treating fever

[ktwlpn, LPN]

I'm involved in implementing "comfort care" guidelines in our LTC (we don't consult hospice) and I can't find much on treating fever....It seems futile to me-if you have good pain control and symptom management what's the sense in sticking a supp up someone's bum every 4 hours? Especially when the temp is due to an infection that we are not going to treat...Why not cool clothes,etc? Anyone have any sources for me? ( I have easily a dozen web sites I'm using now-)

[doodlemom]

We do treat fever with tylenol PR when someone is actively dying and feverish. I don't know about you, but when I've had fevers in my life, I felt absolutely horrible. I'd rather someone give me a suppository than suffer with fever. I continue to believe this is a comfort measure.

[leslie :-D]

ita w/doodlemom.

a fever is just an added stressor to the body. it elicits further tachycardia; the stress response produces lg amts of cortisol and andrenaline. if i can bring down that fever, then yes, i definitely consider it a comfort measure.

additionally, i've never agreed with those md's who don't treat infection in a dying patient, unless they're septic, neutropenic and actively dying anyway.

leslie

[rosemadder]

we use peppermint soap on our hospice unit. if the patient cannot withstand a bath in it then you can use it behind the ears, on the wrists, and on the ankles. it helps cool the patient down.

normally, it is the family who desires tylenol for the patient which is usually not effective in a patient who is in the last stages of dying...at this point their thermoregulator is not working properly.

if the patient is nonresponsive and in no apparent distress, i normally use the peppermint soap if the family is worried about the temperature.

[ktwlpn, LPN]

ita w/doodlemom.

a fever is just an added stressor to the body. it elicits further tachycardia; the stress response produces lg amts of cortisol and andrenaline. if i can bring down that fever, then yes, i definitely consider it a comfort measure.

additionally, i've never agreed with those md's who don't treat infection in a dying patient, unless they're septic, neutropenic and actively dying anyway.

leslie

I'm talking about residents that are actively dying-they are long past tylenol or antibiotics......I'll keep the peppermint soap tip in mind.

[leslie :-D]

I'm talking about residents that are actively dying-they are long past tylenol or antibiotics......I'll keep the peppermint soap tip in mind.

i cannot think of any stage in the dying process that you would not attempt to treat a fever. apap pr works wonders, provided the pt. isn't constipated.

very seldom do i see thermoregulation irregularities as a contributing factor....

lesllie

[webblarsk]

I have a question kind of related to this one. I am also a firm believer in trying to treat the fever. But has anyone noticed that the body stops absorbing the supp? I noticed this on a patient last week. Do you have any other suggestions in a case like this?

[leslie :-D]

I have a question kind of related to this one. I am also a firm believer in trying to treat the fever. But has anyone noticed that the body stops absorbing the supp? I noticed this on a patient last week. Do you have any other suggestions in a case like this?

the only reason i can think of a suppository not being absorbed is because of stool being present in the rectal vault. in the absence of stool, i cannot think of any reason why a suppository wouldn't be absorbed, therefore cannot offer any alternatives. i just make sure there is no stool present.

leslie

[abnerRN]

I'm with you in the actively dying patient Tylenol is usually ineffective and the temp will go down on its own. I prefer cool cloths on the forehead and a light sheet only for cover. And you're right the Tylenol is usually at the request of family, I just explain that A suppository is invasive and therefore not really comfortable Most familiy members only want a comfortable death and are usually satisfied when reassured.

We use Peppermint soap on our Hospice unit. If the patient cannot withstand a bath in it then you can use it behind the ears, on the wrists, and on the ankles. It helps cool the patient down.

Normally, it is the family who desires Tylenol for the patient which is usually not effective in a patient who is in the last stages of dying...at this point their thermoregulator is not working properly.

If the patient is nonresponsive and in no apparent distress, I normally use the Peppermint Soap if the family is worried about the temperature.