Pt assessment and trouble shooting; was I wrong?

  1. I had a pt that I can't stop thinking about. 50 year old female. The diagnosis from the doc wasn't infection related, but they were not very communicative or active -stuporous is probably accurate. They were brought in with altered mental status which turned out to my be more psychiatric in nature. regardless...

    lungs were clear, otherwise stable vital wounds.

    Periodically their temperature would go up to 100.1 or 99. I think if I remember it MAY have gotten as high as 100.6.

    Anyway, on my first assessment it was 100.1 or 100.6, and then i rechecked it an hour later and it was 99. On my next assessment it was 100.1. NOW this patient had a heating pad (the kind with the water circulating, like a blanketrol) on their upper arm per physician order d/t a DVT. and the temperature in the room was elevated because for whatever reason, people love to crank up the heat in the patient's rooms at night. (I work 3rd shift).

    I had a suspicion that the temperature was probably related to the room, especially because where I work we generally don't call unless it's over 101, and the physicians usually appreciate it if we stick to that train of thought, unless the pt is otherwise symptomatic with infectious like symptoms.

    So I lowered the room temperature, and got a fan for the pt to help fan off some of the surrounding heat coming from the heating pad -which was toasty! Obviously it didn't burn them, but it was rather warm.

    I rechecked their temperature later and it was normal.

    I made a note (we use EPIC) and documented that I was going to reassess their temperature and the steps I took and noted I would notify the physician if the temperature remained elevated. (I'm big on documentation, I've seen too many incidences where too little was documented and actions were explainable later).

    Keep in mind I work on an advanced care floor.

    Was this outside of my scope? I've only been on my own as a nurse for about a year and a half. I put a lot of thought into what I do..but I think I am starting to depress myself my second guessing everything and worrying about losing my license or getting sued. I see the world as out to destroy me/my choices; or at least not there to help.
  2. Visit LovesFerrets profile page

    About LovesFerrets

    Joined: Mar '13; Posts: 5


  3. by   HouTx
    Interesting. But without more info - Hx, Med DX, other vitals, lab,etc. it's not possible to provide you with any meaningful feedback. I don't understand why you feel you need to chart 'maybe' stuff - "if this happens, I will . . ". The place for this information is in the plan of care, not your notes. BTW, altered LOC & inc temp are associated with early sepsis - did you consider this?
  4. by   eatmysoxRN
    Did you give tylenol? Had the patient already had blood cultures done? We really need more info.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  5. by   LovesFerrets
    Yes, I had thought of sepsis, but there were blood cultures done that were negative previously that week. Nope, I gave no tylenol because I had in mind if it didn't go down, I would call about it and go from there. Plus where I am we don't give tylenol unless it's over 101.6. Vitals were otherwise unremarkable. Blood pressures on my floor always run high because it's a stroke care floor and we allow permissive hypertension for 3 days, and then gradually lower it and they seem to stick to that even if stroke was ruled out completely. so it was around 130-150 systolic, which had been her norm. 02 was normal for her, she lived on 2L nasal canula at home and it was satting upper 90's. HR was WNL. and i wouldn't say it was a change in level of consciousness. The MD felt it was a psychiatric situation.
  6. by   LovesFerrets
    nope no tylenol
  7. by   Ter.Rn.Er
    Lab values? Wbc, neutrophil, basophil, eosinophil..? Cmp..
  8. by   loriangel14
    Really a temp of 99-100.6 is nothing to be concerned about and doesn't qualify as a fever..Even having a extra blanket on/a warm room could bump it up a little. Some people are just naturally warm.Would a doctor like being called in the middle of the night for a temp of 99?
  9. by   LovesFerrets
    Thank you, that tends to be what I think as well -It's nice to have some reassurance. Like I said where I work we don't call anything under 101 a fever necessarily, especially in someone who isn't over 60. Also she DID have a heating pad (one that is similar to a blanketrol design) on her arm and the room was very toasty because certain people go around cranking up the heat at night.
  10. by   LovesFerrets
    I don't know this was a while. I'm just now thinking of it again. I do that sometimes. I don't keep my brains that go with my patients so I have little to no idea from sheer memory, but if they were elevated I would have remembered that.
  11. by   NRSKarenRN
    Thanks for the advice. Topic closed per OP request.