Fever vs. Warm Blanket

Editorial Team / Moderator · Aug 6, 2009

Shivering = blanket. Sweating = sheet. Generally speaking, of course. Shivering is going to jack up temps more than a blanket would, I would think.

mmutk, BSN, RN, EMT-I · Aug 7, 2009

There are times when some nurses obviously lack common sense.

(I suppose some of us ER nurses fall into that category)

Like with fever and not giving blankets. I don't know how many times I've overheard a shivering, patient asking for a blanket, only to be refused by the nurse because they have a fever. Ohh Gasp!* So what if they have a fever, I'll say. "I don't want their temperature going up, they'll say."

Well look here's the deal.

There are two main ways to the body's temperature goes up. The first is when your body's thermoregulatory mechanisms, coordinated in part by the hypothalamus, are overwhelmed by exogenous heat, i.e. you sit in a car on a hot summer day. Or lay out in the sun for 12 hours... This is hyperthermia. In this case by all means lets hold off on the blankets and go with the usual heat illness treatments: ice packs to the groin and neck, get a fan and maybe a cooling blanket.

Far more commonly (and in this case) you develop a fever from infection. Here, your hypothalamus has decided it is for the greater good to raise your temperature a few degrees in an effort to fight the disease. And warm blankets, cold shower, whatever isn't going to change anything, your body's just going to compensate to stay at the new set-point. You have to act on the hypothalamus directly, either by craniotomy or taking a tylenol to alter this setting.

Now, just for the sake of argument, what if a blanket did raise a fever a degree or so. Is it gonna kill the patient? Is it gonna give that disease the upper hand?? No it's simply going to provide some comfort to a shivering patient.

We take these people and strip them down, place them in ill-fitting gowns, stick them for blood, put fingers, plastic, and long rubber tubes in all their holes, keep them in a frightening environment, and restrict their families from seeing them. Then when they ask for a blanket we say no.....because you have a fever?!?!?!

In all my years as a paramedic and nurse and human for that matter, I have never seen a blanket kill anyone with a fever.

trainedclinician · Jan 2, 2011

This is such a ridiculous issue. I've been an emergency physician for 10 years and have never (including my work in peds ed) seen a negative outcome as a result of giving a febrile patient even a warm blanket. I peruse this site because I care about my nurses. One of our nurses actually got "written up" for giving a poor, shivering, febrile patient a blanket. This disciplinary action was born out of pure ignorance. As in the above post, fever from normal physiologic, host defense response cannot harm a patient even if the temp goes up a little from a blanket. Pathologic hyperthermia is totally different. This includes neuroleptic malignant syndrome (toxic drug effect, usually haldol), familial malignant hyperthermia (rare genetic effect with general anesthesia), environmental hyperthermia (heat exhaustion/ heat stroke) and tumor lysis syndrome. These patients may require active and passive (and sometimes chemical) cooling. All of these are rare conditions. Some patients my have had neurologic abnormalities from a febrile disease like meningitis or rheumatic fever but this is a result of the invading organism's effect on the brain not the elevated temp. So, please, give a shivering patient a warm blanket. What's next? We withold milk from a febrile kid because it might "sour their stomach?"

Larry77, RN · Jan 3, 2011

If you worked in my dept I would go with your suggestion, until you do, I will go with what my docs want and that's a sheet...but I really appreciate the info :-)

allnurses Guide · Jan 3, 2011

mmutk and trainedclinician - thanks.

Prior to being a nurse my 18 month old daughter was in the ER for projectile vomiting and fever. She was crying for a "blankie". I kept putting the sheet over her - the ER doc kept taking it off and yelling at me.

Here at home I usually don't treat for fever unless it is over 101. My 9 year old is sick now - 103.6. Ibuprofen and a blanket and he is comfy.

Is there some credibility for "blanket fevers" at all though? My mother-in-law used to bundle my eldest son up in so many blankets in summer . .. . he'd get so warm and I'd take the blankets off and he'd cool down.

steph

Roy Fokker, BSN, RN · Jun 13, 2011

I have gotten so much flak from so many colleagues about giving "febrile" patients a blanket... don't even get me started!

I wonder if they all slept naked under a fan at home whenever they had a fever...

cheers,

Roy (the 'I will blanket you if you need so' Nurse)

pedicurn, LPN, RN · Jun 15, 2011

I usually give these ones one blanket - get their temp down and make them feel better with fluids and Tylenol.

steelydanfan · Jul 6, 2011

Quote
mmutk and trainedclinician - thanks.
Prior to being a nurse my 18 month old daughter was in the ER for projectile vomiting and fever. She was crying for a "blankie". I kept putting the sheet over her - the ER doc kept taking it off and yelling at me.
Here at home I usually don't treat for fever unless it is over 101. My 9 year old is sick now - 103.6. Ibuprofen and a blanket and he is comfy.
Is there some credibility for "blanket fevers" at all though? My mother-in-law used to bundle my eldest son up in so many blankets in summer . .. . he'd get so warm and I'd take the blankets off and he'd cool down.
steph

If they are shivering, give them a blanket. All the shivering will do is make the temp go up further, so make them comfortable while the tylenol takes effect. But by all means, DO divest the little ones and really old ones of their 17 layers of clothing.

coley1930 · Apr 3, 2021

Thank you for asking this question. I was recently in the ER with my mother who is 65 years old with 106+ fever. I could not understand why the nurses kept giving her warm blankets after warm blankets she had a total of at least eight of them. I understand The pathophysiology of shivering and why it is best to give them at least one blanket I just didn’t understand eight of them and the fact that they were warm. I was missing two key point elements. I didn’t know what her fever was since it was taken in the ambulance nor did I know the outcome of her temperature after Tylenol was given. I did not see them check her temperature until she discharged ( Which was another thing I did not understand but I am aware different units have different protocols) . Her discharge temp was 100.7 But prior to that during her stay in the ER she was drifting in and out and she felt hot. I did not speak up because my specialty is neonatal intensive care and I thought they knew more than I did about adult fevers . Now I do wish I would have Ask for Clarification respectfully of course

amoLucia · Apr 3, 2021

This is quite an old post, but please, if I have a temp and ask for a blanket, PLEASE, give me a blanket! I'll stop at two.

Never could understand why my NH LOLs & LOM (and my aging parents were always sooooo cold). Not until my health changed dramatically.

I wear socks, long leg slacks and sweaters even in the Summer. I'll start shivering if I get cold. To withhold a blanket would appear to be cruel & uncaring, to the point of being deliberately MEAN.

PLEASE give the dang blanket! Is there any evidence-based info that withholding a blanket improves or hinders pt temp status???

londonflo · Apr 4, 2021

17 hours ago, amoLucia said:

To withhold a blanket would appear to be cruel & uncaring, to the point of being deliberately MEAN.

Visible shivering can boost your body’s surface heat production by about 500 percent but it takes an hour or two, Meanwhile shhivering can only warm you up for so long, though. That the actual feeling of shivering is awful! Have you had your teeth chatter? What's happened to giving the patient comfort?

amoLucia · Apr 4, 2021

My point! At times, I've shivered so badly that my knees were buckling. And I have bitten my tongue also.

Temp is short term, so give the blanket for comfort!.