Treating fever with acetaminophen

brithoover · Mar 16, 2013

I would tend to agree with you however you have to do what your policy says

ClearBlueOctoberSky · Mar 16, 2013

The NP that I work with closely has a stance to medicate at 100.5 or above. I agree. I think a little fever is a good thing, especially when there are no s/s or no voiced discomfort associated with the low grade fever. There is a nurse that relieves me though, that will medicate if they have a fever of 99.

I personally think there are other things that will affect temperature, other than infection. Do they just need a little fluid, is the room too warm and they are wearing nine layers of clothes, have they been in bed and just need to get up and breathe a little better? (I would say deep breathing, but I work with the dementia population. Trying explaining THAT concept to my LOCP.)

Vespertinas · Mar 16, 2013

I mean despite a clear parameter that states for fever >xx degrees. :unsure: ...I know

But I still want thoughts on the physiology behind this.

MunoRN, RN · Mar 16, 2013

I agree that for most people with mild to even moderate illnesses, a little fever is beneficial (as opposed to a higher fever that can cause brain damage). But you have to weigh the benefits of a little fever with the additional metabolic demand this places on someone. In ICU we're not very tolerant of fevers, mainly because we're trying to reduce metabolic demand as much as possible.

ckh23, BSN, RN · Mar 16, 2013

I agree that for most people with mild to even moderate illnesses, a little fever is beneficial (as opposed to a higher fever that can cause brain damage). But you have to weigh the benefits of a little fever with the additional metabolic demand this places on someone. In ICU we're not very tolerant of fevers, mainly because we're trying to reduce metabolic demand as much as possible.

This.

RNsRWe, ASN, RN · Mar 17, 2013

The NP that I work with closely has a stance to medicate at 100.5 or above. I agree. I think a little fever is a good thing, especially when there are no s/s or no voiced discomfort associated with the low grade fever. There is a nurse that relieves me though, that will medicate if they have a fever of 99.

My, I think that nurse would keep me on enough Tylenol to kill off a major organ, as 99 is not unusual for me at all....and I don't start feeling "feverish" until I'm 101. or higher.

I don't believe in medicating for a "fever" unless the patient actually feels uncomfortable. Otherwise, fluids, rest, and monitoring. That's for me and my own family, though.....and whenever I've had the leeway to medicate floor patients with PRNs as I've seen fit. Have another set of orders to medicate at X degrees? Gotta do it.

joanna73, BSN, RN · Mar 17, 2013

I agree that a low grade fever should not always be medicated. Take off a layer of blannkets, fluids, sponge them off a little, reassess.

However, this depends on the client population and the condition of your patient. Geriatric patients can and will go downhill quickly with no medical intervention. If one of my geriatric patients has a fever of 38.1, I'm going to give them tylenol in addition to the basic interventions I mentioned. I would also check the rest of their vitals and look to see when their last BM was.

So it depends.

hiddencatRN, BSN, RN · Mar 17, 2013

My, I think that nurse would keep me on enough Tylenol to kill off a major organ, as 99 is not unusual for me at all....and I don't start feeling "feverish" until I'm 101. or higher.
I don't believe in medicating for a "fever" unless the patient actually feels uncomfortable. Otherwise, fluids, rest, and monitoring. That's for me and my own family, though.....and whenever I've had the leeway to medicate floor patients with PRNs as I've seen fit. Have another set of orders to medicate at X degrees? Gotta do it.

We were taught in school that a fever is 100.4 (my employers have all had the same parameter) and above anyway, so 100.5 IS a low grade fever. I'd never think to treat a temperature of 99 unless the patient had been having fevers and looked like they were on their way up again. We do treat 100.4 and above though.

wooh, BSN, RN · Mar 17, 2013

We've had parents lately that are DEMANDING around the clock tylenol on their child. "He woke up, he needs tylenol!" Sadly, since our customer satisfaction surveys will come back before the kid needs a liver transplant, we're obliging.

Working with kids, where the numbers can vary widely from kid to kid and even on one kid from minute to minute, I've learned to look at the patient more than the numbers. 37.6 but breathing fast and looks miserable will get tylenol before 38.5 and feeling fine. Unless we're looking at seizure-inducing kind of fevers, I don't tend to treat "fever" but rather the "discomfort that comes with a fever."

ClearBlueOctoberSky · Mar 17, 2013

It used to be that when she received her temps back before I was done charting, and she start to medicate with Tylenol, I would feel like I haven't done my job properly.

Now, I just shake my head and suggest that maybe they need to take a shirt off. Our unit is incredibly hot almost all year around, and with our little old people, wearing nine layers of clothes, all it takes is some cold juice and removing a few layers.

I don't hesitate to put someone on the 72 hour monitoring report if I have concerns for them. Most of the time, it turns out that it really isn't anything and I get asked if it really is necessary to chart on them, and then there are those times when I am glad I did it.

And as always, you need to treat the patient, and not the machines. That may sound a little cavalier, but it is something that I learned as a Paramedic, and it has always served me well.

ZenLover, MSN, RN, NP · Mar 17, 2013

I still think of my uncle who had his PhD in Pharmaceutical Science and said all the time how useless Tylenol was. Though I guess if you have a patient that can't take Aspirin or an NSAID it has it's moments. I still am not completely sure about it's efficacy though.

Besides that...a little fever is good. I do work with Oncology patients though and when you have neutropenic issues you can't mess around, but for my two small kids I don't medicate unless it is above 101 or they can't sleep, etc.