FEVERS IN GENERAL
Fever is an abnormal condition characterized by an elevation of body
temperature, quickened respiration and circulation, and a certain
amount of tissue waste. This elevation of temperature may be due to
various conditions, such as local inflammation, infectious diseases,
disturbed metabolism and food poisoning (ptomaine).
~Tissue Waste in Fevers.~--Fevers of short duration, such as accompany
colds, tonsillitis, chicken pox and intermittent fever, remittent
fever, and at times malarial fever, do not cause sufficient tissue
waste to make the nutrition the important feature of the treatment. In
ptomaine poisoning the tissue waste may be great, but it is the result
of the poisoning, as is the fever, so that the diet needs to be
adjusted only after the disturbance has abated. In the beginning,
starvation is instituted and the fever disappears when the poisoning
is controlled.
~Treatment of Fevers of Short Duration.~--In all fevers of short
duration then, the treatment is directed with the following points in
mind: (1) relieving the cause, (2) preventing gastro-intestinal
disturbances, (3) saving the heart, kidneys, etc., extra strain.
~Dietetic Treatment.~--In doing this the diet is so formulated as to
meet the above-mentioned conditions, and fluids seem the best form in
which food can be given to bring about the desired results. The
quantity of fluids should be small and the intervals between feedings
short. Two-hour intervals seem best in the beginning. These intervals
are lengthened as the fever decreases and the amount of food at each
feeding increased. When convalescence is established, semi-solid, soft
or convalescent diet may replace the fluids and the patient gradually
brought back to a normal diet.
~Fluid Diet.~--The following foods constitute a fluid diet: milk,
whole milk, plain, peptonized, or albumenized, buttermilk, koumiss,
malted milk, milk shake, milk punch, cream, whey; fruit beverages,
plain, albumenized, or mixed with whole raw egg; eggnog, milk and
ginger ale, cocoa, strained gruels, broths reenforced with egg or
plain. Carbonated water may be added to milk or fruit beverages.
~Schedule of Feeding.~--The following schedule may be used as a guide
in fevers of short duration:[95]
I
7 A.M. 6 oz. hot milk or cocoa.
9 A.M. 6 oz. broth reenforced with egg.
11 A.M. Milk shake.
1 P.M. Oatmeal gruel, 4 oz.; 2 oz. cream.
3 P.M. Albumenized orange juice, 4 oz.; 1 egg white.
5 P.M. 6 oz. broth reenforced with egg white.
7 P.M. 6 oz. cocoa.
9 P.M. 6 oz. malted milk.
12 M. 4 oz. hot milk and 2 oz. cream.
and
4 A.M.
The above furnishes approximately 750 calories.
II
7 A.M. 6 oz. cocoa.
9 A.M. 4 oz. oatmeal gruel, 2 oz. cream.
11 A.M. Eggnog.
1 P.M. Milk broth reenforced with egg. (3 oz. milk, 3 oz. broth,
1 egg white.)
3 P.M. Cream, egg and vichy.
5 P.M. Albumenized milk, 6 oz.
7 P.M. Hot malted milk chocolate, 6 oz.
9 P.M. Milk broth reenforced with egg.
12 M. 4 oz. oatmeal gruel, 2 oz. cream.
4 A.M. 6 oz. malted milk (half water, half milk).
Furnishing approximately 1500 calories.
III
7 A.M. Oatmeal gruel, 4 oz., 2 oz. cream.
9 A.M. Orange eggnog.
11 A.M. Malted milk chocolate (3 oz. milk, 3 oz. water).
1 P.M. Clam broth (milk), 6 oz.
3 P.M. Milk shake, 4 oz.; 2 oz. cream.
5 P.M. Cornmeal gruel, 4 oz.; 2 oz. cream.
7 P.M. Hot cocoa, 6 oz.
9 P.M. Hot malted milk.
12 M. Hot milk, 4 oz.; 2 oz. cream.
4 A.M. Hot milk, 4 oz.; 2 oz. cream.
Furnishing approximately 1460 calories.
The two night feedings may be omitted if patient is asleep.
These diets will be seen to be below the maintenance requirements in
health, but the need for care in preventing gastro-intestinal
disturbances makes it safer to have it so for a few days, especially
if the elevation of temperature is great. After the temperature
becomes normal the following foods may be added to the diet:
~Soft or Convalescent Diet.~--Cream soups, soft-cooked, creamed, or
poached egg, soft or baked custard, junkets, egg, cocoa, or plain
vanilla ice cream, soft toast, milk or cream, buttered toast, cereals,
gelatin jellies, fruit, wine, or meat jellies, vegetable purees, baked
white potato, apple sauce, baked apple, fruit whip, blanc-mange,
broiled lamb chops, beefsteak, or chicken, sweetbreads, broiled or
creamed brains.
