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!

mt0715 said:
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.

mt, i am sorry about your painful loss.

was your mom diabetic?

anyways, with her advanced age, having heart disease and an ailing circulatory system, death would not be an unexpected outcome.

as for wondering if she could have been saved, the only one who truly knows that is God.

your mom's death is so recent.

you could ask your pcp, for a referral to a bereavement counselor.

take this time to honor her legacy.

pamper yourself, eat healthy, sleep well...

this is such a stressful time for you ;being good to yourself, is always good medicine.

one hour, one day at a time...

and peace be with you.:hug:

leslie

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Hello.

My Dad passed away yesterday (Tuesday) just before 4:00 MST. We were fortunate to be able to care for him at him and I was fortunate to be with him when he passed. He suffered only briefly, but in the hours before his death, he did experience a very high fever. We never did take a temperature reading, but when I relieved my brother at 23:00 MST, my Dad's body was very warm. My brother was treating him with cold compress to his forehead and had the overhead ceiling fan on. Dad's temperature eventually dropped and he seemed to rest comfortably for the next few hours. I had stopped the fan so he would not get a chill. At about 3:00 MST his temperature because to rise again so I covered his chest, restarted the fan and applied a cool cloth to his forehead. At about 3:30 MST, his breathing became, not rattled, per se, but a new steady, rattle-like, sound accompanied his breathing. He was burning up. I changed out his pillow, as the one he had been laying on had become moist, applied a cool cloth lightly to his forehead, cheeks, back of neck and up and down his arms, gave him three applications of water-soaked sponge lollipops, which he seemed to welcome, held his hands and let him know it would soon be okay. This went on for several minutes with his eyes, not opening (he had been in a sleep-like state for most of the day), but fluttering back and, seemingly, upwards. It was hard for me to leave him, but I finally did assure him I would be right back and ran to wake my brother. Minutes after that the fever broke, his breathing lost it's rattle and his temperature cooled considerably. Very soon after that his breathing became very quiet and then stopped.

My Dad was in hospice care and they were wonderful, save that I was never alerted to the possibility of fever and/or how to treat. My questions are only ones of curiosity.... if there was something I could have done to relieve any fever pain during his last hours and if fever advances death? We are grateful that he was released from his suffering almost immediately after his fever broke, if it did indeed break, but I am very curious about this phenomenon as I am not familiar with high fever.

My Dad had a very large, inoperable brain tumor, diagnosed seven weeks before. He did not experience fever at all during those seven weeks, but weakened gradually over time and then rapidly in this past week. His last food intake was on the Thursday (Thanksgiving mashed potatoes and gravy) prior. On Friday he had only a few tastes of same. We did not force him to eat and gave him sips of water and the sponge lollipops as tolerated. He was on liquid morphine and Lorazepam, increased dosages during his last 48 hours. His appetite had been good up until a week before his passing. On the Monday morning preceding his passing, as his last bowel elimination had been five days prior, our hospice nurse administered a laxative suppository to no result. His last urination was after that and before noontime on Monday. He remained dry to his passing and there was surprisingly little release after death.

I know my Dad's circumstance is not unique, but the fever condition has me quite perplexed. And while we are glad he is released from this earth, my curious questions remain: (1) What IS the pain experienced from fever (as, knock wood, it has been a very long time since I have experienced one personally)? (2) Regardless of "time remaining," if the patient cannot swallow what could/should be done to bring comfort/relieve fever pain if Tylenol suppository is not available and (3) How (pardon my ignorance) does a high fever cause or advance death?

Thanks, in advance.

Denise

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Specializes in Medical-Surgical/Oncology.

To HollyHubby: Beautifully said. :)

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Specializes in Med/Surg, Geriatric, Hospice.

I can't imagine not medicating a terminal fever 'just because it's natural'. It's extremely uncomfortable even if they're dying, not to mention the potential for seizure due to the elevated temp, (right)?

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LoveDenise said:
Hello.

My Dad passed away yesterday (Tuesday) just before 4:00 MST. We were fortunate to be able to care for him at him and I was fortunate to be with him when he passed. He suffered only briefly, but in the hours before his death, he did experience a very high fever. We never did take a temperature reading, but when I relieved my brother at 23:00 MST, my Dad's body was very warm. My brother was treating him with cold compress to his forehead and had the overhead ceiling fan on. Dad's temperature eventually dropped and he seemed to rest comfortably for the next few hours. I had stopped the fan so he would not get a chill. At about 3:00 MST his temperature because to rise again so I covered his chest, restarted the fan and applied a cool cloth to his forehead. At about 3:30 MST, his breathing became, not rattled, per se, but a new steady, rattle-like, sound accompanied his breathing. He was burning up. I changed out his pillow, as the one he had been laying on had become moist, applied a cool cloth lightly to his forehead, cheeks, back of neck and up and down his arms, gave him three applications of water-soaked sponge lollipops, which he seemed to welcome, held his hands and let him know it would soon be okay. This went on for several minutes with his eyes, not opening (he had been in a sleep-like state for most of the day), but fluttering back and, seemingly, upwards. It was hard for me to leave him, but I finally did assure him I would be right back and ran to wake my brother. Minutes after that the fever broke, his breathing lost it's rattle and his temperature cooled considerably. Very soon after that his breathing became very quiet and then stopped.

My Dad was in hospice care and they were wonderful, save that I was never alerted to the possibility of fever and/or how to treat. My questions are only ones of curiosity.... if there was something I could have done to relieve any fever pain during his last hours and if fever advances death? We are grateful that he was released from his suffering almost immediately after his fever broke, if it did indeed break, but I am very curious about this phenomenon as I am not familiar with high fever.

