I had an issue with a doctor at work today and I'm just looking for some advice.
My pt was admitted with pyelonephritis and spiked a temp of 103.1 today. I immediately put a call out to her doctor and got the nursing assistant to make a couple of ice packs to cool the pt down. The doctor was on the floor a minute later and I let him know what was going on. After berating me on my pronunciation of the word "pyelonephritis," he asked if I thought Rocephin was a pain medicine, then he went to see the pt.
The pt had an order for PO tylenol 650mg prn for pain 1-2/10. The order said NOTHING about tylenol in the case of a fever. Do I know tylenol is used to reduce fevers? Of course. But I was following the orders I had in front of me.
Anyway, this doctor made a huge deal and gave me loads of attitude for "sitting on" the tylenol order when I could have given it 20 minutes sooner. I'm just wondering.. was I wrong for not giving the tylenol right away?
I'm a new nurse. I've been off of orientation for a little over a month. In school we were taught to follow orders specifically. I even have a nurse friend who says if an order is for Tramadol for a pain scale of 1-5 and the pt says their pain is a 6, I cannot legally give Tramadol for that level of pain and I should get another order. Maybe that is extreme, but I am just trying to be a safe practitioner and protect my newnlicense.
AS a STUDENT who had something similar on a test, I can state that the correct answer is to follow the orders and not give it.
That covers the rules and the legal portion.
IF at any point something happens to the client and their file goes for a review, giving it for fever, when the order was for pain only might be a bad flag. I would not do it, unless I could give it for pain or get the DR to change the order. Even if I had to call him and bug him about this 'little' detail.
As a student, it is nice to be able to hear how other nurses work around this issue. We are called to think outside the box. But how far can we go? Getting alot of ideas from these examples
Wow you guys are paranoid. No one is going to care if you gave Tylenol that is indicated for pain for fever instead. Even in ESLD you can give Tylenol in lower amounts. You just have to critically think.
Even EBP says we don't need to jump on treating fevers, it's mostly for patient comfort.
Working nights in the ICU you get good an anticipating doc orders and putting in orders you know they will want (x-ray, labs, restraints) if they forget. I am not going to call at 3am and ask about a routine xray I know they will order.
The NCLEX and all the dogma that comes along with it is no longer applicable in the real world.
@dranger Tylenol is a nonsalicylate ....Not and NSAID. an NSAID is a no steroidal anti inflammatory and Tylenol is not anti-inflammatory . Tylenol is only antipyretic and analgesic. 😉
@dranger by the way Tylenol it's not like ibuprofen. Ibuprofen is an NSAID because it is anti-inflammatory. Again Tylenol is not anti inflammatory. ðŸ˜
Wow you guys are paranoid. No one is going to care if you gave Tylenol that is indicated for pain for fever instead. Even in ESLD you can give Tylenol in lower amounts. You just have to critically think.
One of our hospitals was sited by the DOH for nurses giving Tylenol for fever when it was only ordered for pain. They had no pain documented and documented in their note they gave the Tylenol for the fever. The hospital had to submit a plan of correction to the site and will be having a follow up visit for compliance any time now. So yes, some people do care about giving prn medications without an appropriate order/indication.
One of our hospitals was sited by the DOH for nurses giving Tylenol for fever when it was only ordered for pain. They had no pain documented and documented in their note they gave the Tylenol for the fever. The hospital had to submit a plan of correction to the site and will be having a follow up visit for compliance any time now. So yes, some people do care about giving prn medications without an appropriate order/indication.
No, you should not give a medication for reasons other than what is indicated; however some fevers are painful. With some directed questions "are you achy", "does your head hurt from the fever", even a pain score of 2 or 3 out of 10 warrants medication and viola you have your indication and can treat both the pain and the fever.
If you can not get the patient to admit some pain or discomfort, I would ask the doctor to change the indication for Tylenol to include fevers.
gouranga
144 Posts
Is toradol an anyipyretic? Wow. I still have so much to learn. Thank you!