Fever in the Elderly

itsme · Jun 19, 2003

do they use tympanic thermometers there? I hate those- if the elderly person has a wax build up in the ear, the temps will register lower. Maybe they had checked like that and didnt think he had a fever? We have a doc who only wants oral or rectal temps, and if we give him a tympanic temp he goes ballistic!

Shamrock, BSN, RN · Jun 19, 2003

I have often found that elderly often do not run a temp. even when they are very sick. Temp. is not always a good indicator of

their physical status.

suehp · Jun 19, 2003

I have found that a lot of my residents dont spike a temp very often if they are not well. If they havent I do other checks like obs, how they look , how they feel, and I also trust my instincts too.

In fact I had that today, one of my ladies felt very hot. I took her temp - it was 36.8. Nothing wrong with that but her urine is very cloudy (MSSU already gone to lab and awaiting result) - so I suspect that she has a UTI. So i made her comfortable and gave paracetamol.

I do find a lot spike a temp when they are really poorly, after it is obvious they are not well!

atownsendrn · Jun 19, 2003

Jay-Jay

The elderly often do not feel hot or run a fever until they are very sick. We often recieve patients into the ER from the NH who have altered mental status. They aren't responding like they usually do. They are sleeping alot and often lethargic. When they get to the ER and we do a rectal temp, they have a fever of 103. It is hard to assess exactly what is going on - especially if the person is unable to tell you that something is hurting them.

If I were in your situation I would be very upset that my concerns/request were ignored. I would go to the DON and explain that you are upset and why. Explain that you aren't trying to get anyone in trouble, but you would like concerns regarding your father to be addressed more promptly. Although contacting the doctor earlier probably would not have changed the treatment (he still would have been sent to the ER), he would be feeling better sooner. Good luck. And I hope he feels better soon.

kids · Jun 19, 2003

Originally posted by Shamrock
I have often found that elderly often do not run a temp. even when they are very sick. Temp. is not always a good indicator of
their physical status.

I agree 100%. I have always found mentation, appetite & activity to be far more accurate indicators of illness in the elderly...even in the severly demented.

renerian, BSN, RN · Jun 19, 2003

I agree with the above posts.

renerian

Jay-Jay, RN · Jun 19, 2003

Originally posted by atownsendrn
Jay-Jay

The elderly often do not feel hot or run a fever until they are very sick. We often recieve patients into the ER from the NH who have altered mental status. They aren't responding like they usually do. They are sleeping alot and often lethargic. When they get to the ER and we do a rectal temp, they have a fever of 103. It is hard to assess exactly what is going on - especially if the person is unable to tell you that something is hurting them.

If I were in your situation I would be very upset that my concerns/request were ignored. I would go to the DON and explain that you are upset and why. Explain that you aren't trying to get anyone in trouble, but you would like concerns regarding your father to be addressed more promptly. Although contacting the doctor earlier probably would not have changed the treatment (he still would have been sent to the ER), he would be feeling better sooner. Good luck. And I hope he feels better soon.

BINGO!! Yes, I AM very upset my concerns were ignored!! The ER dx. him with pneumonia! I KNOW MY FATHER!!! Why the heck didn't someone listen to me??? GRRRRR!!

Anyway, he is back at the nursing home after IV abx and hydration, and is feeling much better. He is eating normally, and when I called this AM, had gone for physiotherapy. Still, I plan to make a visit later today, and let them know (POLITELY!!) my feelings. I DO have an RN after my name, so next time, PLEASE pay attention to me!

srose · Jun 19, 2003

One of the first things covered in our gerontology unit was that it's actually relatively rare for the elderly to spike a fever in response to infection; other signs such as altered cognition, confusion, etc are much more reliable. If you DO see a high fever in an older adult, then you REALLY have cause for alarm.

Love-A-Nurse · Jun 19, 2003

jay-jay, i am glad your father is improving.

this is why it is so important for family members to check often on their loved ones and the nurses...be an advocate for those who do not have loved ones/family/friends.

Jay-Jay, RN · Jun 19, 2003

I am drafting a letter to the NH right now. I hope you don't mind being quoted on this?? (anonymously, of course!!) :devil:

The staff in that NH really needs to pull up its socks!

Oh, yeah, they use tympanic thermometers exclusively, and I know dad has a problem with wax, as his hearing aid keeps plugging up with it! So, that's another thing I'm going to mention.

A big THANK YOU for all your contributions!

:kiss:

atownsendrn · Jun 20, 2003

Good luck. Let us know how things work out. I'm glad your dad is feeling better