Pneumonia Question

Pepper The Cat, BSN, RN · Sep 7, 2013

Well I'd go with d because most of our docs do blood cultures when the temp is over 38.5

B no extra blankets for fever

C I don't know what is meant by "wrapping the axils and groin.

A I think 3 litres is a lot of water!

blondy2061h, MSN, RN · Sep 7, 2013

I'm so sick of the "no extra blankets for fevers" myth. If someone is chilling, you need to warm them up enough so they stop chilling. Shivering will raise the body temperature more than a blanket.

MunoRN, RN · Sep 7, 2013

I would hope we could rule out A, since we don't know the patient's Hx in terms of cardiac or renal function, we don't know if the pneumonia is thought to be due to or exacerbated by aspiration, possible hyponatremia, etc.

As for B, the patient isn't cold and doesn't claim to be cold, and to a point we don't actually want to discourage a fever. Rigors in these patients are usually due to the hypothalamus getting signals that there has been a sudden increase in cytokines and other infection biomarkers, and as a result causes rigors to create a sudden increase in body temp to combat what it interprets to be a sudden "bloom" in infectious bacteria, which is why I might go with "D". This is not always true, I would never call a Doc on an ICU patient with Rigors unless we weren't already suspecting sepsis.

I have no idea what "C" is referring to.

jamd11 · Sep 7, 2013

Ahhhhaa....Blood cultures! I knew I was missing something with my thinking process thanks !

Pepper The Cat, BSN, RN · Sep 7, 2013

I'm so sick of the "no extra blankets for fevers" myth. If someone is chilling, you need to warm them up enough so they stop chilling. Shivering will raise the body temperature more than a blanket.

But they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

blondy2061h, MSN, RN · Sep 7, 2013

But they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

Their body thinks it is cold because of the change in set point of the hypothalamus. Adding additional warmth can make the body feel warmer and calm shivers. A fever will break when it breaks. Blankets won't prevent that. Shivering is aerobic activity that warms the body. In this state, that is what the body is trying to do. If shivering cooled the body we would do it when it was warm out, not cold. Now, if someone had a critically high fever I would feel differently, but not a 38.6.

SouthernPoint · Sep 7, 2013

A = Too much fluid

B = Not at this given moment.

C = Pt is Hyperthermic, not Hypothermic

D = Yuup, hopefully the MD will order BC x's2.

Now after you get your BC order and they are obtained. Go get your Pt a cup of room temp water and a nice blanket.

nurseprnRN, BSN, RN · Sep 7, 2013

But they are not shivering because they are cold. They are shivering because their body is trying to lower the temp. Add extra blankets and the temp just keeps going up

No, shivering increases temperature by making for a lot of metabolic energy being expended with the work of the muscles. The patient is shivering to make heat (this is why you shiver when you're cold, too, BTW). Wrapping her up in blankets so she gets hotter will eventually tell her body it's done its intended job to make her hot enough to kill bacteria, and might make her feel better (do you feel better with shaking chills when you wrap up?) but since we have more resources at our disposal than Florence did, we will probably go further than that. :)

Backing up here, if this is for NCLEX land, you must look at only what they tell you. Only.

Someone who is febrile might become dehydrated, but they haven't told you any other information to say that she is -- no decreased BP, no dry mouth, no tachycardia. So... no dice on the bigtime fluid bolus, oral or otherwise. :no:

The extra blankets' insulation will make her hotter, probably not a good idea, and not therapeutic, as above. :no:

The axilla and groin thing is to capture the people that remember something about warm packs in axillae and groins in hypothermia and they'll confuse it with the shivering. :eek: Nope.

Now, normally, NCLEX wants to know what you, the nurse, would do. They usually hatehatehate the answer that says, "Turf to social work/dietary/chaplain/etc." for that reason. However, the nurse's responsibility is to do an assessment and deduce that something is going on that will, in fact, require a medical plan of care, and does, in fact, include notifying a physician of a significant change in condition. They have given you no other choice in terms of addressing this new development from a purely nursing intervention standpoint, and they have given you every indication that there is something here that will require doctoring as well as nursing. So the answer is D, notify the doc of the patient's change in condition.

xoemmylouox, ASN, RN · Sep 8, 2013

D sounds like the NCLEX answer to me.

~PedsRN~, BSN, RN · Sep 8, 2013

Totally D. 1) If the fever is new, we need blood cultures for sure. 2) patients who just become distressed when you are talking about airways freak me out.

chrisrn24 · Sep 8, 2013

D to me.

Patient is "distressed." That is a key word to me.