On my shift today I snowed a patient, badly. I gave a PRN dose of medication based on patient's subjective rating of some symptoms. The patient was aware, alert, and oriented but a little drowsy. The dose was correct and based on the physician's orders, which were very reasonable. There were two medications to be used: one for pain and anxiety, both oral agents. Even though the patient was a little drowsy, they were rating both very high (10/10). I gave one medication first, and then waited an hour and gave another medication next. When I re-assessed them about 30-40 minutes later, their respiration rate was very low and we needed to institute a critical response team.
The patient was fine in the end, but I felt horrible. I felt like I had made a bad judgement call. I shouldn't have given so much medication when the patient was already drowsy. I always do a neuro score before administering pain medicine. Also, looking back, the patient was at risk for becoming over-medicated because of age and diagnosis. I have had many times a drowsy patient tell me their pain was 10/10 and given IVP medications, but never had this happen. The doctor told me "This is what sometimes happens when you rely on subjective scores." I feel like a fool as other nurses were pulled to help with this situation. It makes me question my ability as a nurse and my critical thinking skills.
