A patient who has an infected abdominal wound develops a temperature of 104° F (40° C). All the following interventions are included in the patient's plan of care. In which order should the nurse perform the following actions?
(Put a comma and a space between each answer choice [A, B, C, D]).
a. Administer IV antibiotics.
b. Sponge patient with cool water.
c. Perform wet-to-dry dressing change.
d. Administer acetaminophen (Tylenol).
ANS:
A, D, B, C
The first action should be to administer the antibiotic because treating the infection that has caused the fever is the most important aspect of fever management. The next priority is to lower the high fever, so the nurse should administer acetaminophen to lower the temperature set point. A cool sponge bath should be done after the acetaminophen is given to lower the temperature further. The wet-to-dry dressing change will not have an immediate impact on the infection or fever and should be done last.
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