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???

[SDS_RN, RN]

I have not given that much MS at one time even for my heaviest of pts. Some times pre-op we would have orders like 2mg q 10-15min which would equal out to about 8-12mg an hour but they were usually to OR before the hour was up. For IVP I've never seen an order exceed 4mg @ one time in my facility.

If they were needing that high of a dose then they would be on a PCA pump along w/ scheduled toradol q 6hrs.

[smk1, LPN]

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

i completely agree.

[RazorbackRN, BSN, RN]

As others have said, the dose really is really not an issue. I have given doses larger than that on several occassions, and would feel comfortable with it.

My question is this: If you were concerned about it, why didn't you speak up PRIOR to her giving the med? From the way it sounds, you were right beside of him, you even knew his exact VS from the moment this occurred.

I firmly believe that an A & O pt or family member should question what is happening whenever someone comes to your bedside with syringe in hand. This should be done PRIOR to the intervention.

If your brother is not a medical person, this would have been the perfect opportunity to educate him on the importance of being knowledgable about what is going on with his care, but first and foremost, you should've questioned it for him.

[MaryAnn_RN]

I have not given that much MS at one time even for my heaviest of pts. Some times pre-op we would have orders like 2mg q 10-15min which would equal out to about 8-12mg an hour but they were usually to OR before the hour was up. For IVP I've never seen an order exceed 4mg @ one time in my facility.

If they were needing that high of a dose then they would be on a PCA pump along w/ scheduled toradol q 6hrs.

I have nursed patients that were prescribed morphine 2-10mg iv, and usually make it up with normal saline so that it is 1mg per ml.

Give very slowly 1mg at a time until the patient is settled. Very rarely have to give the whole 10mg.

When the pain is that bad they definitely need to be on PCA plus regular iv paracetamol.

In the UK student nurses don't give iv drugs at all, never mind without supervision.

Morphine is a controlled drug anyway, so what was a student nurse doing with CDs on her own?

[Elvish, BSN, DNP, RN, NP]

Please be aware that this is part of our Terms of Service that everyone agrees to upon signing up:

This is a board for nurses and nurses-to-be to discuss nursing issues. Please do not ask for any medical or nursing feedback related to a health situation that affects you, a family member, or somone that is not a patient under your care. This is not a free medical advice board. Please be aware that allnurses.com cannot be responsible for problems resulting from reliance on medical or nursing advice received here.

I do wish a speedy recovery for your brother.

[vashtee, RN]

Did the OP say this medication was pushed IV? I've given MS as an IM injection, and 8 mg is within the safe range. Students are allowed to give IM injections independently where I live.

[BlueRidgeHomeRN]

did the op say this medication was pushed iv? i've given ms as an im injection, and 8 mg is within the safe range. students are allowed to give im injections independently where i live.

good point--i read it as iv since pt was post-op, but op doesn't specify. does change the discussion if im.

[Altra, BSN, RN]

Did the OP say this medication was pushed IV? I've given MS as an IM injection, and 8 mg is within the safe range. Students are allowed to give IM injections independently where I live.

She gave it over maybe 2-3 minutes.

While OP has not explicitly said the morphine was given IV, I am making that assumption based on the "given over 2-3 minutes" data provided.

[pinksugar]

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

Blee

In med-surg 3 once our instructor saw us give an IV push drug safely she let us go on our own. I am not saying that is right or wrong (if I was a CI I would feel the need to be present with every student giving IV push), but that is the way some places are doing it. Granted, when I was a student nurse in med-surg 3 I had worked as an extern for a year on a hem/onc unit. I could push meds in my sleep by then.

FTR, 8mg of morphine can be appropriate, depending on the patient. Onc patients tend to get high doses, so I am pretty used to giving them. Post-ops can get some pretty hefty doses as well.

[clee1]

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

Blee

Myself....

I have and do frequently give doses like that to 170lb male fresh post-ops; but I don't think I want a student to wander around with a dose of MS and pushing it w/o me being there.

[Fiona59]

Unless you are on epidural or PCA morphine (which doesn't happen for cholis and appis up here) all morphine is subq.

Nobody on our floor does IV push meds. That skill is restricted to ICU, ER and dialysis.

[TiredMD]

Nobody on our floor does IV push meds. That skill is restricted to ICU, ER and dialysis.

My God.

I'm hyperventilating just thinking about managing a postop patient with those restrictions on the floor nurses.