Who needs to be seen first?

Nurses General Nursing

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As nurses, prioritization is very important. How about in this situation? Which patient should you see first?

-- A patient on continuous IV infusion of Magnesium?

-- A patient on continuous IV infusion of Morphine?

Specializes in ICU.
This is just a perspective of someone who just graduated nursing school...

If this is a question from school, or on the NCLEX like Roy said, with that little information, I'd have to say morphine. What other real life application could you use a Mg gtt for besides L&D? I mean im not really familiar with any drips besides the few things we learned.

I just graduated too. The only other use of Mg++ (besides hypomag and pre-eclampsia) that I recall is for Vtach--Torsades de Pointe.

Being in NCLEX mode, I too would have gone w/ the morphine answer, but thats the "theory" part thats been drilled into me. No practical experience to speak of.....yet anyway :specs:

i'm going to see the mso4 gtt pt first.

unless a pt has renal impairment, hypermag is seldom seen.

our (functional) kidneys do a fine job of filtering and excreting.

whereas w/an opioid infusion, there just are not any compensatory mechanisms in place, and toxicity can/does occur.

i say the morphine gtt pt.

leslie:)

i would check the mg patient first, unless i had to walk by the ms patient to get there, not so much for the consequence from mg, but the reasons to hang it are so severe....

Specializes in LTC/Rehab, Med Surg, Home Care.
This is just a perspective of someone who just graduated nursing school...

If this is a question from school, or on the NCLEX like Roy said, with that little information, I'd have to say morphine. What other real life application could you use a Mg gtt for besides L&D? I mean im not really familiar with any drips besides the few things we learned.

I had a peds. pt in status asthmaticus that had mag sulfate infusion ordered...not continuous, but it was a pt. that already had breathing issues (never heard anything like that before her!). In her case A (of ABCs) was already at issue. We monitored her BP carefully for s/s of it dropping too low, dizziness, etc.

She was also on continuous albuterol nebs & O2.

Given the little info, it seems like the Morphine pt. should be seen first b/c of the breathing/airway concern. However, in practical terms, more information is needed. My gut instinct says that because of the issues surrounding *WHY* Mg is given, that pt. is likely to be higher priority.

I would definitely choose patient on Magnesium,since magnesium also depresses respiratory system.

Specializes in EMS, ER, GI, PCU/Telemetry.

it really depends on why the patients are on those drips.

magnesium would probably be my answer. magnesium is a potent vasodilator and antiarrhythmic (used in vtach, torsades, heart failure, AMI, etc), and can also be used in severe cases of asthma or pulmonary embolus. i work on a tele floor and alot of my patients are on mag drips during their reperfusion therapy....

morphine drips... if the pt is post-op or something, their PCA should be checked at the beginning of the shift and end of the shift by 2 nurses anyways... but most patients where i work are on dilaudid PCA post-op due to the decrease in respiratory problems. otherwise, i'd assume a patient on a morphine pump was end-stage with a very painful condition and probably getting morphine around the clock for comfort measures.

but... like roy said, if it's an NCLEX question--morphine. A, B, then C....

Specializes in med/surg, telemetry, IV therapy, mgmt.

as nurses, prioritization is very important. how about in this situation? which patient should you see first?

a patient on continuous iv infusion of magnesium

a patient on continuous iv infusion of morphine

the answer is the patient on the continuous infusion of magnesium. iv magnesium can cause circulatory collapse and cardiac arrest. morphine can cause respiratory arrest. the distinction is subtle, but cardiac arrest will lead to death faster than a respiratory arrest, by moments to be sure, but it will still be faster. see the patient on magnesium first and then the patient on morphine.

Specializes in ER.

That's a stupid question.

The first thing I'd want to know would be how long they'd been on it, what for, and what the previous nurse's assessment was of the patient's condition, BUT if they won't tell you....

I still think I'd go to the morphine room first for NCLEX, because respiratory arrest has a better survival rate. If you assume BOTH patients are toxic on their meds morphine is faster reversed, and more survivable. Push your narcan, put them on o2, then go to the other room where you'll have to spend more time. I'd also feel just fine giving narcan without a doc, if someone was toxic, but calcium can affect the heart so there would be a lot more discussing re doseages, RT would end up bagging in the meantime, possibly calling pharmacy, etc. That's my NCLEX answer, and I'd get it wrong (sigh).

OK, but in real life...we're more familiar and comfortable with morphine as a nursing group. Everyone knows and has pushed narcan, and watches resps. The LPNs I work with can identify issues with morphine, but I don't believe they've ever seen a mag drip. Not everyone is really comfortable checking reflexes, or watching for mag toxicity. I'd also want to get a quick baseline mental status right at the beginning of the shift so I'd recognize a decline. If neither is reported to be toxic I'd go into the mag room first, just to see for myself how the patient is doing.

Hi guys......:D....I am truly truly sorry for posting such a question. I know it does sound stupid being lacking in info and all. It IS an NCLEX question. And I wrote it just the way I remember it----lacking in details!:D:down:

The two answers which I eliminated I think involved a very stable patient with a fracture, and another one who was obviously not a priority.

Then I was left with two conditions: a patient on Mg and a patient on Morphine. I think it was a Medical-Surgical Unit so I am pretty sure the Mg drip wasn't something for L&D.

Again, I am very sorry for the lacking information. And the way I also remember it, the actual question was very short and very brief.

By the way I am pertaining to a practice test which didn't have an answer key. I am still about to take my NCLEX.

I too hate NCLEX:down:

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