Fever and dying

Nurses General Nursing

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I am a relatively new nurse. I have a patient who is in the process of dying and is experiencing a low grade fever. I was getting a tylenol suppository for the patient and someone stated to me that the fever was just part of the process of dying and the fever would continue to go up until death occurred. Is this correct? Thanks for the help!

cherrybreeze said:
I agree that a high fever may add to their discomfort overall, even if they're unresponsive. I would consider tylenol supp, in that case, a comfort measure, same as morphine for respiratory distress, etc. I think the very brief time it takes to give the suppository is less discomfort compared to the 4-6 hours of relief it may offer if it helps bring the fever down (the few times I've run very high fevers, what stuck out to me the MOST was how much my skin hurt...just brushing it lightly with clothing was painful).

i appreciate your testimony.

any process that disturbs homeostasis, is uncomfortable.

without a doubt.

leslie

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Reference:

Symptom Management Algorithms: A Handbook for Palliative Care 2nd Ed. By Linda Wrede-Seaman, M.D.

Fever over 100 degrees oral can be treated with Acetaminophen, Ibuprofen, Indomethacin, or other Non Opiod Analgesic and NSAID and recommends symptomatic treatment according to the advance directive.

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erroridiot said:
Reference:

Symptom Management Algorithms: A Handbook for Palliative Care 2nd Ed. By Linda Wrede-Seaman, M.D.

Fever over 100 degrees oral can be treated with Acetaminophen, Ibuprofen, Indomethacin, or other Non Opiod Analgesic and NSAID and recommends symptomatic treatment according to the advance directive.

thank you for this, error.

it makes my hair stand on edge, when i read about folks/nurses not treating a (high) fever.

these temps can reach 107.

just because temps happen, it doesn't make it natural!!

if anything, a truly peaceful dying process will mimic one's body in its natural, disease-free state.

and that's what makes hospice incredibly challenging.

to treat a pt w/multi-organ failure, carries the responsibility of understanding and honoring what our amazing bodies are trying to do, while keeping pt comfortable.

for instance, dying pts do NOT want to eat.

families just don't get that.

when our organs fail, they no longer require nourishment to sustain them...

and so, pt has no appetite.

perfectly natural.

i'm getting on a tangent here, but please, PLEASE...

give your dying, febrile pts TYLENOL.

the fever is much more uncomfortable than a 2 second act of insertion.

leslie

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Hi im a new grad nurse, working in a resthome in NZ. I just had a similar case for one of my resident. He had a low grade fever before I left my am shift. when I came on to am shift the next day, the night nurse handed over to me that he is dying. I asked her how is his tempurature, he turned around and said to me: the man is dying and I didnt bother to take his tempurature. she is a agency nurse. I sat there and felt like I asked a stupid question. I went to check on the resident after handover, poor him, lying in bed, his breathing is really laboured, his temp is 39.7 degree celsius (sorry, dont know how to covert it to °F). Anyway, I am so mad at that agency nurse. I know he is dying, but how can you just watch him suffer and didnt do anything? not even to take his temp? Its my first dying resident and im quite scared. Try to ring the doctor at 7am..but its weekend and cant get hold of her. contacted the family, all went into voice mail...start to panic...im the only nurse on..so i called manager. in the end, i called ambulance and send him to hospital. they put him on syringe pump in the hospital and cool him down to make him comfortable, and his family is there with him, he passed away after two days..manager said i did the right thing, to make him comfortable.

Thanks you guys for the great posts. Give me an idea of what to do in the similar situation next time.

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YES! YES! YES!

Feeding dying people...

That is my big pet peeve!

I know the family may be desperate to comfort or even try to miraculously heal their loved one... but aaaaack!

:redlight: STOP!!! Just stop, in the name of love!!

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leslie ? said:
thank you for this, error.

it makes my hair stand on edge, when i read about folks/nurses not treating a (high) fever.

these temps can reach 107.

just because temps happen, it doesn't make it natural!!

if anything, a truly peaceful dying process will mimic one's body in its natural, disease-free state.

and that's what makes hospice incredibly challenging.

to treat a pt w/multi-organ failure, carries the responsibility of understanding and honoring what our amazing bodies are trying to do, while keeping pt comfortable.

I totally agree. Fevers are definitely very uncomfortable. Why would anyone withhold antipyretics just because it's "normal" for a dying patient to run a fever? It's normal for patients dying of cancer to be in pain-do we withhold their pain medicine? Of course not.

leslie ? said:

for instance, dying pts do NOT want to eat.

families just don't get that.

when our organs fail, they no longer require nourishment to sustain them...

and so, pt has no appetite.

perfectly natural.

