First time poster CP help???

[megzj29]

Hey guys!

I am long time user of Allnurses but this is my first thread post! ! So please forgive me if I am not posting this in the right section... I just am hoping for some advice on an 84 yr old post hip surgery patient. The day after her surgery she had her PRN pain medication (Morphine) at 9 AM, I got there at 5 PM and the day shift nurse informed us that she had not really woken up all day long (I know, I won't even go there). When we (the nurse I was shadowing) went in for our initial assessment, the pt was completely out of it. She would just mumble incoherently when we spoke to her. Her family was present and said this is completely new to them and they were worried because she has had morphine 3X's in the last 2 years and never responded this way to it. She did have a UTI, but had been on antibiotics for three days for it, and when we called the doc he said it couldn't be the UTI, and ordered a "pinch" of Narcan. Within five mins of the push, she woke up (pretty mad, as I am sure you guys know ) and was A&OX4 again! Anyway my question is on the top three nursing DX. I know our big concern with Morphine is resp depression, but during everything her SATS were 98%. So I know she can be a Risk for ineffective breathing pattern, but a risk can never be a #1, is that right? Also I know it can be ineffective tissue perfusion, but I am having a hard time coming up with 3 supporting evidences of that one because everything was good except her confusion. The doc obviously discontinued all of her pain meds before the Narcan so he could re-evalulate her, so I was worried that she was going to wake up in horrendous pain and we wouldn't be able to give her anthing for it. So would it be acceptable to use Acute pain for my top priority and risk for ineffective breathing pattern and risk for ineffective tissue perfusion next? or can I just not put risk in front of anything I want? The patient wouldn't actually tell us if she was in pain, because she was too busy calling us a few very creative names and telling us to "get out"~! And I had post conference and left before I could visit again. Sorry about the length of this post! Any help is soooo appreciated! I am stumped and must be having a mental block!

[ckh23, BSN, RN]

I don't think you would be wrong to use pain as number 1 especially after they d/c'd all the patient's pain meds.

I hope the doctor prescribed something after he re-evaluates the patient. There is no reason to discontinue pain meds for this patient all together because she had too much. She may just need a lesser dose or perhaps something PO like percocet.