Fevers & traeatment off

[annmariern]

Just wondering if anyone has a link on the subject. I work med/surg, post op pts tend to spike and temp 101, in the first 8 hrs. Then it comes down. Everyone freaks, tylenol for temps over 100. To me, this is a normal immune response. The body reacting/defending itself. If there not uncomfortable I monitor only. Today, young guy, celluilitis with a temp which climbed to 103.9. He was symptomatic, so i treated him with tylenol. and monitored him closely. My boss is freaked and is upset I didn't cover him with ice. He was shivering like crazy. I was taught icing down actually increased the core temp. Makes sense when you think about it. The more they shiver, the higher the bodies metabolic rate goes, the core temp increases. I asked the ID doc, he agreed. They looked at me like I was nuts. I got motrin ordered, it worked. Just curious what the fuss was about. I don't get excited until I see 105!

[TazziRN, RN]

She wanted you to ice him down?????? What was she thinking??? You NEVER ice anyone down unless they're malignant, and that happens rarely. Even then it's not the first treatment of choice.

If your boss tries to take it any farther I would suggest to education that they arrange for a refresher course for her about post op care.

[Lacie, BSN, RN]

I feel you did appropriately. In fact standards we used were not to give tyelnol unless temp was 101 F. I wouldnt ice someone down with a temp of 103 if he's shivering by any means. We usually dont ice unless the temp hits 104 and isnt responding to antipyretics such as rotating tylenol and motrin. Then we use a cooling blanket if necessary. Sounds like someone needs a crash course regarding not only postop care but basic pathophysiology.

[jetscreamer101]

just wanted to say i had a temp of 105.7 before. course i was septic from a perforated bowel. man those hallucinations seem so real.

[morte, LPN, LVN]

yup, some persons do get "freaky" about rxing fevers......was this fellow already on ABT? if so, you need to see where the fever is going, to help gauge rx.....also, if he was on ABT, was some of the shivering, really a herxheimers reaction? (sp) i think a little cont ed from the ID doc is in order, and (s)he should be pleased to have YOU working on/with their patients!

[JBudd, MSN]

Systemic Inflammatory Response Syndrome is a normal response to trauma (surgical or not), there are some really good articles about it out there.

[NurseWi_JennJenn]

we have orders for fevers above 101.0f...

question, do you guys give 2 doses of an antibiotic post-op? we always do with our surgicals...just wondering if this was a part of your protocol!!

:monkeydance:

[rn/writer, RN]

Post-op fever can also be a response to anesthesia and have nothing to do with infection, especially within the first 24 hours.

Many pediatricians have backed off getting hysterical about kids' fevers. We have learned that the body is doing what it is supposed to and we only interfere when we rush to medicate. Of course, you do want to monitor and treat if the temp gets to, say 104, but many times, the lower fevers are evidence that the immune system is revving up and fighting whatever is going on. That's a good thing.

I would think these same principles apply for adults as well.

[zacarias, ASN, RN]

What about fevers being an indicator for more pulmonary hygiene (or the more crass "toilet")? This is wildy believed by nurses and doctors and I've seen it work if people use there IS enough. However, I believe the research says that good pulmonary hygiene for early post-op fevers has no proof that it works.

[cardiacRN2006, ADN, RN]

The first thing I think about with post-op fevers is Cough and deep breathe.

[UM Review RN, ASN, RN]

We usually have postop orders to get blood cultures X2 for temps over 101.4 (or thereabouts, depending on the doc).

Some patients feel lousy with a temp of 99, but I usually try to avoid giving postops tylenol for the first few days. We've been taught not to mess with the body's inflammatory process.