Doc have right to get upset with me?

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Specializes in Intermediate care.

Losing sleep over this, need support from fellow RN's.

Had a patient last night that was hit by a car. He is quadriplegic and is ventilator dependent. He is 19 years old and has been with us for a while.

He is to be discharged home with home care nurse/mother and girlfriend doing cares. Because his mom does not yet have a vehicle that can transport him, we had to arrange a ride. Well this ride can only pick him up at 10am. Pretty early for a discharge! So it is 3am the morning of his discharge (today this am) and the PCT comes to be and says he has a temp of 100.4 (axillary). I went him, asked him how he was feeling he said fine but a little warm. I set him up with a fan and pulled off the blankets leaving him with just a sheet as he requested. I had to go back in at 5am for a lab draw they needed. So i waited until 5am to get another temperature, thinking maybe he was just warm. I went in at 5am, and i got a temperature of 99.1 oral. A little feverish, but better than before. I looked on the MAR and didn't see anything i could give for a temperature. So i left it and would report it off to the morning shift at 6:30am so they could report it off to the doctors on their morning rounds at 7am.

Ok, so it's 6:30 exactly and the doctor, a new resident actually, came up to me and the oncoming nurse as we are doing report and he was like "did you notice he had a temperature of 100.4 last night?" i told him the situation and he rolled his eyes and said to me like i'm stupid "Why didn't you call someone to get an order for something?"

He seemed very annoyed and he was like "Now i have to deal with this and decide what to do before 10am. you really should have paged the on-call" then he walked away not saying a word after that.

i'm like losing sleep over it, what did i do wrong?? he was feeling ok, didn't feel feverish. i really felt it could have waited until morning rounds. And besides, if i wold have given Tylenol (which i didn't have an order for, but would have gotten) then it would just mask the fact that he has a fever. It's not like the tyelnol i going to "cure" whatever is causing his "fever." given, we don't even know if it is a true fever because he is very warm blooded and is always complaining of being hot.

Was i in the wrong?? i'm loosing sleep over it, and i have to go back in for 2 more nights of a night shift this week.

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Specializes in ICU, Telemetry, PACU, Med-Surg.

What is the policy on your unit? Are you supposed to report a temp that is the least little bit above "normal"? At my facility we are not *required* to report a temp under 101, but we may do so at nursingn judgement if the patient feels awful or is symptomatic with a low-grade fever. In your particular situation, with the guidelines I have, I would not have notified the doc until morning rounds.

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You acted totally appropriately. Who gives a med for 100.4??? Taking off the covers was the best thing to do. And his temp came down, anyway. 99.1 is NOT a fever if oral. Nothing to worry about.

The doc is a toad. If you had called him at 3 AM he would have been annoyed. I am surprised that there weren't any prn orders for fever.

I do have one question - - why Axillary temp one time, then Oral temp at another time? Consistency is important.

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Specializes in Intermediate care.

i don't know the exact policies on this to be honest. i think it is just nursing judgement. She originally got a temp of 101 something, she repeated it on the other arm, because the arm she got 101 on he was laying on that side. So she did it on the other side and got 100.4 and thats the one she charted.

I feel like he would have gotten more upset with me if i would have called him at 3am with this. because working nights im always hearing "this could have waited till morning rounds" and i really felt this could have.

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Specializes in Intermediate care.
You acted totally appropriately. Who gives a med for 100.4??? Taking off the covers was the best thing to do. And his temp came down, anyway. 99.1 is NOT a fever if oral. Nothing to worry about.

The doc is a toad. If you had called him at 3 AM he would have been annoyed. I am surprised that there weren't any prn orders for fever.

I do have one question - - why Axillary temp one time, then Oral temp at another time? Consistency is important.

yea, consistency is important i agree. but the PCT did axillary as he was sleeping. He has trouble sleeping at night, so she wanted to leave him sleeping and not bother him. This is when i said i want to see an oral temperature and i would do it when i go draw 5am lab draw. I trust oral more than axillary. but yes, i agree it should be consistent all the way through.

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Specializes in Oncology, ID, Hepatology, Occy Health.

It's hard for me to think in farenheit as we use centigrade in Europe. I would say if the teperature was low grade (less than 38.5 centigrade) you did right. If the patient is geuinely febrile (38.5 and above) we immediately take blood cultures and inform the doc. In either case, the doc had no right to be so rude to you. Politeness costs nothing.

Have just looked up a temperature converter - our 38.5°C threshold equals 101.3°F. So yes, I'd have done as you did.

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Specializes in Intermediate care.
The doc is a toad. .

:yeah:

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..............

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Specializes in ED, ICU, Education.

If you lost sleep over every negative comment a doc said to you....you get the idea?

Don't sweat the small stuff. Typically, if the patient's temp is > 100.5 at my hospital, we are to report it and/or give Tylenol. Then probably panculture etc, etc. So, I kind of do agree with you and the MD. If the patient was brewing some sort if infection, then the more quickly you identify it, the easier it is to treat.

You also wrote that your next temp was 99.1 ORAL. Axillary is much more accurate, and your repeat should have been from the same source IMO. What have his temps been over the past 24-48 hours?

Please try to get some rest. I hope this helps.

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Actually many textbooks debate what is considered fever, overall docs will only order a med if its 101 or above. I think what your intervention was for 100.4 AXILLARY (WHICH IS UNRELIABLE) was just fine.

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this makes me think of something that annoys the hell out of me at work.....

A pt has a temperature of 100.4 or something not too crazy... i hate when the first intervention they like to go for is having me go up to central supply to roll down our big hyperthermia machine and cooling blanket and have me put it under them....

i can understand doing this if the pt is high risk for infection and/or the temp to rising rapidly....or anything 101 or above...

but 100.4... before you take off the blankets....get an order for tylenol...put in a fan or give the pt some ice packs....the FIRST thing they want to do is have been bring down this ******* machine and put ******* plastic blanket underneath

sorry had to vent...lol

and yes i think the doctor over reacted....and what you did was appropriate...

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Specializes in LTC, assisted living, med-surg, psych.

The patient should've had a standing order for Tylenol, but lacking one, yes, you should have called for it. One of the things that happens with quads is called autonomic dysreflexia, and fever can trigger a response which can be life-threatening. I once saw it happen to a youngish (40s) quadriplegic nursing-home resident I used to know as a result of sitting in filtered sunlight for about 20 minutes. He wound up in the ICU and almost didn't make it.

This is probably why the doctor was upset with you. It's partially HIS fault not ordering the APAP in the first place, but you also need to know that doctors are human and they forget things too......that's one of the reasons we're here. :nurse: And you shouldn't be the one making the call as to whether the APAP is going to "cure" something---that temp needed to come down regardless of what was causing it.

It is also your right and responsibility to notify the MD at any hour of the day of any issues or concerns involving their patient. That's why they get paid the big bucks, and if they're cranky about getting paged at 0300, too bad---maybe they should've ordered the Tylenol when they were there earlier in the evening.

Don't take it personally, either. The doctor isn't angry with YOU, he's upset at the situation and the potential for disaster, and probably himself as well for not having the foresight to have APAP on hand in the first place.

No need to lose sleep.......just remember: When in doubt, CALL. :redlight:

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