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.
Luckily we had reversal agents readily available. I have HS meds that I would imagine kill a bull elephant. For example, trazadone, oxycontin, xanax, seroquel, oxycodone, etc etc all at once. The people had developed a tolerance to this, but it still made me nervous. In fact one time I held some and notified the doctor of concerns of over sedation (the patient was very drowsy) and was yelled at and instructed to administer the dose. However the doses I gave to this patient I would never have, in a million years, predicted would have caused the level of sedation that occurred. They were pretty small, and were oral. I suspect something else was going on, because the patient was reported as drowsy all day. But it goes to show you how important re-assessment of the patient is. I predict that if I had left the patient to "sleep," he would be dead.
Last edit by 0.adamantite on Sep 22, '13