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 reËnforced 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

The above furnishes approximately 750 calories.

II

Furnishing approximately 1500 calories.

III

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 purÉes, 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

Dinner

Supper

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.