Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Fever


Related Terms

  • Pyrexia

Differential Diagnosis

Specialists

  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Cardiovascular disease
  • Immune system disorders
  • Neurologic conditions

Factors Influencing Duration

The severity of underlying disease, complications, and the effectiveness of treatment influence the length of disability.

Medical Codes

ICD-9-CM:
780.60 - Fever, unspecified
780.61 - Fever presenting with conditions classified elsewhere
780.62 - Postprocedural fever
780.63 - Postvaccination fever

Overview

A fever (pyrexia) is an increase above normal body temperature, which ordinarily ranges between 96.0° F and 99.5° F (35.5° C and 37.5° C) if measured by mouth (orally). In response to illness, the body may release chemicals such as prostaglandins affecting a hormone-secreting area of the brain, the hypothalamus, which regulates body temperature much like a thermostat.

Historically, the normal body temperature has been considered to be 98.6° F (37° C), although it is now known that fluctuations of about one degree occur throughout a 24-hour cycle. Temperature may be measured in the mouth, rectum, the armpit (axilla), or ear, but will vary depending on the location. The rectum is about 0.5° F (0.3° C) warmer than the mouth and 1.5° F (0.8° C) warmer than the axilla.

A temperature is considered low if under 96.0° F (35.5° C). Fever or high temperature is above 99.5° F (37.5° C) orally or above 100.5° F (38.1° C) rectally.

The body often produces higher-than-normal temperatures to ward off invading microorganisms that produce disease. The most common cause of a fever is an infection, and the most common causes of infection are viral syndromes such as common colds and influenzas. Fever can accompany almost any infection, although the absence of fever does not exclude infection. While fever is the most prevalent symptom of infection, it is also a manifestation of many other medical disorders listed as differential diagnoses, below. Fever also may occur with trauma, heart attack (myocardial infarction), vascular lung obstruction such as a blood clot (pulmonary embolism), autoimmune disease, and tumors.

Fever may be associated with use of certain medications such as sulfonamides, penicillins, thiouracils, barbiturates, quinidine, and some laxatives. An individual's temperature may increase with strenuous exercise or in high, ambient heat, causing hyperthermia which may lead to heat stroke. About 200 different conditions that may cause fever have been identified (Kortbus).

Usually the cause of a fever is easy to identify and the fever resolves promptly. Rarely, fevers persist and the cause remains unclear. "Fever of Unknown Origin" (FUO) is the medical term used to describe persistent unexplained fevers. To be an FUO, the individual's temperature must be at least 100.9° F (38.3° C) on several occasions, and the fever must last for at least 3 weeks. In addition, there will be no obvious cause for the fever despite a comprehensive inpatient diagnostic evaluation extending over 1 week. Eventually all but 5% to 15% of these cases are diagnosed, though it may take months before the diagnosis is clarified. Primary causes of FUO in adults are unusual infections (30% to 40%), malignant neoplasms (20% to 30%), and collagen vascular diseases such as rheumatoid arthritis, scleroderma, and lupus (10% to 20%) (Chan-Tack).

Rapid increases in temperature may prompt an isolated seizure in infants.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report recent travel, use of immunosuppressive medications, or drug use. However, minimal history is required to diagnosis fever. The individual commonly reports having experienced an elevated temperature. He or she may report fever, chills, shaking, sweating, muscle pain (myalgia), and general lack of well being (malaise). Prolonged temperature elevation can cause fatigue, weakness, difficulty with concentration, and lack of strength and energy (asthenia). Individuals may also have localized symptoms resulting from the specific illness such as a sore throat, cough, or painful burning urination.

Physical exam: Individuals with a fever have elevated temperatures and may have chills, sweats, and malaise. They may appear flushed. Commonly the heart rate is mildly elevated during a fever.

If the cause of the fever is an overwhelming infection (sepsis) findings include rapid breathing (tachypnea), rapid heart rate (tachycardia), and low blood pressure (hypotension). The individual usually appears acutely ill and has altered mental status.

Associated findings vary with the cause of the fever. The physical examination may identify localized or generalized findings depending on the patient's underlying problems. In some cases the physical exam will focus on a single organ system. In other cases, the individual will require a complete physical exam. FUO requires an exhaustive physical exam repeated several times over the course of a week.

