Can a patient purposefully become febrile?

[GermPhobe]

I have a patient who has been 100% afebrile during the day. At HS he says he's chilled (but has no temp). So I bring him a warm blanket, which he hides under. Several hours later, he has a 102-103 degree temp. He's done this two nights in a row.

Normally, I wouldn't question this--but this particular patient has a long, sordid history (including MANY years in a federal prison). I really wonder if he's learned some tricks to make it appear that he's sicker than he is.

Or am I just paranoid????????

[leslie :-D]

i know many people who only spike temps at noc.

if you don't mind the extra work, you can always take his temp q30min, and see where it's trending.

even having extra layers of blankets, would not make one's temp spike that high.

take care.

leslie

[CT Pixie, BSN, RN]

I am one of those who only tend to spike temps during noc. What usually happens is during the daytime, I feel "yucky" and feel like I am running a fever but when my temp is taken its normal or only slightly elevated but nothing high enough to be considered febrile. But when sleeping I tend to spike that fever. When I wake up its only slightly elevated again and then the next noc the same thing.

My older daughter takes after me in respects to being febrile normally only at noc.

[EmmaG, RN]

i know many people who only spike temps at noc.

if you don't mind the extra work, you can always take his temp q30min, and see where it's trending.

even having extra layers of blankets, would not make one's temp spike that high.

take care.

leslie

I think it's related to the natural nadir in cortisol levels at night. (increased cortisol inhibits IL-1)

Patients' temps tend to trend upward in the evening into the night and then down again in the early morning.

[birdgardner]

When my kids are sick, they're often afebrile in the day, and burning up at night. Your patient really may be experiencing chills prior to fever, which is why he's asking for the extra blanket and hiding under it.

[pattycakeRN]

what is noc?

[EmmaG, RN]

what is noc?

Night.

[SteveNNP, MSN, NP]

Are you doing oral temps? Is it possible he's drinking something hot before you take it? Or maybe he's ovulating.....

[Ohmygosh]

Has he been tested for TB??

[Dolce, RN]

Or maybe he's ovulating.....

What about encouraging IS use (10 per hour, Q 1 hour) while he is chilling. And, no warm blankets at nocs. You have obviously discovered a trend.

[Dolce, RN]

Has he been tested for TB??

Good point. He has a prison history.

[wooh, BSN, RN]

Has he been tested for TB??

That's my thought.