Emergency Room Registered Nurses Finally Answers Your Questions!
Sitting in my triage chair I watch as mothers pour in from the other world, what us ER nurses like to call out of the hospital, bringing in their infants and children to the ER for fevers. I sit as patiently as I can and try to triage the first patient. I ask the mom and I say mom because in my practice the person that usually brings in the sick child is the mother, but there are some dads so let's not leave them out. Let me rewind then, I ask the parent why they brought their child to the ER today. The parent usually answers that question with "the baby has a fever". I proceed to ask what the fever was and I get 99.8 degrees Fahrenheit. In my mind obviously, I am already telling myself that this is not a fever. I am a good nurse and knowing that this is subjective information, I ask the parent how they took the temperature. "Under the arm," replies the parent. Inside I am furious but contained. Here is when my real job begins. As I start to take the child's vital signs I teach the parents how to properly take a child's temperature. I repeat myself about fifty times that by no means is the temperature to be taken under the arm, because it gives a false reading. I inform them that if the child is too young to hold the thermometer in their mouth, they need to purchase a rectal thermometer and at this point I get the winches of pain coming from the parents. I then show the parents the end of a thermometer and explain to them that their child passes bowel much larger than that and that the rectal thermometers that you buy at the store have a marking or a bulge as to where you should stop insertion so you do not harm the child. The parents, of course, hating the idea of rectally probing their child then ask me about ear thermometers. My reply is that I have used those thermometers before and then to check them I took the same patient and used an oral thermometer and the degrees do not even come close. I tell the parents that I do not trust those. I also tell them that is a personal opinion and that in nursing school we were only taught that taking an oral or rectal temperature is the best method and in fact, even in adults, the rectal temperature is the most accurate.
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!
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