Nursing Care Plan for Fever and Vomiting: Assessment, Diagnoses, Interventions

The three anchor diagnoses in most cases: Hyperthermia related to underlying infection or inflammatory process (as evidenced by elevated body temperature above 38°C, warm skin, tachycardia); Deficient Fluid Volume or Risk for Deficient Fluid Volume related to excessive fluid loss from vomiting and insensible loss from fever (evidenced by decreased urine output, dry mucous membranes, tachycardia, hypotension); and Nausea related to gastrointestinal irritation, drug side effects, or central causes (evidenced by patient report and observed retching). Secondary diagnoses to consider based on presentation: Risk for Electrolyte Imbalance, Acute Pain (headache or abdominal), Imbalanced Nutrition Less than Body Requirements if vomiting is protracted, and Risk for Infection Transmission when the underlying cause is a communicable pathogen. Priority ordering follows Maslow, fluid balance first, then temperature, then comfort.

At minimum every 4-6 hours during the acute phase: temperature (route consistent, oral, axillary, or tympanic; note the route), heart rate, blood pressure (including orthostatic if the patient is ambulant), respiratory rate, oxygen saturation, level of consciousness, and pain score. Fluid balance: strict intake and output charting, urine specific gravity or colour observation, weight if possible daily at the same time. Vomiting characterisation: frequency, volume, colour and content (bilious, coffee-ground, undigested food, blood), and relation to food or medication. Assess mucous membranes, skin turgor, and capillary refill each shift for hydration status. In endemic Indian settings, note any petechiae, rash, or bleeding, early signs of severe dengue that shift the care plan significantly.

Establish IV access early, deteriorating patients can lose the option to hydrate orally quickly. Initiate rehydration per protocol (oral rehydration solution if tolerated; IV normal saline or Ringer's lactate if vomiting persists or dehydration is significant), correcting electrolyte deficits based on baseline labs. Administer prescribed antipyretic (paracetamol is first-line; avoid NSAIDs if dengue is on the differential due to bleeding risk) and prescribed antiemetic (ondansetron is common first-line for adults; metoclopramide alternatives). Cooling measures: tepid sponging if temperature is over 39°C, adequate exposure, ambient temperature control. Send off diagnostic samples early. CBC, electrolytes, urea/creatinine, urine routine, and pathogen-specific tests based on epidemiology (dengue NS1, malaria smear, typhoid Widal or blood culture, stool if diarrhoea present). Document baseline for evaluation.

Objective indicators of successful intervention within 24-48 hours: temperature trending down toward 37.5°C or lower without persistent antipyretic dependence; vomiting frequency reduced by at least 50%, patient tolerating small oral fluid volumes; urine output restored to at least 0.5 mL/kg/hour with clearing urine colour; heart rate and blood pressure normalising toward baseline; improving level of consciousness and patient-reported comfort. Red flags requiring escalation to the treating physician: persistent fever above 39°C beyond 48 hours of appropriate antipyretic use, worsening tachycardia despite fluid replacement, oliguria, altered mental status, new bleeding manifestations (particularly relevant in the Indian dengue season), rising creatinine, or persistent inability to tolerate oral intake. The care plan is not a static document, nursing diagnoses should be re-prioritised as the aetiology clarifies from diagnostic workup.