Question

After consideration of her history and her pain, the pain management specialist recommends that the patient should receive patient-controlled analgesia (PCA). After discussing PCA therapy with her, an infusion is started with morphine as a basal infusion as well as interval self-dosing. The next morning while reviewing the infusion notes, the nurse sees that the patient dosed herself four times during the night. She is awake and states that her pain is now at a “5” and that she feels “a bit of relief now.” Later that afternoon during rounds after lunch, the nurse sees that she is asleep and has not touched her meal. Her respiratory rate is 12, but she does not answer when the nurse calls her name.

3. What would the priority action by the nurse be?
4. What additional actions should be taken?

Answer 1

ANSWER

* Priority action by the nurse

                 * Patient respiratory rate is low due to morphine toxicity so nurse should stop

                   morphine infusion and provide adequate ventilation by a bag and mask method

                   to regain normal breathing pattern and avoid hypercarbia.

* Additional actions by the nurse.

          * Administer antidote naloxone to reduce the toxic effect of morphine overdose

            as per physicians order.

         * Prepare the patient for emergency intubation if the patient can not regain normal

           respiratory pattern by other methods of oxygen therapy.

         * Give intravenous fluids to maintain fluid volume and reduce toxicity.