So I had a pt that was post op came at 1830, heavier pt older... They came to the floor sound asleep, and only had 0.9mg of dilaudid in post op. We had a PCA set up for 0.3mg dilaudid PCA only (basal rate of 0.2 after 2200). Pt was on 3 L/min O2 to keep sats above 94%, and otherwise just sedated.
Pts color started to look bad, and the pt had to be laying flat for 48 hours. I discussed this with my charge nurse and we voted to do a log roll and keep flat with pillows because pt was snoring so badly pts sats were dropping. Also, I removed the lower dentures that were hindering the airway. Color improved immedately, and I kept coming in every few minutes to check vs and 02 sats. During a snore it was 75%, then after 97%. I spoke with a RT who was doing things on our floor and she found that to be normal for pts that snore and the pt should seek advice about sleep apnea, which I told the daughter and spouse who were in the room. (Patients resps remained constant at 18).
Pts VS were stable, pt was just sedate. I took the PCA button away from pt, which I noted was pressed twice for 0.6mg dilaudid when the pt first was to the floor and more alert..but that knocked them out. I called the MD who wasn't too thrilled with me for calling without an emergency happening (I wanted to know what he would like me to do about the sedation level..and he agreed with the button being held, and no basal rate which I had suggested...but other than that just monitor vs!).
Patient remained stable but sedate...and this was post recovery hour 3, and my change of shift. I alerted the next RN of the probelms and what I had done and what the MD had said and that we are to monitor pt closely. And also I had heard from the spouse that pt is overly senstitive to any IV medications, and this was not new for pt to be this sedated, and suggested that we switch to PO pain meds ASAP and DC those IV meds.
SO as soon as I left, I guess the next shift tweeked and narcan was given times two and pt awoke in serious pain. (I forgot to tell the RN about another pts fever that was controlled and needed to be followed up on so I called the moment I got home and found out about this).
Now...do you feel the use of narcan was vital? VS were stable, it was midnight when they gave and woke the pt in pain. AND now what are we going to use for pain meds till the narcan wears off? Was this really necessary or couldn't the pt just be monitored and sleep the meds off (which was my trend...I was watching the pt carefully and ready with narcan if probelms started, and was also alert enough to warn admin that if needed I may have to transfer pt to a tele floor for continous pulse ox).
When I called the MD, we didn't even go there on narcan...I wonder why all the sudden! I asked the RN and she said vs were still stable but the sedation level was too much and she couldn't get an accurate assessment done! Okay so who was the narcan for the RN or the PT?
THoughts???? (I am open to comments, I want to learn from this one...I felt narcan was out of line at midnight and considering there was no set plan for pain management afterwards!).
