Morphine Question

PAERRN20 · Oct 23, 2009

I think you misread. Normal saline is not measured in MG but rather in ML/CC. That order is not correct and doesn't make any sense. Realistic post op patients usually get their fluids around 75-150 cc/hr- sometimes more, sometimes less, sometimes none. Morphine orders usually around 0.5-4mg IV q 4-6 prn. IM dose may be a little higher. 250mg or morphine would most certainally kill someone! Even half that dose and you are looking at the same outcome.

BmoreCRNP · Oct 23, 2009

I think you must have misread something. It sounds like the concentration is 1mg/1ml. If so, there is no way the person is getting 100mg of morphine per hour. Even intubated patients don't get that much. Not only does morphine supress respirations, but it can cause hypotension. Plus I've noticed that once a certain amount of morphine accumulates within a short period of time, the person tends to start itching and breaking out in a rash. I'm used to patients getting about 2mg per hour and maybe something for break through pain.

mamamerlee, LPN · Oct 23, 2009

Seems like there is a decimal point missing, but even 10 ml/hr would be WAAY too much. possibly NS, 250 ml w/MS 25 mg at 10 ml/hr - - PCA is providing 2.5 mg/hr of Morphine at a basal rate.

For a Laparoscopy?????

patwil73 · Oct 23, 2009

I am a first semester nursing student and during clinicals was looking at a patients chart. I know my patient had a laparoscopy and one day later was receiving morphine IV. I think it was written in the chart Nacl 0.9% 240 mg + morphine 250 mg IV. On the IV bag, it said 100 ml/hr. Can some help me decipher this? Does this seem right or did I missread? I am just trying to understand this for myself and not going to use this for anything else. I have not started on administering medications or IVs yet. What would be a realistic post surgery Morphine, Nacl, gtt/hour?
Thanks again

By chance did it read NaCl 0.9% 240ml + MgSO4 250mg? That would be magnesium added to the IV fluid solution which seems a lot more likely than her receiving 100mg of morphine an hour. Also a good reason why we should not use abbreviations as MgSO4 can look a lot like MSO4.

You can receive magnesium for a potentially lethal rhythm problem called Torsades de Pointes, or because your level is just low, or if the patient was also pregnant it can be used to help treat pre-eclampsia, although in that case the woman is usually a 1:1 nursing care. In both Torsades and Pre-eclampsia though the dose is often much higher - anywhere from 1-4gm. I don't know if I have ever come across someone receiving only 1/4 gram of Magnesium.

Of course if you missed a decimal and flipped an abbreviation it could read MgSO4 2.5gm which would equal out to 1.25 gms an hour which is within the guidelines for a continuous dose.

Hope this helps

Pat

CASTLEGATES · Oct 23, 2009

Reading into your question I think the morphine was 10cc to make up 250

jistravel · Oct 23, 2009

Thank you all for your response. Looking at the way I deciphered the writing made no sense to me either and seemed way off even with my having no knowledge of meds or IV administration. I knew there was something missing and misread. I just want to throw this out to all you folks who know more about what is realistic/possible for post laparoscopy, fluid and IV in general. I was there to basically to check vitals and do general assessment but knowing she was receiving morphine IV just wanted to make sense of this for myself and the future.

BmoreCRNP · Oct 24, 2009

Thank you all for your response. Looking at the way I deciphered the writing made no sense to me either and seemed way off even with my having no knowledge of meds or IV administration. I knew there was something missing and misread. I just want to throw this out to all you folks who know more about what is realistic/possible for post laparoscopy, fluid and IV in general. I was there to basically to check vitals and do general assessment but knowing she was receiving morphine IV just wanted to make sense of this for myself and the future.

What was the laparoscopy for? Just exploratory? Did they do anything specific once they got in there? The reason I'm asking is because a lot of laparoscopy patients go home the same day. It depends on why they had it done and whether or not the surgeon removed anything.

jistravel · Oct 26, 2009

The admittance was for exploratory laparoscopy due to abdominal pain. But they also mentioned was lysis of adhesions. I know the person had a hx of abdominal adhesions and GERD.