditional number considered to be a normal temperature is 98.6 F (or 37.0 degrees C). The individual’s core temperature is most accurate, as oral temperature or other routes of measurement can be affected by normal things like drinking cold or hot fluids.

Fever is actually good because it means that you’re able to fight off an infection such as the flu or something else that is compromising or threatening your body. In the emergency department, it’s just one piece of the data we look at.

If someone feels hot and ill, when should that person begin treatment?

Meg Carman

Meg Carman

It depends on the overall picture. You can get an elevated temperature or a fever simply by being outside on a hot North Carolina day. For that, you need to go inside and get cool if you’re feeling ill.

It depends on how sick the person is, who has the fever or, with a child, what a parent observes. If a child is not eating or drinking, if they are not making tears when they cry or aren’t urinating, that’s when we really want you to say, ‘Wow, this is time to get some medical help.’ With prolonged fevers or fevers that don’t come down, if medicine is not making the fever come down, or if there is confusion or lethargy (unusual sleepiness), then it’s time to get some expert advice and to either call a nurse line or go to an urgent care location or to the hospital.

But it’s all about the big picture. How much is fever affecting the patient? For instance, parents know their children and can tell if something’s really off and the fever’s not coming down after giving them medicine. If they’re still not playful or they’ve had a fever for several days or you see the fever represents something causing them to pull at their ears or cry a lot or they’re really flushed, that’s concerning and it’s time to ask somebody for help. Fever itself most people can manage, but if you are concerned or something seems wrong, seek medical help.

Adults also need be aware of earaches, sore throat or other symptoms that might indicate that there is serious infection, perhaps caused by bacteria.

In addition to medicine, applying cool compresses to pulse points or a tepid bath are fine. Nothing cold, as cold can make people with fever have seizures.

How do you respond to the old saying ‘Feed a cold, starve a fever’?

Individuals usually don’t get a fever with a simple cold, but a fever with serious pain, shortness of breath or severe symptoms likely means you should seek medical care. In terms of ‘Feed a fever, starve a cold,’ I would consider that an old wives’ tale. If you have fever, you are at risk for becoming dehydrated, so make sure that you drink plenty of clear liquids. Water is fine. Stay well hydrated no matter what the source of a fever. It could be the flu; it could be anything, so you want to make sure that you stay well hydrated. If you don’t feel like eating, don’t push yourself to eat when you’re sick.

During the pandemic, do you and your colleagues have any advice about care options?

Yes. If you have an emergency, it’s important to go to the emergency room. Certainly, every time you call the doctor’s office, a recording tells you to dial 911 if it’s a medical emergency. However, if you’re just concerned, then a lot of times it’s better to pick up the phone and talk with someone about whether you should proceed to the emergency department or to a doctor’s office.

We’re all concerned about transmission of flu and COVID. Visiting a physician’s office or an urgent care clinic or an emergency department only because of fever isn’t usually necessary. If you have a question, you should call and get some advice from medical professionals, from a nurse line or ask your physician’s office. It might not be necessary to come into the office and possibly spread infectious disease like the flu or COVID-19.

Telemedicine offers many options if you have an emergency.

Some of the things that need immediate attention by a medical professional are if you are unable to reduce the fever or if there is neck pain or stiffness with the fever. Certainly, if you have fever and shortness of breath or fever with chest pain or abdominal pain, or if someone has confusion or has a severe headache or prolonged fever that doesn’t go down.

(Editor’s note: Many healthcare providers offer nursing advice via phone or via video visits. UNC Health Care, for instance, offers virtual care three ways.)

When a child has fever, what should we be aware of?

Make sure that they are nursing or drinking plenty of fluids and are making tears if they cry, particularly for infants and babies, and that they’re making good amounts of urine. If the urine is getting very dark or they’re not urinating for long periods of time, then make sure to get those children checked out. Make sure that they’re not becoming severely dehydrated.

It’s more important for kids and elderly. People should also know that newborns and elderly or people who are immune-suppressed may have severe infection but not mount a fever. So, if something’s wrong, don’t not call because there is no fever.

If you get a headache when your fever’s high, it may be associated with the fever. But, if you take some medicine and the fever comes down and you still have severe headache or neck pain, we start worrying.

How high does a fever need to be for an adult or a child before we seek medical care immediately?

It’s not solely about a number. Kids, not much over 104. Adults in general, 101.5-102. But it’s not just about a number.