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???

[leslie :-D]

for an uncomplicated lap chole, it sounds high.

but this isn't my area of expertise.

i'd be curious as to the normal range.

leslie

[Fiona59]

Depends on the patient. Big guys usually come up with orders for 5-15 mg q4h. People under 175lbs usually come with 2.5-7.5 q4-6h.

So, personally, I probably would have given him 5 to 7.5 mg depending on how big he is.

Male patients with family around often underestimate their pain especially when there are family members around. I have worked on surgical units where pain meds are given q4h for the first 24 hours.

But my question would be why is the student walking around with prefilled syringes?

[Deb123j]

But my question would be why is the student walking around with prefilled syringes?

This was one of the things that really bothered me. Typically I ask the pt if they would like medication before I draw it up.

He's not a big guy...maybe weighs 170ish.

[TazziRN, RN]

"Too much" means higher than normal, or higher than is safe. 8 mgs is not too much for an adult, no matter what the problem. More than he needed, probably, but not too much. And yes, morphine will cause sleepiness and lightheadedness. One Vicodin can do that.

[Reno1978, BSN, RN]

I'm a new nurse too, but 8mg sounds high to me considering how he reported his pain.

For a patient who is resting comfortably and only reporting a small amount of pain, I would not give them 8mg of morphine. I doubt it would be dangerous for him, but he'd definitely be feeling the side effects of that dose, as he did.

Why on earth is a student nurse carrying around a syringe full of morphine!?!?

[locolorenzo22, BSN, RN]

true, but perhaps the student was told to "go see if x wants this scheduled morphine"...and didn't think to ask first and go draw it up....thought to draw it up and then ask....it happens...

[Fiona59]

But there's the problem. Morphine post op is not a scheduled drug on my unit. It's a prn and we do pain rounds to check on the patients needs before we draw anything up. It's up to our judgment on how much to give a patient. If it's just discomfort 5mg would probably have done the job.

[Blee O'Myacin, BSN, RN]

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

Blee

[linzz]

In any hospital I have been at, morphine is not a drug that is given on a regular basis, it is given as a PRN injection. I also wondered why this student has an injection prepared before a pain assessment is done. I would think that if any was left over, it would have to be signed for as being wasted.

[AprilRNhere]

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.

That sounds very high to me..but since the rest of you don't seem to think so..I'm wondering if our dr's are very conservative with morphine! Unless we call and tell them our pt's pain is uncontrolled...it's often 2mg q 2-4 hours...sometimes less.

Some of our more extensive surgicals get more...but I've NEVER pushed more than 4 mg morphine at once. If that doesn't control it...we usually try dilaudid. Or- we'll put the pt on a PCA.

Our lap chole's don't usually need much for pain.

[WSU_Ally_RN, BSN, RN]

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

Blee

I totally agree.... I see the OP is from Dayton, I went to school down there and am sure I did some clinicals at the hospital the OP is referring to, and we were NEVER allowed to give IVP meds without our instructor being right there. We drew it up with the instructor, then gave with the instructor. Doing so without the instructor could have gotten us kicked out of our program... Even if the RN you're working with wanted to watch or help, we couldn't...