Approach to a fever (over 2 months) Quiz: Ace Your Exams

A 3-month-old girl is brought to the emergency room for a one-day history of fever, cough, and rhinorrhea. The highest temperature before presentation was 39.6°C (103.4°F) rectally. Parents report she is drinking well with good urine output. She was born at 39 weeks gestation and has no significant past medical history. She is hitting her developmental milestones. Immunizations are up to date. She is 60^th percentile for length, 55^th percentile for weight, and 70^th percentile for head circumference. In the emergency room, temperature is 39.9°C (103.8°F), pulse is 165/min, respirations are 45/min, blood pressure is 75/48 mmHg, and oxygen saturation is 97% on room air. On physical examination, she appears alert and fussy but consolable. The anterior fontanelle is open and flat, tympanic membranes are pearly gray with good light reflex and no effusions. There is evidence of nasal congestion, and mucus membranes appear moist without pharyngeal erythema, ulcers, or exudate. There is no nasal flaring, retractions, or abdominal breathing. Lung examination is normal. A respiratory viral panel has been obtained and is pending. Which of the following is the most appropriate next step in management?