Need thought processes

[emt2rn82]

I need some help with my thought process. Today I had a resident with deteriorating mental status, beginning of shift was awake and mildly confused. Normal base line is awake and alert orientated x3. Started on fentanyl patch 2 days prior. Midway thro shift noticed increase in confusion and started neuro checks, later in the shift resident is with increase in lethargy and becoming stuporus, increase confusion orientated to person only. Notified MD to remove fentanyl patch, fentanyl patch removed and area cleaned. patient back to baseline by end of shift, But requesting opiates for pain management. I was relucantent to give the opiates due to the events prior, but the resident insisted and become aggressive when I voiced concern. I gave her percocet x2 tabs as she wanted, still not wanting to give them to her, I did a complete neuro check and vitals, everything was back to baseline. I was just wondering if anyone has anything else they would have done, or maybe something I missed all feedback is great. Thanks

[Whispera, MSN, RN]

Sounds like the Fentanyl patch was working incorrectly--absorbing too quickly. After you removed it, it wore off and she needed pain meds. How often is the patch changed? Was a new one just applied and then she became stuporous?

Six months or so, the company making Fentanyl patches recalled some of them because they were "leaky" and providing way too big an amount of the drug on application. I'm wondering if this was the case with your lady's.

[emt2rn82]

Her patch was placed two days ago, she is a renal patient, and we change our patches every 72 hrs. Thanks for the reply

[CoffeeRTC, BSN, RN]

Was the patch an new order (never been on it before)? Maybe the dose was too high to start with? Anything else going on with the res? Renal pts are sometimes hard to pin down the changes etc. Are the percocets holding her for pain?

[barefootlady, ADN, RN]

My guess is the dose of Fentanyl was too high in regards to her decreased renal function. Lower dose of Fentanyl and careful assessment every shift during the next week. Good luck.

[emt2rn82]

Thanks to all