Did he get too much morphine?

Nurses General Nursing

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I'm a new nurse and am still learning drug doses and such.

My brother had a lapchole today. After the surgery he was in his room resting comfortably. A student nurse comes in and asks if he's in any pain (syringe of pain medication in hand), he said a little only when he tries to urinate. She asks if he wants the pain med and he says sure. So in it goes.

A little later he's feeling light-headed and really sleepy. Student nurse comes in and I asked how much morphine she gave him...she gave 8mg. Isn't that a bit much for a pt who really isn't in much pain??? I would think that 2mg would have been much more appropriate. I'm assuming the doc wrote a range for the pain medication, like 2-8mg prn.

What do you all think???

Specializes in ICU-CVICU.

I think the student nurse, the clinical instructor and especially the assigned nurse were wrong on every level if this is what really happened....and I think 8mg IV is too much, period.

May

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Specializes in Step-Down Vascular, Renal, ESRD.

Yes too much.

My question too..What is she doing with 8mg of morphine? How fast did she push. 1 mg = 1 to 2 minutes. Was it diluted in ns? I am on a vascular floor with many kinds of amputations and I have never had to push 8 mg of morphine...

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Specializes in CVICU, MICU, CCRN-CSC.
I'm a new nurse and am still learning drug doses and such.

My brother had a lapchole today. After the surgery he was in his room resting comfortably. A student nurse comes in and asks if he's in any pain (syringe of pain medication in hand), he said a little only when he tries to urinate. She asks if he wants the pain med and he says sure. So in it goes.

A little later he's feeling light-headed and really sleepy. Student nurse comes in and I asked how much morphine she gave him...she gave 8mg. Isn't that a bit much for a pt who really isn't in much pain??? I would think that 2mg would have been much more appropriate. I'm assuming the doc wrote a range for the pain medication, like 2-8mg prn.

What do you all think???

I too would have an issue on why a RN would not be there when a narc (MSO$, Percocet, Vicoden, just to name a few). We do give 10 mg morphine at times (IV) but not too often. Usually we give 4 of morphine and some toradol. Did she do a pain assess? Does he have a hx of taking a drug for pain everyday? Did his BP stay WNL? RR? lots of things could be playing into this...but I would be concerned about the student with out a nurse assess.:uhoh3::uhoh3: Hope he feels better!!:heartbeat

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Specializes in CNA.

I agree with most repliers on this thread. 8mgs sounds extraordinary but it is a median dosage. Many doctors will perscribe pain medications such as Morphine but list them on an as needed basis. Not scheduled.

My guess here, is that your brother's script reads 8mgs as needed.

I must also quote and note (can't remember who said it without hitting my browser back button) but yes, a nurse normally shouldn't be walking around with vials of Morphine unless it is scheduled

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Specializes in Trauma, MICU.
It may have been a prefilled syringe. Our morphine comes like that and we use a carpuject to push it. I often take it in with me..I can always return it to the pyxis if needed.

It wasn't a prefilled syringe. It was in a standard 3cc syringe. I'm assuming that the morphine was probably 8mg=1ml and she added 2ml of NS? She gave it over maybe 2-3 minutes.

At the college that I went to, we had to tell the CI about the meds we were about to give and why. I'm suprised that a CI would allow a student to pull up the morphine without have a pain ax first. :nono:

He ended up being fine (I knew it wasn't a dangerous dose, just an un-needed high dose - IMO), BP 118/66, R 16, P 66. He typically doesn't take too many pain meds, just the occasional tylenol or advil.

He actually ended up ambulating a few times in the evening and eating a small dinner, when I left he was feeling fine. I'm afraid he might need the 8mg tomorrow though. :chuckle

It also irritated me that she hung 20meq of K+ and didn't give any explaination as to why. I asked and she said his K+ was a little low. I always tell my pts what and why I am giving/hanging something (even when I was a student). :banghead:

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Specializes in vascular, med surg, home health , rehab,.

I work med surg/ortho; 8mg iv is unusual, IM, no. Even if its ordered 8mg, isn't it the RNs judgement and given a partial dose and reassessing in 20-30mins and if need be give the additional dose? Have seen large doses of narcs ordered for frail folks, and the low dose snowed them. Opiate niave, low pain level, first post op dose, I'd have given less. 2-4mg morphine is our most common dose. No supervision there bothers me. Hate to see a student learn the hard way that being a bit cautious with IV narcs until you know a pt can tolerate it is better than calling a code.

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Specializes in Peds, PICU, Home health, Dialysis.

The only place I have seen an order of PRN Morphine over 5 mg is when I did a rotation on the burn unit -- they have orders over 15 mg.

I had taken care of a patient last semester that was 3 days post-op from a colostomy repair, and he has a fentanyl patch, morphine PCA, and still asked for his PRN demerol q3.

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Specializes in Emergency Dept.

We have patients come up with orders for Morphine 2-8mg IV PRN fairly frequently on our unit. I have never given that much, but we do have the option. I tend to start with 2-4mg (depending on what they've already had, home meds, etc.).

It sounds like the student nurse followed her parameters, except I would've wanted an instructor there for that much narcotic being pushed. I would've hoped they would've advised her on a smaller amount.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

I would never give morphine 8 mg all at once. Generally you start out with 2-4 mg IV q 30 min-1 hour and see how that works. If the patient was in the PACU I can see how she might have wanted to give 8 mg but still not all at once. You are supposed to titrate medication to effect. She wasn't titrating anything if she gave it all at once.

As a side note...when I was in nursing school we would have been expelled from the program for administering ANY IV medication unsupervised. Even in my final semester I had to have supervision AT THE BEDSIDE for any IV administered medication. Sounds like this nursing student is marching to the beat of her own drum. Hope she doesn't kill anybody in the process.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Who said the RN instructor wasn't there?

Please be cautious about reading INTO posts things that are not there and making assumptions....

I'd need a lot more info before making a decision re morphine dosing i.e.

a. amount of PO analgesics patient taking prior to surgery

b. prior medical history/co-morbidities

c. pain history esp if chronic pain for other condition

d. height AND weight

e. recreational drug use

f. response to pain meds immediately prior to this time interval

All of these factors influence amount of morphine I'd give....not just the 8 mg...might have needed 12mg to keep him comfortable at level HE chooses to accept.

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I have more of an issue with a student nurse giving an IV push drug without supervision than I do with the dosage.

Blee

This is what I was thinking. I am shocked that this is allowed.

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Specializes in Post Anesthesia.

Apparently it wasn't too much- your brother is still breathing. Morphine is pretty short acting. I think the dose was generous, but if you brother is under 60y/o and over 120lbs more will probable serve him better than less. For pain management get the pain under copntrol and then keep it there. If my patients aren't sleepy I haven't given enough pain meds to keep them comfortable.

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