Altered LOC--Dx help, please!

[Faith&Service]

I've chosen to do a big project on a patient I had (first clinical ever!) who experienced very profound intolerance to pain medication (Percocet, Ultram) (manifesting low BP, confusion, unresponsiveness, lethargy-obtundation). He had to be taken from the TCU and hospitalized when he was found unresponsive. Upon eval, meds were not administered incorrectly. It was decided pt could not 'tolerate anything stronger than Tylenol.'

The Dx I've proposed (and my instructor encouraged) is "Altered Level of Consciousness." I can't find any resources on such a diagnosis, however, and I'm wondering if there is a more astute Dx I should be ferreting out. Nothing I've seen quite matches the narcotic intolerance/reaction picture I think my instructor and I want to deal with in the form of a sound nursing Dx.

Any help appreciated.

[sfn2008, RN]

I've chosen to do a big project on a patient I had (first clinical ever!) who experienced very profound intolerance to pain medication (Percocet, Ultram) (manifesting low BP, confusion, unresponsiveness, lethargy-obtundation). He had to be taken from the TCU and hospitalized when he was found unresponsive. Upon eval, meds were not administered incorrectly. It was decided pt could not 'tolerate anything stronger than Tylenol.'

The Dx I've proposed (and my instructor encouraged) is "Altered Level of Consciousness." I can't find any resources on such a diagnosis, however, and I'm wondering if there is a more astute Dx I should be ferreting out. Nothing I've seen quite matches the narcotic intolerance/reaction picture I think my instructor and I want to deal with in the form of a sound nursing Dx.

Any help appreciated.

You have described

1. Hypotension, (Alteration in perfussion:redbeathe)

2. Altered LOC, :zzzzz

3. Adverse Effect to a Medication

I am even thinking with what you have described,

4. Altered Respiratory Status might have been present.

Good Luck

[Daytonite, BSN, RN]

normally risk for injury is used for reactions to medications, but this isn't quite the case, is it? there is nothing that prohibits you from developing your own nursing diagnosis as long as you keep within the spirit of nursing language and diagnosing. after some thinking on this, i came up with

• ineffective therapeutic effect of opioids r/t drug idiosyncrasy aeb low bp, confusion, unresponsiveness, lethargy and obtundation.

i had to look up drug idiosyncrasy in my pharmacology textbook. it is unusual or unexpected responses produced by a drug (i.e., untoward effects) and has to do with the way the person's body is metabolizing the drug. that pretty much sounds like what is going on with your patient.