Help for my 19-year old daughter!

Daye · Aug 18, 2007

I have worked w/many pt who are/have gone through recovery after bowel perf running a temperature is not uncommon, most often it tells us the body is working and doing it's job to fight and get well again. However it is something that also has to be taken into consideration w/all systems too. Normal intake and output of fluids, abdomen soft and so forth. Concern is natural and it's good to help keep you alert for unusual changes or a decline in her progress. Best wishes to you and your family on a full recovery.

Daytonite, BSN, RN · Aug 18, 2007

hi, mz. mother!

i had a right colectomy (the first 1/3 of my colon was removed) on june 28th. everything went fine and i went home after 4 days although they told me i would probably be in the hospital for 7 days. i was thrilled i was doing so well. then, a week later a seroma, a open area, developed in my incision. let me also tell you that i am a bit overweight with some fat tissue there so there was room for this area of unhealing to develop. it was 4 inches deep and drained and drained. a month later i woke up one morning feeling just awful. went to the doctor and found i had a fever of 101.9 and my blood count came back the next day with a white cell count of almost 30,000 (this is abnormally high). this indicated a probable septic infection, mostly likely in this open wound. so, i was back in the hospital for 11 days on iv antibiotics--three of them at the same time to knock out this infection. i finally got home a week ago and just finished up the last of some oral antibiotics yesterday. so far, no more fever. the wound has actually made some dramatic improvements toward healing.

now, my understanding about bowels is that they have bacteria in them that live there. this is quite natural. surgeons are aware when they open them up that this bacteria is likely to contaminate the open wounds. this is why they try to cover you with antibiotics in order to kill off any stray bacteria that made their way out of the bowel and into the surrounding tissues. there can be other reasons for fevers as well when there is healing going on.

the only thing i can say to you and your daughter is to just hang in there. take each day as it comes. let the professionals treat each problem as they find it. i think about what could have happened to me if i had lived 100 years ago or more. i most surely would be dead because they didn't have the technology or the antibiotics that they have today.

here are some websites where you might find helpful information. you might want to investigate "night fevers" or "night sweats". you can look for information about crohns disease and other medical problems on some of them:

http://surglinks.com/icu.htm - what to expect before, during and after surgery - there are also links at the left side of the page to explore
http://www-medlib.med.utah.edu/webpath/tutorial/ibd/ibd.html - short tutorial from the university of utah school of medicine with links to images of tissue slides
http://www.clevelandclinicmeded.com/diseasemanagement/gastro/inflammatory_bowel/inflammatory_bowel.htm - physician article about inflammatory bowel disease which includes crohn's. includes its definition, incidence, pathophysiology, signs and symptoms, diagnosis, treatment and outcome.
medline plus (use the search box) http://www.medlineplus.gov/
medicine net diseases & conditions a to z index http://www.medicinenet.com/diseases_and_conditions/article.htm
encyclopedia of surgery http://www.surgeryencyclopedia.com/index.html
web md index list of medical conditions http://www.webmd.com/a_to_z_guide/health_topics.htm

i wish a speedy recovery for your daughter! welcome to allnurses to you! :welcome:

Tweety, BSN, RN · Aug 18, 2007

Sometimes believe it or not a side effect from the antibiotics are fever. I looked up septra and that is on the list of side effects.

Sometimes the "Fever of Unknown Origin" is baffling indeed. I hope she continues to progress.

Remember the function of this site is not to offer medical advice, but to share our nursing experiences.

GeminiTwinRN, BSN · Aug 18, 2007

Hi, I just wanted to come in and add my well wishes for a speedy recovery for your daughter. I know this must be concerning for you, to see her well enough to eat and drink and be mobile, but yet still in the hospital.

You mentioned Crohn's disease. One of the symptoms of Crohn's is fever. While her immediate problem of peritonitis (the perforated bowel results in the leakage of the contents of the bowel into the abdominal cavity causing peritonitis) has been addressed, the underlying condition of Crohn's may still be symptomatic and require adjustment of her meds to allow her to go into a remissive state with her disease process.

Again, hugs! :)

CRNI-ICU20 · Aug 18, 2007

I agree with Tweety. Sometimes, a FUO (fever of unknown origin) will persist because of major shock to the body...ie, the surgery, the recovery, the onslaught of heavy antibiotic therapy....

If she's eating, and has a normal blood count, and has no other probs: ie, low urine output, low blood pressure, chills, muscle weakness, thready pulse or irregular pulse, frequent and persistent cough with or without mucous production....then I would say that she's mending normally....some folks are just like this....some people will normally run an afternoon temperature as their norm....sometimes an increase in temperature is also a pain indicator....even if she doesn't "feel" alot of pain, her body is still reacting to the trauma of surgical incisions and drains....

Sometimes,people will eventually drop this temperature spike when the drains are removed....it's more related to the immune system response of having a foreign object inside the body....

Make sure they follow up all CT scans...etc...it's normal, after bowel surgery to have small amounts of air and fluid collections in the peritoneal cavity....these should dissappate over time...

The reason for this is that during the surgical procedure, the cavity is rinsed over and over again with sterile saline solution, esp. when the surgeon is ready to close each layer of tissue....this affords him/her an excellent way of determining whether or not there are any oozing "bleeders" ie, vessels that have not completely coagulated off....with each layer, until the fascial layer, this is done, so that the patient isn't left with a "leak"....

