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 Operating Room.

In my state, Rns, no matter what their specialty, can do IV push of meds. LPNs cannot.

After my Lap Chole, I had a PCA but I also had a Nissen Fundiplication along with it. Between the gas still in my abdomen, the shoulder pain, and the manipulation of my stomach, I thought a bus hit me!:crying2::rolleyes:

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Specializes in Trauma, MICU.

First off, I want to thank everyone who has responded to my thread!!! :heartbeat I knew that I would get some awesome opinions on here...that's why I love this web site soooo much!!! :p My brother did not have any ill effects (and I figured he wouldn't) of the amount of morphine that was given. I was just curious as to what you all thought since I'm a new nurse. I think if he had been my pt I would have started off with 2-4mg.

This post was in no way of searching for medical advice. I am a nurse and can usually figure things out for myself or find the answer out in other ways rather than the internet. However, I do totally value the very experienced opinions of the nurses on here and was asking for such. No "medical" advice needed. :banghead:

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

At the hospital that I worked at as an NA and the one I presently work at as a nurse, a nurse can hang K+ by her/himself. Yes, the student was by herself. I'm assuming that the hospital nurse did an initial assessment on my brother and then left the student to take care of his basic needs. At least that is the way it happened when I was a student and did clinicals at that hospital.

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.

First off I didn't realize she was a student, otherwise I would have questioned her right then and there. Secondly, I can't stand it when a visitor is a nurse and totally butts her nose into the situation. Once I noticed his s/s I questioned the student about the amount give. Then I stayed with him for several hours until I was sure he was ok. I do educate my family members on medical issues as much as they will listen.

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.

It was an IV push. :wink2: I don't think my brother would have allowed it if it was IM. :lol2: He had a fit with getting the lovenox injections. :no:

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Specializes in Home Care, Hospice, OB.

:pwith love to all our brothers out there--

young, healthy men are the biggest babies sometimes

:chuckle

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Specializes in Hospice, Med/Surg, ICU, ER.
My God.

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

That's what I was thinking.

I'm wondering where that poster works?

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Specializes in Hospice, Med/Surg, ICU, ER.
:pwith love to all our brothers out there--

young, healthy men are the biggest babies sometimes

:chuckle

true... but i'll tell you this as a semi-young, health male: no way will i hurt unnecessarily when modern pharmacology can significantly reduce my pain.:nono:

if i have a pain issue, it will be aggressively addressed. i guarantee it.:chuckle

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
:pwith love to all our brothers out there--

young, healthy men are the biggest babies sometimes

:chuckle

and the most likely to pass out during an iv start. :chuckle

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My God.

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

You and me both!

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Specializes in Trauma, MICU.
:pwith love to all our brothers out there--

young, healthy men are the biggest babies sometimes

:chuckle

:chuckle:chuckle so so true!!!!! :chuckle:chuckle

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As my profile states I work in Canada.

Maybe one in ten of our patients come back with a pca or epidural infusing. Our pain control rounds are done q2h and we monitor them frequently. Whenever we have a pt. report an unmanageable level of pain we're on the phone to the Drs and the meds are changed. Very rarely is a PCA ordered after a patient has returned to the unit.

Maybe we just manage our pain differently up here.

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Specializes in neuro, ICU/CCU, tropical medicine.

A couple of years ago I spent the night as an in-patient after varicose vein surgery.

Just before I was discharged, the day shift nurse asked if I was in pain, then picked up the syringe left by the night shift nurse and said, "I don't want to waste this." She gave me 8 mg of morphine. I did not protest.

I left the hospital STONED - and I'm a big guy!

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Specializes in Home Care, Hospice, OB.
a couple of years ago i spent the night as an in-patient after varicose vein surgery.

just before i was discharged, the day shift nurse asked if i was in pain, then picked up the syringe left by the night shift nurse and said, "i don't want to waste this." she gave me 8 mg of morphine. i did not protest.

i left the hospital stoned - and i'm a big guy!

better living through chemistry!!:bugeyes::bugeyes:

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Specializes in Wilderness Medicine, ICU, Adult Ed..

A lot depend on the route. Did the student give the MSo IV (in which case 8 mg would be high), SQ (still high, and too much volume) or IM (a pretty standard dose for a fresh adult post-op). In any case, I would not be too worried. MSo is not toxic, and the therapeutic window is quite wide. Even a high dose (not TOO high, just high!) is not likely to be a problem in a stable, normovolemic adult without respiratory or neurological impairment.

However, drawing up before determining need is, I think, a mistake. I wish that I could say that I never made a mistake like that as a student, or after licensure, but mommy says it is wrong to tell lies.

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