lists the subjective and objective information which needs to be elicited from the patient presenting with fever
| Subjective | Objective |
|---|---|
| Symptoms | General |
| How long has the temperature been present? | Measure vital signs. |
| Is it constant or does it fluctuate? Have there been any episodes of ‘hot and cold’ shivers? | Take the temperature. If the fever seems very mild and the patient reasonably well then the back of your hand applied to the patients forehead in a ‘hot/not hot’ assessment is acceptable. If the fever seems significant or the patient looks ill then a more objective measurement is mandatory. This may be best provided by an electronic tympanic membrane temperature thermometer though there has been recent debate on their reliability. |
| Has any medication been taken to help it? If so what was it, how much was taken and how long ago? Did it work? | Is there a rash – is it diagnostic of anything? Chickenpox blisters and non blanching purpuric rashes are generally the only ones to be reliable as indicators of a specific cause. |
| Associated symptoms | Is there muscle tenderness? |
| Do they have any pain or swellings anywhere? | Is there any evidence of meningism or blunting of consciousness? |
| Are they aware of having a rash? | The latter may be seen in the early stages of encephalitis. |
| Ask specifically about things such as unsteadiness/vertigo, ability to concentrate, dysuria, frequency, offensive vaginal discharge. | Check the tympanic membrane, throat and cervical lymph glands. |
| Infective contacts/travel | Check the eyes for evidence of jaundice. |
| Has anyone else in the family/at work had a similar problem? | Systems exam |
| Has the patient recently returned from abroad? If so where from? | Listen to and percuss the chest. |
| Have they been in contact with anyone with a known infectious illness? | Palpate the abdomen and renal angles. Ask the patient to cough – does it hurt their abdomen to do so? This may indicate a degree of peritonism. |
| Tests | |
| Check a urine specimen for blood or nitrites if appropriate – it is always appropriate if no other obvious cause has been found even in the absence of urinary symptoms. This is especially true of the very young and the elderly. |