when a patient has chills and shivers?

mappers · Oct 16, 2012

Did the patient have a fever? If so, no do not put blankets on them. They need to be cooled down, not warmed up.

Was the patient having a reaction to rituximab or another MAB drug? In this instance, give Demerol for Rigors. In that case a blanket might help since fever isn't the issue.

KelRN215, BSN, RN · Oct 16, 2012

In my experience, chills and shivers in an oncology patient almost certainly means they're about to spike a fever. What was this patient's temp at the time?

tokebi · Oct 16, 2012

It wasn't a reaction. She was six days post transplant, had spiked a fever previous day, so she had all the fever work-up done and antibiotics started.

When she started shivering badly, I instinctively put all those blankets on her. Her temperature was about 99.0 at the time, but rapidly went up to 102 within 30 minutes! Then I hurriedly took away those blankets thinking, "Oh shoot, maybe I shouldn't have!"

So, during that time where temperature is rapidly increasing and the patient feels chills, we should not offer blankets even if patient asks for them?

blondy2061h, MSN, RN · Oct 18, 2012

We give patients warm blankets when they're shivering. Shivering is the body's way to warm up when it thinks it's too cold. Allowing a patient to shiver is going to cause a higher temp than a blanket. A fever is a transplant patient's only natural defense against infection. As a rule, in our adult patient we don't attempt to lower a fever via Tylenol or ice packs until it reaches the very high zone. If they are rigoring we'll give steroids or Demerol.

She was almost certainly shivering because she was well on her way to spiking. You didn't cause the fever.

tokebi · Oct 18, 2012

Thank you all!