Tylenol Suppository

[sh1bby69]

I have a question in regards to Tylenol Suppository. I am a LVN and have been one for 15 months so I am still learning. I work in an assisted living and I deal with hospice as well. My question is there is a nurse who works with me. We had a few hospice pt with fever actively dying. She has administer Tylenol Suppository but it does not melt and when they have a BM it comes out with it. She said if this happens the best thing to do next is to take saran wrap and place a Tylenol Suppository on the belly and wrap it over it and it'll melt into the system.....I personally do not think that is correct yet does it even work. Is this a correct alternative method? If not, what are your suggestions for Tylenol Suppository not melting into the system? Anything suggestions will help. I would love to learn different techniques and tricks to make my pt die comfortably. Thanks guys!

[WSU_Ally_RN, BSN, RN]

I have never heard of this.... I would think if it's a suppository, it should go in the rectum, not on the skin. Its supposed to be absorbed through the gi tract, not the skin.

I don't know what other options you may have if it is not absorbing well... maybe someone else will have other suggestions for you.

[systoly]

I'm still learning too. I've never encountered either (supp. not melting, supp on the belly). My questions would be: since the rectal route in itself is likely to produce discomfort for the patient (oral route obviously not available)was the supp. perhaps not inserted far enough in order to reduce discomfort during administration and what would be the difference between supp. on the belly and a topical such as anti inflam. which should still have antipyretic properties.

I guess what I'm saying is I'm not sold on the topical version. I would love to hear from hospice nurses on this. In the absence of having advise from hospice, I'd try crushed acetaminophen in a gel cap. Then there's the lady partsl route, but I'd definitely want a hospice or Dr's order for this.

[systoly]

I guess I was tired last noc. Most likely (hopefully), the patient is gonna be dehydrated anyway so you're gonna see elevated temp. I wouldn't worry about the Tylenol too much and use conservative measures, cool compresses, drape bed linen over bed so they are not directly touching patient , etc.

[tewdles, RN]

Your instincts are correct...topical application of your tylenol suppository is not effective and not part of the hospice plan of care.

Temperature instability is a common sign observed in people who are "actively dying". It is, in large part, due to the CNS destabilization as the person nears death. Those things controlled centrally become less stable...things like reflexes, temperature, respiratory patterns, etc. Many times the tylenol is ineffective but helps family to feel like they are helping. My experience is that if you give tylenol the "fever" goes away, and if you do not give tylenol the "fever" goes away. My recommendation would be, in an unresponsive actively dying patient who has a temp of >100, put a cool damp cloth on their forehead, give them rectal Tylenol if ordered, don't worry if they poop it out. Don't try to melt it into their skin on the abdomen...just hold their hand, reassure them, make sure they are in a comfortable position on their bed...etc...keep them comfy.

[ellakate]

Hello sh1bby69! I think that you are right. From a patient care perspective, this is kind of magical thinking. If the person is actively dying, ask the physician for orders. Hospice has a lot of tricks that make things easier. This is by no means standard procedure. Check your policies and procedures. Arm yourself with knowledge.

[sh1bby69]

Thanks for your response guys. I know when I deal with non responsive actively dying patients I would do the suppository as order and just continue with cooling measures. Like some of you said just doing something assures and comforts the family. From what I get from end to life hospice care is that you are still making sure that the patient is comfortable but also that the family is well taken care of and that they are also comfortable as much as they can. Just finding some time to sit down and speak with them about their love one and sharing memories that you had with their love one really makes a different instead of just going in and out of the room. For me as a new grad, I feel like it makes a big difference. Thanks guys!!

[loriangel14, RN]

Just my two cents but I think the nurse that thinks saran wrapping a Tylenol supp and letting it "melt" into the patient is ummmm.......goofy.

[Emergency RN]

Just my two cents but I think the nurse that thinks saran wrapping a Tylenol supp and letting it "melt" into the patient is ummmm.......goofy.

LOL, What even "goofier" is that it even works with NITROGLYCERIN, too...

Seriously, TYLENOL is absorbed into the very vascular rectal tissue transdermally to begin with, though the dermis there is much thinner, and the temperature is much higher, allowing the TYLENOL to melt more easily. Thus, routine transdermal application of the TYLENOL outside of the rectum is probably not a great or rapid route of administration.

However, if the pt has no rectum, or if the suppository keeps popping back out (make sure the blunt end goes in first, so that the conical shaped end points out) then applying it transdermally isn't goofy at all. Unconventional? Sure. But it shows that perhaps one particular RN was thinking a lot faster, more deeply and more resourcefully in using that nursing body of knowledge in delivery of her care.

That, IMHO, is going the full distance for your patients. Rather than laugh, I would applaud her for her ingenuity.