Tests: Vital signs, specifically temperature, establishes the diagnosis of fever. Other testing is done if needed to determine the cause of the fever. Testing can be extensive, and specific tests depend on the suspected cause. These may include blood tests, tissue culture or tests, diagnostic procedures and imaging studies. The workup of FUO commonly involves all of the above. Certain tests, such as blood cultures or viral antibody tests may need to be repeated several times as part of the evaluation.

A complete blood count with differential may be ordered to check for signs of infection. Cultures of the blood, urine, stool, or vaginal drainage may be obtained. Other diagnostic tests may include blood chemistries, erythrocyte sedimentation rate (ESR), tuberculin skin testing, HIV testing, hepatitis tests, urinalysis and urine culture, and blood tests for rheumatoid factor (RF) and antinuclear antibodies (ANA). Chest x-rays, CT scan, or intravenous pyelogram (IVP) may also be necessary for diagnosis.

Source: Medical Disability Advisor



Treatment

Most fevers do not need to be treated. They are the body's response to infections and will subside on their own. Antipyretic drugs (e.g., acetaminophen and nonsteroidal anti-inflammatory agents) lower elevated temperatures and can be prescribed if needed for patient comfort. Cooling blankets or baths may be used in rare instances when it's important to lower body temperature rapidly; for example with malignant hyperthermia or heat stroke.

Treatment of the underlying condition causing the fever varies. If the individual is stable, aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) may be prescribed for relief of symptoms. In rare cases, individuals with FUO who experience serious, rapidly worsening symptoms may require a trial of antibiotics or steroids, even in the absence of a specific diagnosis.

Source: Medical Disability Advisor



Prognosis

Fever generally resolves without complications. Temperatures above 106° F (41.1° C) are life-threatening. In cases of fever of unknown origin (FUO), between 5% and 15% are never diagnosed (Kortbus).

Source: Medical Disability Advisor



Complications

High fever may be complicated by seizures, tachycardia, low fluid volume (dehydration), hypotension, and the inability to supply oxygenated blood to the body (shock). High fever in pregnant women may cause congenital abnormalities (teratogenic).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations will be determined based on the specific diagnosis. Generally, individuals with contagious disease should not be in the workplace.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has the cause of fever been identified?
  • Was temperature elevated for a prolonged period?
  • Were localized symptoms present?
  • Were signs of sepsis (tachycardia, hypotension, tachypnea) present?
  • Did individual appear acutely ill?
  • Was mental status altered?
  • Were appropriate diagnostic tests performed such as cultures, chest x-ray, blood studies, and/or urinalysis?
  • Were additional specific tests performed depending on the underlying condition?

Regarding treatment:

  • Has fever persisted despite treatment of the underlying cause?
  • While low-grade fevers do not necessarily require treatment, was fever addressed because individual was at increased risk of complications (i.e., those with heart disease, risk of seizures, or pregnancy)?
  • Was treatment effective in resolving fever?

Regarding prognosis:

  • How severe was the fever, and how long did it last?
  • Has underlying condition been controlled or resolved? Has fever persisted despite treatment of underlying cause?
  • Should diagnosis be revisited?
  • Has individual experienced any complications such as seizures, tachycardia, dehydration, hypotension, or circulatory collapse?
  • Does individual have an underlying condition that may impact recovery such as heart disease, pregnancy, or being prone to seizures?

Source: Medical Disability Advisor



References

Cited

Chan-Tack, Kirk M., and John Bartlett. "Fever of Unknown Origin." eMedicine. Eds. Wesley W. Emmons, et al. 17 Nov. 2004. Medscape. 21 Dec. 2004 <http://emedicine.com/med/topic785.htm>.

Kortbus, Michael J., and Kelvin C. Lee. "Sinusitis and Fever of Unknown Origin." Otolaryngologic Clinics of North America 37 2 (2004): 339-346. MD Consult. Elsevier, Inc. 21 Dec. 2004 <http//home.mdconsult.com/das/journal/view/38264681-2/N/14611727?ja=410867&PAGE=1.html&sid=276415425&source>.

Source: Medical Disability Advisor






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