My Dad had a very large, inoperable brain tumor, diagnosed seven weeks before. He did not experience fever at all during those seven weeks, but weakened gradually over time and then rapidly in this past week. His last food intake was on the Thursday (Thanksgiving mashed potatoes and gravy) prior. On Friday he had only a few tastes of same. We did not force him to eat and gave him sips of water and the sponge lollipops as tolerated. He was on liquid morphine and Lorazepam, increased dosages during his last 48 hours. His appetite had been good up until a week before his passing. On the Monday morning preceding his passing, as his last bowel elimination had been five days prior, our hospice nurse administered a laxative suppository to no result. His last urination was after that and before noontime on Monday. He remained dry to his passing and there was surprisingly little release after death.

I know my Dad's circumstance is not unique, but the fever condition has me quite perplexed. And while we are glad he is released from this earth, my curious questions remain: (1) What IS the pain experienced from fever (as, knock wood, it has been a very long time since I have experienced one personally)? (2) Regardless of "time remaining," if the patient cannot swallow what could/should be done to bring comfort/relieve fever pain if Tylenol suppository is not available and (3) How (pardon my ignorance) does a high fever cause or advance death?

Thanks, in advance.

Denise

The fever doesn't necessarily cause "pain"- but discomfort from being overheated.

We can't offer medical advice :o A hospice nurse, or MD office would have better answers based on the specific situation.

The fever doesn't necessarily cause or advance death. It depends on a lot of circumstances (disease process).

I'm so sorry for the loss of your dad....

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LoveDenise said:
I know my Dad's circumstance is not unique, but the fever condition has me quite perplexed. And while we are glad he is released from this earth, my curious questions remain: (1) What IS the pain experienced from fever (as, knock wood, it has been a very long time since I have experienced one personally)? (2) Regardless of "time remaining," if the patient cannot swallow what could/should be done to bring comfort/relieve fever pain if Tylenol suppository is not available and (3) How (pardon my ignorance) does a high fever cause or advance death?

Thanks, in advance.

Denise

(((denise))), so, so sorry about your dad.

to try and address some of your concerns...

fever isn't 'painful' per se, but the hypermetabolic state it puts our bodies in, is uncomfortable...even distressing.

whenever our bodies aren't in (homeostatic) balance, it creates chaos and we do what we can to restore symmetry.

if you don't have an antipyretic available, then cool, damp cloths to head, underarms, groins, can be soothing.

but the cloths have to be continually rewet, since the high fever tends to dry them out quickly.

we humans, could not sustain ourselves with a high fever.

inevitably, it'd cause organ shutdown, then death.

we don't fully understand terminal fevers, but it is thought that as fluid shifts to areas/organs of perceived need, the brain sees this as a fluid overload.

the fever then serves to 'burn' off the excess fluid.

that's one thought.

but since your dad had brain injury, it could very well be that his function had shut down in the area that regulates temperature.

that, and along with dehydration, results in high temps.

when it is *this* close to the end, i assure you, dad wasn't aware of what was happening.

more often than not, it's harder on the families than it is on the (dying) patients.

again, please accept heartfelt prayers for acceptance, comfort, and healing.

leslie

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Specializes in ICU.

Fevers make me feel the worst, extremely uncomfortable and miserable. why not give Tylenol to relieve that discomfort?

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My father spiked a fever rather suddenly, the floor nurse said (paraphrase) ' oh that happens when people are about to die, we see it all the time.' I got another nurse to evaluate, and prescribe a strong antibiotic. 6 hours later the fever was gone, the delerium was gone, my father could sit up, talk coherently, feed himself for the first time in several days. Best guess is an undiagnosed UTI , possibly sepsis from the catheter. My brother had decided that it was time for him to die and put him on hospice care ( in the skilled nursing unit) and no one bothered checking him out for anything else. Moral: don't assume high temp has anything to do with dying, in the absense of other symptoms.

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I have found that nurses and doctors all are guilty of having death discussions in the room in front of the patient. We have chosen not to tell grandma it is the end and instead we are having a goodbye party with Facetime videos from far away family and friends. I think she knows and she is choosing not to tell us it is her end.

I would recommend bathing the patient every shift when they are incontinent. I know it sounds excessive but would you like to be on your death bed laying in filth? Nurses here have 12 hour shifts and only looking once at a patients bottom in 12 hours is negligent. Some don't look at all. THey just ask if you need anything for pain. Change their pad, wash and lotion their legs and adjust the pillows for every terminal patient. Put on chapstick for mouth breathers. It feels so good. Also offer them a drink. My mothers kidneys have shut down but she is still eating jello and drinking coffee.

When a person is dying, give them warm blankets every 2 hours or so. I know you will complain about running low on blankets but this is the end of life, not a cold and sniffle. They are afraid, cold and exhausted. They are laying there with their thoughts on their entire lives. A cool towel over the eyes or behind the neck feels wonderful when you are hot.

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honeybee888 said:
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!

Increased temp naturally occurs at the end of life due to dehydration. Also, sometimes patient have other things going on like infections at end of life that are not being treated anymore. In any way, the idea is to keep a person comfortable and focus on symptom control (quality of life). I do think that tylenol supps are a very good way to ensure the person is comfortable. In increased temp also leads to increased breathing and heart rate and the pat may just feel uncomfortable because of it. A tylenol supp is usually a good way to help with this....

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