Antipyretics on a dying patient

[Faust09]

Hi, I'm a new RN and it was my first time to look after a dying patient in a resthome. She was an elderly patient and she hasn't been eating/drinking well. She's dehydrated and having aspiration pneumonia. But despite those, she's not for resuscitation. I checked her vital signs after I received her from handover. I noticed her temp was >39 degrees C (or >102.2 F). So I gave her cooling cares - gave her sponge bath, opened windows, gave her an electric fan and minimized her linens for cover. Her temp hasn't settled after all those interventions, It was still >39 degrees C. So I decided to give her 500mg paracetamol supps. However, one of my colleagues said that giving her paracetamol (antipyretics) can accelerate the patient's death because I'm trying to lower her body temp she said. I've never heard such statement before. I gave the supps anyway because >39 degrees sounds uncomfortable for a person. The patients temp lowered to >38 degrees C (>100.4 F) afterwards.

I've researched journals about antipyretics and dying people, but I couldn't find any topics about it. Fever is a homeostasis imbalance and may cause discomfort on people, but does treating fever actually accelerate the death of a dying patient?

[HappyWife77, BSN, RN]

I would go for comfort measures....like you did.

I have not ever heard of treating a fever will cause death acceleration.

[beckyboo1, BSN, RN]

I'd ask said nurse to show you where she got that information. I've never heard such a thing. If I were dying or not, fever is uncomfortable and acetaminophen should be considered a comfort measure.

[kool-aide, RN]

A febrile pt who is already most likely dehydrated will only speed up the disease process and cause discomfort.

[toomuchbaloney]

You did fine. Standard hospice protocol allows and even encourages exactly what you did.

Your colleague is misinformed.

[Wile E Coyote, ASN, RN]

I wouldn't change anything you did for that patient...carry on.

[BrandonLPN, LPN]

Even if it were to accelerate the dying process, who cares? Having a temp of 39 can't be comfortable no matter how you look at it.

Some nurses I work with also seem to have a fundemental misunderstanding of death and dying.

We have a dying resident right now who has scheduled sublingual morphine and ativan. The day and evening shift nurses have held every doese on their shifts because he doesn't "look painful" and is sleeping. His respirations are consistently above 20. They seem puzzled that I continue to give it.

[beckyboo1, BSN, RN]

Even if it were to accelerate the dying process, who cares? Having a temp of 39 can't be comfortable no matter how you look at it.

Some nurses I work with also seem to have a fundemental misunderstanding of death and dying.

We have a dying resident right now who has scheduled sublingual morphine and ativan. The day and evening shift nurses have held every doese on their shifts because he doesn't "look painful" and is sleeping. His respirations are consistently above 20. They seem puzzled that I continue to give it.

You can educate and educate and some ppl just never "get it". Do they not understand Morphine's ability to ease air hunger? How very sad for those who are dying and should be allowed to so as comfortably as possible.

[dudette10, MSN, RN]

Even if it were to accelerate the dying process, who cares? Having a temp of 39 can't be comfortable no matter how you look at it.

Some nurses I work with also seem to have a fundemental misunderstanding of death and dying.

We have a dying resident right now who has scheduled sublingual morphine and ativan. The day and evening shift nurses have held every doese on their shifts because he doesn't "look painful" and is sleeping. His respirations are consistently above 20. They seem puzzled that I continue to give it.

I followed a nurse who also skipped Roxanol for 12 hours. He had supraclavicular retractions with an RR of 36. It took me five hours of q1 hour dosing to get him comfortable. Assessments of a dying patient need to go past fidgeting and facial grimacing, but I was puzzled as to why his air hunger was missed because I could hear him breathing outside his door.

[BuckyBadgerRN, ASN, RN]

IMO, it's just cruel not to treat the fever. You're not speeding up or slowing down the process that is already well under way. Your colleague needs to pony up proof of what's she's telling you. Of COURSE you're trying to lower the body temp--to a normal temp. How low does she think you can take a core body temp with 500mg of APAP?

[Here.I.Stand, BSN, RN]

Here's another vote for you did the right thing. First I have no idea what she's talking about. I've seen Tylenol drop BP in neuro pts, but have never seen it withheld in the actively dying b/c it speeds anything up. You do what you need to to keep her comfortable.

[Here.I.Stand, BSN, RN]

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