First job.....feeling like a failure (long rant sorry folks)

[juststartinout]

Hi all,

I was taking care of a pt last night. During a normal round i noticed that the patient felt really warm to the touch so i took the pt's temp. The temp was 104! I already gave some motrin for pain earlier in the shift. I called the doc, and got a one time order for tylenol. (I then felt dumb, because i later realized i should have asked for it to be prn) and orders to call back in four hours if the temperature remained elevated. One hour later i checked the temp and it had actually risen a little. I asked my supervisor if i should call the doc, and she told me to wait another hour. I talked to another nurse, and she said she would call anyway, if it felt wrong to me call him up. So, I called I recommended that maybe we could start some fluids to flush out the pt, but the dr. said no because bp was normal. Then the doc ordered some labs but didn't order anything else for the pt. So, I put ice bags in the pts armpits and groin. An hour later the temp was down to 100. Hours later when the attending came in I told him too, and he didn't seem concerned. I just really feel like the patient deserves a little more than motrin and tylenol, but I didn't know what else to do for him. I gave him another dose of motrin as soon as it was available. I just feel at a loss for what else could have been done for the poor pt.

I feel terrible, because i feel like i really didn't get much help from the doc for the pt. I wish I had stuck to my guns and asked the doc to come in and look at the pt. I just don't know, what to think at this point. I feel like this situation could definitely come up in the future, and I wonder if a few of you could share what could have been done better.

[ChristineN, BSN, RN]

Sounds like you did everything you could. I'm assuming the doctor ordered a blood and urine culture? Besides that, depending on the underlying cause, sometimes there really is nothing more you can do besides ice and Tylenol/Motrin.

[mazy]

I'm not sure what was going on with that specific patient but I do know that sometimes the doctor won't order PRN anti-pyretics because they want to monitor where the temp goes to see what is going on with the patient infection-wise. If they plan on taking a culture they actually don't want the patient to get tylenol or motrin until after it is done. Of course they never bother to tell you that.......

I worked with one doctor in a skilled facility who flat out refused to ever order PRN Tylenol for his patients because he was worried that nurses would just medicate for elevated temps without following up with him -- which is exacly what was happening with other patients. It was a pain, and he was a nasty little man to deal with, but I could see his logic.

But it sounds like you were definitely advocating for your patient, so don't kick yourself. Just keep doing what you're doing. You pick this stuff up as you go along, and unfortunately no one really ever takes the time to explain it.

[juststartinout]

Thanx you both for the insight and wisdom provided. I think coming out of nursing school, that you're instilled with a sense of solving every problem while you're there. This experience provided me with wisdom that as a nurse, I just can't help everything. Another nursing mile stone passed, thank you both again.

[Nurseinprocess]

Thanx you both for the insight and wisdom provided. I think coming out of nursing school, that you're instilled with a sense of solving every problem while you're there. This experience provided me with wisdom that as a nurse, I just can't help everything. Another nursing mile stone passed, thank you both again.

You will find yourself solving problems that occur during your shift on the way home in your car; or the next day when you are eating your breakfast . Sometimes you get inspired or kick yourself later when you think of a solution that was buried deep in your head in the moment. It's all good as long as we learn from each hurdle :).

[Meriwhen, ASN, BSN, MSN, RN]

Thanx you both for the insight and wisdom provided. I think coming out of nursing school, that you're instilled with a sense of solving every problem while you're there. This experience provided me with wisdom that as a nurse, I just can't help everything. Another nursing mile stone passed, thank you both again.

You're also going to learn that there will be a few times you can't even solve the problem for the time being, that all you can do is maintain the patient the best that you can. And that's not necessarily a poor reflection on you and your abilities.