That's so true. Families who don't get that are a frustration to me...think back to any illness you have. You're not hungry. When families claim "he's starving to death," it's hard for me to be patient. But I do count to ten and explain it to them just as you have. I also add, "he's not dying of starvation, he's dying of _____ and as a consequence, he's just not hungry." They usually reply, "well, then, how can we make sure he eats?" Sigh.

leslie ? said:

i'm getting on a tangent here, but please, PLEASE...

give your dying, febrile pts TYLENOL.

the fever is much more uncomfortable than a 2 second act of insertion.

leslie

Very well said.

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Specializes in Emergency/Trauma/Critical Care Nursing.

i work in ER and don't often have patients that are actively dying for prolonged periods of time, so this is the first i have ever heard of the fever associated w/dying. I'm just wondering if someone could explain why this occurs in dying patients, just for my own education please? i would have assumed they would get more hypothermic as circulation slows as well as the body's metabolic functions diminishing. thanks for any info!

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Christy1019 said:
i work in ER and don't often have patients that are actively dying for prolonged periods of time, so this is the first i have ever heard of the fever associated w/dying. I'm just wondering if someone could explain why this occurs in dying patients, just for my own education please? i would have assumed they would get more hypothermic as circulation slows as well as the body's metabolic functions diminishing. thanks for any info!

the body has many protective mechanisms, that prepare pts to die a natural and painless death.

while no one knows the etio of terminal fever, it has been correlated to those pts with fluid overload...

the hyperthermia assists in burning off extra fluid.

others get this fever r/t presence of known or unknown infection.

and finally others have theorized that parts of brain are shutting down, including function of hypothalamus.

fyi: i do not give apap to those pts with fluid overload, since it would defeat the purpose of decreasing fluid levels.

leslie

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Specializes in Plastics. General Surgery. ITU. Oncology.

Hyperthermia is relatively unusual in dying patients. It can occur and is usually treated by IV infusion of paracetamol on my ward.

Hypothermia is much more common in the dying. The patient rarely experiences any discomfort from a low temp but we pile on the blankets anyway.

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Hi, my mother was 77 when she died on July 25. She was fine the night before.She had lots of problems; had a pacemaker, had dementia, double amputee due to vascular issues and she was on coumadin. At 3 a.m., she was rattling her bed to summon her caretaker. Caretaker said she lost control of bladder and was sweating. Changed her and bedding and mom seemed okay and went to sleep. At 7:30 a.m., found mom kind of sideways on her bed. Lifted her hospial bed a bit, so that she could breathe easier. Didn't say much, just , "oh God, Oh God," then when asked shook her head that nothing hurt. Also, tried to say caretakers name, but not clearly. She was gone before 1 p.m. Can anybody tell me if they think this was some sort of stroke? No other symptoms, like crooked smile, she was moving her arms, but had no legs, so we don't know about that. She was also a little warm, but not terribly. Also, her lips were very red. Mom had something similar happen in the winter of 2011, just few months earlier, but it passed quickly. I am just looking for some answers. I pray for all of you and your families.I just need some answers. I am wondering if she could have been saved, or did she have too many problems. I read online that amputees live up to 5 years only. It will be five years in September since her first leg was taken. 2 years ago since her second.

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Specializes in Oncology; medical specialty website.
leslie ? said:
why would a tylenol suppository make them uncomfortable?

i agree, it's going to depend on various factors, but the bottom line, fever is uncomfortable.

if the pt is mostly unconscious, then i give apap supp pr q3-4 hrs.

i'm sorry, but i disagree just because it's a natural part of dying, doesn't mean it's comfortable.

there are sev'l "natural" parts of dying, that we intervene with.

holly, thank you.

your entire post was considerate and sensitive.

but as an old, experienced hospice nurse, i have a couple of observations.

again, temperature (esp high temps) is uncomfortable.

even when unconscious, one can always see a change in facial tone/expression when the pt is uncomfortable vs "at peace".

and tylenol or washcloths on the head, under arms, is due.

but i especially wanted to point out, that your perspective of "never leave a dying patient alone", is not always accurate.

i've known many pts who chose to die alone.

my mil was one such person...

true to her nature, she just would not die.:)

her room was filled with her entire family...

and she was lingering, i'm sure knowing we were all hovering over her.

i finally suggested we all leave for an hour.

within 15min she was gone.

many folks that are like her...

just something to keep in mind.

leslie

You took the words right out of my mouth. There are no absolutes in caring for patients. (Former certified hospice nurse speaking.)

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I've seen them a lot higher than low grade.....when the hypothalamus gets cranky, temps can get pretty high. Had one lady whose temp was 105 after she died (doc figured brain bleed in/around the brainstem). Only had the temp taken because she was noticeably hot when post mortem care was done. But the pre-death temps can get in the 102-103 range, easily....

Depends on why they're dying also--- the higher temps I've seen have been neuro related. Their extremities can still be peripherally cool and mottled/blue.

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