atlkidrn

There is a lot of new evidence-based information regarding fever and antipyretics. Knowing nurses are generally short on time, I am still posting a link to a really good article on fever in the journal "Contemporary Pediatrics": http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=143315 To summarize: Like another poster mentioned, fever can be therapeutic. If a child is running around, able to play, and has a fever, there is not an automatic need to give an antipyretic. Fever will actually enhance the body's ability to fight the infection (viral or bacterial) and hasten the recovery time. An antipyretic can make the uncomfortable child feel better, and that is a good reason to give one. In a child who is has diarrhea, vomiting, or isn't drinking, bringing the fever down can also lessen their dehydration. Interestingly, evidence shows that a child prone to febrile seizures is not less likely to have one just because they received an antipyretic at home. As a PNP, I think pediatricians/PNP's are more likely to take seriously a report of a fever measured by a thermometer prior to the office visit - treated or not - than a report of "he felt hot." Other comments or experiences? :balloons:

The original topic was posted a while back, but maybe this will help somebody.... We used to use Tegaderm/Opsite to secure NG tubes. The only benefit to this product is that it's clear, and so perhaps cosmetically more appealing. However, it either sticks too well, abrading newborns' skin when removed, or it comes off too easily. My hospital currently uses two products. One is called "Tender Grips." This is a beige colored disc that is applied to the cheek; the NG tube is secured by a clear flap that is attached to the beige disc. Tender Grips can be removed easily by applying adhesive remover on the top of the disc, and they also can be used to secure O2 tubing. I will try to get contact info and post it ASAP. The other product we use is a white tape product called Hypafix. It secures well, and is also easily removed with adhesive remover applied to the surface. It's not as cosmetically unobtrusive as Tender Grips, but is a good solution for older kids who often grab at their tubes and pull them out prematurely.

My institution was visited by JCAHO the week of September 11, 2001 (yes, they went through with the survey despite the terrorist attacks!). We scored well, but spent months worrying, fretting, and preparing beforehand. To keep up to date for future visits, I read a newsletter called "Inside the Joint Commission." One of the topics in the December issue was concerned with how to get MDs to sign their verbal orders. This was also a huge focus of our preparation for the recent JCAHO visit. The article - and our administration - suggests that nurses should be the ones to ensure that physicians sign, date and time their orders. Doesn't this perpetuate the idea of nurses in a "handmaiden" type role to the doctors, while excusing inappropriate behavior on the part of the MD's? We must remind, beg, plead, and cajole someone into doing their job? If I forget to sign a nursing assessment, is it reviewed by another person and flagged for my attention? No. The newsletter article makes suggestions for getting doctors to sign their orders, including the usual flagging of incomplete orders, but another suggestion is that institutions host lunches at which the charts are available to be signed while doctors eat a free meal. Doesn't this reinforce or reward negative behavior? My institution initially suggested that the secretaries or the nurses fill in the date and time if they witnessed the MD writing the order. We refused, believing that to be falsification of records since we didn't write the order, and also because it doesn't deal with the problem - the physicians! I'm sure others have dealt with this problem. What are your thoughts?