new grad-advice on when to call doc for febrile pt

[kbear1729]

Hi all, I'm new to allnurses.com, and a new nurse working nights on a med-surg floor with only 2 months experience. I was hoping to get some advice. I had a patient who was admitted with pneumonia yesterday morning and had a temp of 100 on admission. Around midnight when I started he was up to 103. All other VS stable, being treated with IV antibiotics, and doc had ordered blood culture on his admission, awaiting results. He was c/o a headache, so my thought was to give him Percocet as was ordered prn for pain and that would bring his temp down. I went to one of my colleagues, as I am still on orientation, and explained the situation and my reasoning. She advised me not to wake the doc for his temp bc he was running temps when he came in, cultures were ordered, and standing order for perc. This made sense to me-as a temp w/ pneumonia is expected and really what else could he have ordered? I administered the perc and his temp was down to 101 within an hour. I know everyone has different practices about calling a doc in the middle of the night, but I just wanted to get some feedback on whether this should warrant a call to the MD. Pt was comfortable, not diaphoretic, taking PO fluids. Any feedback is appreciated.

[mappers]

I agree with what the other nurse told you. Think along the lines of what would you want the Dr. to order if you called him/her? Do you already have orders or standing orders to cover the situation? In this situation, you already had orders to handle it - the Percocet which has Tylenol in it. On my floor, we had SOs for Tylenol for pain or fever, so that would cover you as well.

I would have done what you did, administered the meds, montitored the pt for response. If he didn't respond or if he deteriorated, then call the doc. What would be the next step? Cooling blanket? Transfer to another unit? When you need interventions beyond what you have available to you, then you call the Dr.

[kbear1729]

thanks mappers. I appreciate the advice!

[NnSweets]

"When you need interventions beyond what you have available to you, then you call the Dr."

Great advice for real life AND for NCLEX world. Love it!

[Biffbradford]

Have something in mind if you're going to wake him up. The Doc may say "103? Okay, what do you need?" Well, I just wanted you to know. "Okay, thank you". Click.

[NickiLaughs, ADN, BSN, RN]

Yeah, you made the right call, there really isn't anything else they can do until the blood cultures come back.

[Isabelle49]

You did the right thing. You also had the comfort of knowing that the patient was being actively treated for pneumonia. Now, if the temp would not come down, I would probably make the call.

[ckh23, BSN, RN]

I would have called just for the simple fact that he was running a temp on admission and he didn't order anything.

[p_hawk]

I would have called just for the simple fact that he was running a temp on admission and he didn't order anything.

She made it pretty clear that the dr had already ordered blood cultures, iv antibiotics, and percocet prn.

[ikay81]

For me it would depend on the doc. Some of ours like called if a temp is above 101.5. No matter what. But with others I would have done what you did. I probably would have heads upped everyone if they needed to call that doc to discuss with them. Then just monitored temp and if didn't improve called later.

[highlandlass1592, BSN, RN]

Sounds like you did the right thing. And more importantly, you assessed both your patient and the situation, reasoning what else the doctor would have done: IV abx already on board, taking in fluids, pt not really symptomatic. Those are all critical thinking skills and it sounds like your's are developing nicely.

When would I call in the situation you presented? Well, if there was a change in LOC, if the fever continued to climb (reasoning: you may need to start IVF and start cooling the pt), if the initial cultures started to show something not covered by current antibiotic regimine. Sounds like you did well, IMHO

[ObtundedRN, BSN, RN]

Our policy is call for a temp of 101.5. And we have on our standard admission orders for tylenol for a temp of 101.5. So basically if you use that PRN, you also need to call.

As for your situation, I would have called. But then again I work in a teaching hospital and always have interns around at night. At the very least I would have called to let them know, so if they are cross-covering, they can pass it along when they sign out in the morning. Also, I would probably want a cooling blanket for a temp of 103, and if you were only giving one percocet with only 325mg of APAP, I'd probably want 650mg instead if I don't already have a PRN order. So yes, I would call.