Did he get too much morphine?

[Deb123j]

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???

[tanthalas]

8 mg does seem like a bit much. When was his last PRN for pain? I guess the student took the concept of "treat pain aggressively at the start" a bit too much.

At least the patient is getting his thrills on morphine, though!

[AprilRNhere]

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

Blee

We gave push drugs all the time as students without supervision. By the last semester we were cleared- she'd seen us do enough of them to know we were ok. As my CI handed me the med..she'd ask me to tell her what rate and what side effects I'm watching for. If I could answer...I was allowed to give the med.

[Virgo_RN, BSN, RN]

We gave push drugs all the time as students without supervision. By the last semester we were cleared- she'd seen us do enough of them to know we were ok. As my CI handed me the med..she'd ask me to tell her what rate and what side effects I'm watching for. If I could answer...I was allowed to give the med.

Same here.

[UM Review RN, ASN, RN]

I'm pretty large, but if anyone gave me that much morphine, I'd probably have to be narcan'd out of it! :)

I don't ever recall giving that big a dose to someone in mild-mod pain.

Would I say it was too much? It really depends on the things Karen mentioned above.

[smk1, LPN]

We gave push drugs all the time as students without supervision. By the last semester we were cleared- she'd seen us do enough of them to know we were ok. As my CI handed me the med..she'd ask me to tell her what rate and what side effects I'm watching for. If I could answer...I was allowed to give the med.

It is illegal for that to happen in my state and I'm guessing others as well so that is probably why some of us are shocked. Clearly all RN students have probably given their fair share of IV push meds, it is just surprising that things are not as strict in other places on this issue. (then again this is nursing so why am I shocked! lol)

[Tweety, BSN, RN]

You're correct. It's too much based on the assessment of light to moderate pain. For that kind of pain some p.o. pills or a lower dose of Morphine should have been offered.

It's not too much for an adult in an acute moderate to severe pain to get. Lightheadedness and sleepiness are side effects of morphine and you really shouldn't be overly concerned with those side effects.

[BlueRidgeHomeRN]

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

blee

yup--and i don't care if she's #1 in her class and 5 days away from graduation!!

[BlueRidgeHomeRN]

it is illegal for that to happen in my state and i'm guessing others as well so that is probably why some of us are shocked. clearly all rn students have probably given their fair share of iv push meds, it is just surprising that things are not as strict in other places on this issue. (then again this is nursing so why am i shocked! lol)

maybe this varies by nurse practice act per state..but sn + ivp narcotics=big problem potential

[Blee O'Myacin, BSN, RN]

OP - I have a question about one of your additional posts - in every facility I've worked at, IV potassium is a two-nurse drug. We need two RN's to be present when the drug is given in order to sign off on it. We manage to do this in a busy ER, so please no "real world/ideal world comparisons" please. Was this student alone in the room when hanging the rider? Did your brother see a nurse that day other than the student? Was the instructor present at all? Just curious because as a previous poster mentioned, we can't assume that the student came in alone, but another person was never mentioned.

Thanks!

Blee

[Altra, BSN, RN]

8mg IV is on the high side for a patient who is opioid-naive, but not out of the ordinary. I have often given 10mg pre- and post-op.

Some degree of sedation is an expected side effect, not necessarily an adverse effect.

[Altra, BSN, RN]

in every facility I've worked at IV potassium is a two-nurse drug. We need two RN's to be present when the drug is given in order to sign off on it.[/quote']

This has not been the case at the 6 hospitals in which I've worked or had clinical experience as a student. Clearly, there are significantly different policies everywhere.

[jessiern, BSN, RN]

If a patient is alert and oriented, I explain to them how to notify me that they need pain medicine. I advise them not to wait until pain is too severe. Then, I leave it up to them. I may ask periodically through the day if they are in pain, but if they don't complian of severe/mod pain I don't take it upon myself to offer meds. I certainly don't walk around with a morphine push "just in case". Sounds like a student nurse that needed a check off on IV pushes, and a CI that was not around enough.