~Sample Menus.~--The following menu is a sample convalescent dietary:
BREAKFAST
7:30 A.M. Cream of wheat 3 oz., cream 1 oz.
1 soft-cooked or poached egg.
1 slice of toast buttered.
6 oz. cocoa or milk flavored with coffee.
2 tablespoonfuls of strained prune pulp with 2
oz. cream.
10:30 A.M. Albumenized orange juice.
DINNER
12:30 P.M. Cream of pea soup, 6 oz.
1 baked potato with butter.
1 slice of buttered toast.
1 cup of cocoa or 1 glass of milk or buttermilk.
3:30 P.M. Ginger ale and milk, 3 oz. each.
SUPPER
6 P.M. 2 slices of buttered toast moistened with 4 oz.
milk and 2 oz. cream.
1 soft-cooked egg or 3 tablespoonfuls of well-cooked
cereal or 2 tablespoonfuls of boiled rice.
2 tablespoonfuls of apple sauce served with 1
tablespoonful of cream.
1 cup of cocoa, malted milk, whole milk, or buttermilk.
9 P.M. 4 oz. hot milk, 2 oz. cream, or 1 cup of cocoa or
malted milk.
The return to normal diet is made with caution that the digestion of
the patient may not be upset or the temperature raised again by
over-feeding.
~Energy Requirements.~--In fevers of short duration it is not
difficult to regulate the amount of food necessary for the maintenance
of the patient, since the body will, as a rule, adjust itself when the
cause of the fever has been removed. At times, however, it is
necessary to make an effort to tempt the appetite of the patient when
convalescence is established, that recovery may be made more rapid and
complete.
~Care of the Mouth.~--Probably there is nothing more essential in the
treatment of fevers in general and typhoid fever in particular than
the care of the mouth. Well-nourished patients rarely ever show the
dry, cracked tongue and lips that was formerly one of the common
occurrences in typhoid fever. However, in any febrile condition the
mouth is apt to acquire a disagreeable taste; this "bad taste" is so
prominent in certain cases as to render it difficult for the patient
to eat. This can be, to a great extent, eliminated by the use of
aseptic mouth washes. When the patient is not strong enough to rinse
the mouth before and after eating, the nurse must use a swab for the
purpose. The food must be carefully selected and attractively served
and every effort made to make food as dainty and palatable as
possible.
~Thirst.~--Thirst is relieved with crushed ice, fruit beverages, and
carbonated waters. In certain conditions it is necessary to limit the
fluids, but in typhoid fever the giving of the requisite amount of
liquids is one of the most difficult tasks confronting the nurse. It
is wise to find out the beverages particularly liked by the patient
and, whenever it is possible, make use of them. As a rule alcohol is
not necessary in the diet of typhoid fever patients. However, in
certain cases of that disease, as well as in febrile conditions
induced by other causes, the use of alcoholic stimulation may be
necessary; it must be left to the discretion of the physician to
prescribe it.
SUMMARY
~Intestinal Disturbances~ are accountable for the majority of the
fevers of short duration during infancy and childhood, and in many of
those cases in adults.
~Malaria~ causes an elevation of temperature which is, as a rule, of
short duration.
~Contagious Diseases~, such as scarlet fever, measles, whooping cough,
and mumps, are likewise accompanied by more or less elevation of
temperature.
~Treatment~ consists of a period of rest in bed, with an abstinence
from food, in order that the disease may manifest itself, and also
that any offending food material which may cause the fever may have an
opportunity to pass out of the body.
~The Heart~, in some of the diseases accompanied by an elevation of
temperature, is more or less strained; this is particularly true in
tonsillitis, diphtheria, etc.
~The Kidneys~ are likewise taxed in certain diseases, even when the
fever is not great or lasting; this is found to be the case in scarlet
fever, tonsillitis, etc.
~Dietetic Treatment~ consists in giving no food for a period lasting
from twenty-four to forty-eight hours. This is followed by a liquid
diet, milk and broth particularly, which is continued as long as the
fever remains.
~Convalescent Diet~ is instituted as soon as the fever has disappeared
and acute symptoms subside.
~Thirst~ is apt to be great with any elevation of temperature. It is
relieved by water, crushed ice, and fruit beverages.
~The Mouth~ requires much care, even in fevers of short duration. A
simple antiseptic wash should be used several times each day.
~Nitrogen Equilibrium~ is not sufficiently disturbed in such cases to
require taking into account. Should the disease, however, develop
into one causing a material breaking down of the body tissues,
measures must be instituted to prevent the upsetting of the nitrogen
balance in the body.
PROBLEMS
(a) Outline the dietetic treatment for malarial fever.
(b) Outline a diet order, using liquids only. Show method of
reinforcing this diet.
(c) Show how the solids are added as convalescence progresses.
FOOTNOTE:
[95] In scarlet fever and other conditions in which the kidneys may be
involved the above diet is not given unless advised by physician in
charge.