Also, during this time of closure, a sponge count and instrument count is done....three times on average....to be sure that all that went up on the sterile field and into the patient comes back out again....

All surgical sponges are "tagged" with a radiopaque (xray visible) tag or tail so that they are locatable on xray, should the worst case scenario happen and one gets left inside a patient....it can happen in bloody cases, where the sponges are difficult to differentiate from tissue....it truly looks all the same sometimes!

I think your daughter is doing very well, considering the extent of her surgery....she has youth on her side....make sure in her days to come that you work closely with her doctors and nurses to get her on a good nutritional path so that she continues to heal well....

Some doctors/surgeons prescribe 500 mg. of Vit C for their post op patients on a routine basis....might be worthwhile to ask about...

I'll be thinking of you and her....you're a good mom to be looking out for her so well...crni

caroladybelle, BSN, RN · Aug 18, 2007

I have Ulcerative Colitis and have had it for 17+ years. It is similar to Crohn's, and both fall into the class of Inflammatory Bowel Disease. A key word in the name is the word "inflammatory". However, while the main focal point of the inflammation is the intestines, frequently other parts of the body also develop inflammation and with the body's response of inflammation, the patient may get fevers, sweats, fatigue, elevated WBCs, elevated sed rate, etc....many of the same symptoms that one would get from an infection.

While there is no known cause for IBD, there are some suspicions that it is due to autoimmune factors - that something provokes an abnormal autoimmune response, causing the body to attack its own tissue. Note that quite a few IBD patients will note other signs of autoimmune disease during a flare up - for example, I get a "butterfly" rash (normally associated w/SLE lupus) and develop atypical erythema nodusem (fevers of up to 105, swollen joints - usually ankles/shoulders, severe pain and fatigue - looks like cellulitis). It took a lot of tests to find out what was going on. Side effects will vary greatly from person to person.

While IBD can be common in certain families, it is definitely not restricted to being inherited - like breast cancer, most cases occur without an inherited link. It also may take a while to be clearly diagnosed. Especially with Crohn's. While one can view and fairly easily biopsy the large intestine, the small intestine cannot easily be scoped and biopsied, barring major procedures.

Even in my case, unless I am severely ill and having a severe exacerbation, my colonoscopy "looks" quite normal and visualization. However, the biopsies/pathology reports show long term changes associated w/repeated inflammation and disease, that have occurred over time. When you figure that small intestine cannot be scoped and easily biopsied, and visualization is usually limited to barium swallow and follow through, it would be more difficulty to diagnose Crohn's, especially when it first starts.

I, personally, find the best way to prevent exacerbations (both of bowel symptoms and fevers/aches/erythema) is to aim for optimal health. I stay well hydrated, obey diet restrictions, get plenty of sleep and rest, de-stress frequently, and take the IBD meds, if ordered. It doesn't work for everyone, but does work for me.

SICU Queen · Aug 19, 2007

I agree with everything that's been posted so far, but would like to add that perhaps a consult with an Infectious Disease doc is warranted, just to make sure she's been cultured appropriately and is on the right antibiotics. Ask if your daughter's being seen by ID, and if not, request it (if you want it).

Best wishes for your daughter, Mom... and please keep us posted on how she's doing!

suanna · Aug 19, 2007

Although this is not the best forum for "medical" advise a will ad my two cents :

1:I wonder about atelectasts causing the fever. Using the incentive spirometer or a round of coughing/ deep breaths may resolve it. In my experience, atelectic fevers are most common in post op patients at night since the patients are less active and not doing post op pulm toilet(c/db, I.S.) as frequently.

2: Night time fevers in a 19y/o I wonder about Mono. if everything else is neg. a mononeucleosis titer couldn't hurt; but this is a long shot.

3: Crohns can cause fever by itself if the bowel is still inflamed or not absorbing fluid well. A crohns flare can last weeks or mos.

4: She is still on antibiotics- even without "a collection of fluid" on C.T. she may have an underlying infection that is not yet knocked out. Her docs are best to evaluate this but I would see if the hospital has a case manager who can set up a meeting with you, your daughter and her docs to explain her course of treatment and thier expectations.

5: Does she have in infectious disease consult? Even with a surgical history a fever of unknown origin lasting weeks may be best evaluated by someone other than a surgeon. It doesn't hurt to ask.

sharann, BSN, RN · Aug 19, 2007

Also not giving medical or nursing advice here, but I think we all know that opinions are not advice, they are opinions based on many things.

My opinion as a person with Crohns myself who happen to be and RN is as follows. I also tend to have evening and night fevers and feel generally crummy like I have the flu coming whenever I am starting or in a bad flareup. The temp always is normal in the a.m. This is just how my disease acts and if you search the HealingWell forums you will find many individuals who can relate!

So glad to hear your doll is feeling better and doing so well. She muct be a strong person(common in chronic disease sufferers...and future nurses...)

Take care of yourself too mom, ok?

Shar

Sabby_NC · Aug 19, 2007

I do hope your daughter is now on the road to recovery.

Sometimes little collections of fluid do occur after gut surgery.

Hang in there as it sounds like she is doing rather well despite the low grade fever.