Tylenol ordered for pain.

Dranger · May 1, 2015

@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. ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½

NSAIDs are also anti-pyretic in nature and indicated for fever. I never said Tylenol was an NSAID, however Toradol is.

NSAIDs inhibit the COX enzyme which blocks prostaglandin proliferation thus reducing a fever.

Read more closely next time, otherwise you look pretentious and also WRONG.

Dranger · May 1, 2015

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.

Me thinks something else went wrong for this course of events to occur. I highly doubt someone just happened to audit a PRN med list and saw Tylenol given for 0 pain if nothing serious occurred.

gouranga · May 2, 2015

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.
Good luck! Sorry the doctor was a jerk.

I see. I definitely could have made the whole thing easier on myself and the patient by just asking if she had pain at the time (she did) and administering the tylenol for pain and fever. Thanks for the advice.

gouranga · May 2, 2015

NSAIDs are also anti-pyretic in nature and indicated for fever. I never said Tylenol was an NSAID, however Toradol is.
NSAIDs inhibit the COX enzyme which blocks prostaglandin proliferation thus reducing a fever.
Read more closely next time, otherwise you look pretentious and also WRONG.

Ha. There's a lot of pretentiousness in this thread.

Tenebrae, BSN, RN · May 2, 2015

Thanks. I'm seeing there are many types of nurses when it comes to following orders.

Its not about the type of nurse you are, but more do you want to ring a doctor solely for the purposes getting paracetamol (tylenol) also charted for fever and take the chance you piss him off and get an ass chewing like the one you did.

Not for one second am I justifying the doctors behavior, he sounds like a douche. Someone with a fever is going to have a certain level of discomfort, give them the tylenol for discomfort and get it clarified with the doctor when they are next on the unit. Imagine NCLEX is sort of like the starting place for learning.

I had an example with a med order that was so illterate neither myself or the other nurses on the unit could decipher it. When the doctor was on the unit, I asked them if they could clarify the order. The doctor looked at me and said "its perfectly clear".

I'm thinking "no it isnt, or else do you really think I would be bothering you given that none of the other six nurses on the unit could decipher it either". Out loud I used some self deprecating humour and said something along the lines of "yea, sorry I must be behind the 8 ball today, because for the life of me, I couldnt figure it, and didnt want to mess if up"

The doctor clarified the order. Now, one could argue that I shouldnt have to use self deprecating humour to get an order sorted. Reality is doctors are doctors, some are asses, some are brilliant, and I'll use what ever tool is needed to get what I need for my patient and to ensure I'm delivering safe effective nursing care.

akulahawkRN, ADN, RN, EMT-P · May 2, 2015

That's what I thought. And if I'd given a med without an order that he didn't approve of, I'm sure he would lose no sleep over writing me up. I just want clear orders, is that so much to ask??

Not so much to ask, really. Earlier today I had a patient that I knew was getting tylenol for pain and the Doc wrote the order for a fever. While I could have just given the tylenol, the patient was afebrile and therefore didn't meet parameters as ordered. I just simply clarified the order with the Doc and gave it. Not a huge thing in the grand scheme of things, but just one of those things that keeps us all on our toes to ensure that the patient gets the right med for the right reason. Side benefit of that is it helps keep us from getting into trouble.

Guest219794 · May 2, 2015

Its not about the type of nurse you are, but more do you want to ring a doctor solely for the purposes getting paracetamol (tylenol) also charted for fever and take the chance you piss him off and get an ass chewing like the one you did.
Not for one second am I justifying the doctors behavior, he sounds like a douche. Someone with a fever is going to have a certain level of discomfort, give them the tylenol for discomfort and get it clarified with the doctor when they are next on the unit. Imagine NCLEX is sort of like the starting place for learning.
I had an example with a med order that was so illterate neither myself or the other nurses on the unit could decipher it. When the doctor was on the unit, I asked them if they could clarify the order. The doctor looked at me and said "its perfectly clear".
I'm thinking "no it isnt, or else do you really think I would be bothering you given that none of the other six nurses on the unit could decipher it either". Out loud I used some self deprecating humour and said something along the lines of "yea, sorry I must be behind the 8 ball today, because for the life of me, I couldnt figure it, and didnt want to mess if up"
The doctor clarified the order. Now, one could argue that I shouldnt have to use self deprecating humour to get an order sorted. Reality is doctors are doctors, some are asses, some are brilliant, and I'll use what ever tool is needed to get what I need for my patient and to ensure I'm delivering safe effective nursing care.

Don't apologize for the fact that he did not do his job. He is well compensated for his work, and chose to do a shoddy job. Much like the Doc about which this post is written. Seriously, if you want a drug given prn fever, write it.

Fly_Nurse · May 2, 2015

@Dranger I know NSAIDs are for fever also and I know Toradol is anti inflammatory and you did say Tylenol was an NSAID you read closely next time I read exactly that âœŒðŸ½ï¸

Fly_Nurse · May 2, 2015

@dranger you said "it's an NSAID like ibuprofen and you were talking about the Tylenol because that's what the order was all about . Thank you!

Fly_Nurse · May 2, 2015

@thats why I said what I said I read it right! âœŒðŸ½ï¸ðŸ˜Œ

allnurses Guide · May 2, 2015

I once had a psych doctor order a big dose of Thorazine for a 10 year old with out of control behavior. Mind you I overheard the psych tech taking the order and saying yes doctor. She hung up before I could get to her so I looked at the order and said you can't give this? She said "Why the doctor ordered it?" " Because Thorazine is contraindicated in children under twelve and can cause sudden Cardiac death!" "But the doctor order it.. I got him on the phone and respectfully told him we could not execute the order and why. He chewed me oout, asked me what medical school I went to etc.....and I better follow the order or he would go to management. I kept my cool and stated "I cannot give this medication as ordered but if you would like to do it you can come on over and do so!" He hung up cursing and never called back. About an hour later the DON called me to her office and asked if I had an altercation with doctor so and so. I explained the situation and stated that I was acting as an advocate for my patient. She told me I had done the right thing and liked that I didn't let the doctor push me around.

PS: I have absolutely no problem calling a doctor in the middle of the night to get and order or clarify an order. I don't do it unless I have to and I actually have some physician's home numbers so I don't have to page them, but one doesn't become a doctor without expecting to be woken in the night - except maybe foot doctors - almost no one has foot emergencies in the middle of the night.

HPPY

Seaofclouds, BSN, RN · May 3, 2015

Me thinks something else went wrong for this course of events to occur. I highly doubt someone just happened to audit a PRN med list and saw Tylenol given for 0 pain if nothing serious occurred.

The DOH was in for a survey and during their chart audits, they noted the use of Tylenol for fever without an appropriate order. That is not what they were looking for initially, but once they found it, they ran with it. It happened enough times in the charts they looked at to get the hospital a citation (I don't know how many incidences they found of it).