## Fevers

After all of this talking, it is time to take the child's temperature and the child is too young for an oral temperature so I tell the parents that I have to take a rectal temperature. They moan with disgust but unwrap the child from it's fleece blanket and pull down it's flannel pants and undo the diaper and turn the child over. I apply some lubricating jelly to the tip of the applicator and I gently insert the tip of the thermometer. Lo and behold the temperature comes back at 103.8 degrees Fahrenheit! The parents are shocked, I definitely was not.

I ask the parents if they have given the child any medication for the fever at home and the usual answer is no or some cough syrup or some crazy home remedy of hot water with lemon, but I digress, I run to grab the Motrin and Tylenol and a syringe. I weigh the baby and the baby weighs, for easy math, 22 pounds. Now it is time to calculate how much to give. NEVER read the back of the bottles and NEVER use their syringes. I'll tell you about that later. So, I grab the Motrin bottle and it says that there is 100 mg of medication in 1 ml. So the formula for figuring out how much to give is to first convert the weight of the child to kilograms and you do that by dividing the weight in pounds by 2.2 which should give you, in this case, 10 kg. The formula then states that you multiply the weight in kg by 10 and divide it by the amount of ml. Let me simplify:10 x 10 = 100. Now since the bottle states that there is 100 mg of medication to 1 ml you would divide the 100 by 1 which would give you 100, which would then tell you that you needed to give 1 ml of medication. Easy enough. So, with my hospital syringe I draw up i ml of Motrin. Since the fever is so high and Motrin and Tylenol are different medications, I decide to give the child both. The formula is the same except you multiply by 15 instead of 10. The most important thing is to check the bottle you are using to see how many milligrams of medicine are in the mL because if it is 160 mg in 5 ml then the equation would go like this: 22/2.2=10x15=150/5=30. So you would give 30 ml of that medication. When I show the parents this method and I explain to them that I am giving both medications because the child is young and the fever is high, they calm down and listen. This is the time that I take to explain the most difficult topic of all. You would think that the math was the difficult part but no it is not. I begin to explain to the parents that when someone whether a child or an adult has a fever, their body's temperature has gone up because it is fighting infection. Sometimes the fever gets too high and you want to control that because it can cause seizures, which is not good for anyone involved. I tell them that besides giving medication there are other things that they can do to help with the fever. If they are at home, undress them down to a shirt. Do not cover them with any blanket or sheet. At this the parents gasp and say that I am evil because the child is shivering with cold. I reply by telling them that I might be evil but I will keep that child from having a seizure so which would they rather have? I explain that covering up a child or person with a fever only raises body temperature and causes the fever to go up. If a few shivers is all the patient has to endure to keep from having a seizure, to me it is well worth it.

The two most ignored pieces of advice given to a parent by a nurse is the covering of the patient, even though they nod and agree. I cannot tell you how many times I have had to walk back into a room and uncover a child. INCREDIBLE!!! The second most ignored advice is that Tylenol and Motrin DO NOT CURE the patient. I have spoken until blue in the face that Tylenol and Motrin are just ways of reducing fever. The only way to get rid of the fever is to find the root of the problem. Yet again, when I am working I see the same child come in the next night swaddled and covered and with the same complaint of fever because the Tylenol and Motrin did not work!

Medications to give for a fever lying on a fleece blanket that should not be used. | Source