Treating fever with acetaminophen

[Vespertinas]

I believe that a little fever is a good thing. My understanding is that it's our bodies' response in an effort to actually kill the offending organism. When patients have a fever, I'm cautious to immediately respond with acetaminophen. I believe it's best used when the patient experiences symptom-related discomfort . If the patient isn't at all disturbed by his fever (when A&O), I feel like it's not worth interrupting a perfectly decent immune process.

This gives me problems when I handoff a patient to an RN who asks, "well did you give APAP for the fever?" I don't feel as though they want to sit there and listen to my stance on fevers but I also don't want to seem as though I'm being irresponsible.

Am I wrong? Should I be automatically treating?

[catlvr]

I, too, think that a little fever is a good thing, as long as they are not uncomfortable (I work in LTC). We have a lot of residents who are one the max daily dose of tylenol for pain management, so I get pretty concerned when they spike a temp; am I being paranoid in this?

[ClearBlueOctoberSky]

No, I don't think you are being paranoid about it. It would be a good idea to take it to the physician, or even your NM, or DON, to try to come up with a better plan. Maybe their pain management needs to be tweaked.

[catlvr]

I've done so, but so many docs don't want a pt to become "addicted" to narcs or don't want to be perceived as the doc who dopes up their pts. I know a lot of nurses who feel this way as well, so sometime I think that I am the odd ball on it, but there are so few pleasures in a LTC setting...why should someone have to live in pain?

My other concern is the potential of "masking" a sign of infection...some folks don't look or sound like they have pneumonia and the only clue is an elevated temp...but if they are on temp suppression via lots of tylenol...that concerns me, but maybe I don't understand the drug's method of action properly.

No, I don't think you are being paranoid about it. It would be a good idea to take it to the physician, or even your NM, or DON, to try to come up with a better plan. Maybe their pain management needs to be tweaked.

[Jory, MSN, APRN, CNM]

I always ask the patient. If there is an order I ask the patient if they are comfortable, educate them that a "little fever" is a good thing and give them the option if they want the medication or not. Most patients that I have encountered typically will live with it during the day, but prefer to be comfortable at night.

[PediLove2147, BSN, RN]

38.5 is considered a fever with most of the docs on my floor. We usually medicate for anything over that and have an order for such. If someone is postop I will have them use their IS an usually their fever will be gone.

[akulahawkRN, ADN, RN, EMT-P]

I'm also of the opinion that a low-grade temp is a good thing. I typically won't medicate for a temperature unless it's over 101° or my kid is feeling uncomfortable at the time. Typically, she doesn't start feeling uncomfortable with a fever until she gets to about 102° or so. I am still a student nurse, but as a parent, I tend to look at comfort and temperature, in that order.

If I'm looking to suppress the fever, because I need to keep metabolic demand to a minimum, then I'm going to most likely medicate much earlier than I would otherwise.

[Racer15, BSN, RN]

I'm pretty stubborn about medicating fevers as far as myself is concerned. I believe a fever is the body's way of fighting infection, and unless I go above 104 degrees, I don't take meds. For patients though? Anything above 100.4 I treat, especially peds. I don't think it's needed, but I'm going to cover my butt and give them their Tylenol/Motrin.

[ClearBlueOctoberSky]

I've done so, but so many docs don't want a pt to become "addicted" to narcs or don't want to be perceived as the doc who dopes up their pts. I know a lot of nurses who feel this way as well, so sometime I think that I am the odd ball on it, but there are so few pleasures in a LTC setting...why should someone have to live in pain?

My other concern is the potential of "masking" a sign of infection...some folks don't look or sound like they have pneumonia and the only clue is an elevated temp...but if they are on temp suppression via lots of tylenol...that concerns me, but maybe I don't understand the drug's method of action properly.

I think when our patients are on scheduled Tylenol, you might get a masking of a fever. I feel that it happened to me last week with a patient that has a habit of going septic very quickly. He wasn't running a fever on my shift, but it started to go up on the oncoming shift. However, because of the way that he was acting, I had already procured orders for stat labs and a UA. We had also been really encouraging fluids all morning.

It is where your assessment skills come in and how well you know your residents. If they are not acting right, then investigate.

[Altra, BSN, RN]

Only temps of > 38 get medicated at my hospital. In the ER we get lots of kiddos at 37.1 - 38 ... but we nurses (AND the docs) firmly educate family about why we're not medicating.

[TerpGal02, ASN]

I am in the a little fever is a good thing camp. We usually don't get fevers where I work (inpt psych) but for myself I won't take Tylenol unless I'm really uncomfortable.

[applewhitern, BSN, RN]

I have worked with a doctor who would not let us give acetaminophen unless the temp. was >103. I have also worked with a doctor who would only let us give one, 325 mg acetaminophen instead of 2. Most doctors, however, will want us to repeat blood cultures for a spike in temp of >101.

[turnforthenurse, MSN, NP]

I agree, I think a little fever is a good thing.

Most of the time docs will write parameters for Tylenol...to give if fever is >/101.5. Other times they don't, the order just reads "PRN pain/fever."