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Discussion

Nsg. Dx. for RR=4 after oxycodone

Pt. 82 yr/old had a lower anterior resection 4 days ago. C/o pain at night and was given Percocet PO. An hour later, his RR = 4. His O2 sat was 97% @ 2L

The next day, in AM, RR=20. Patient ambulated for the first time twice in AM and was really tired. Went to bed. Immediately after, RR=10. He was easily aroused and after waking up, not confused. O2 sat this time was 95% in RA.

Do any of this deserve a nursing diagnosis, and if so, which one?

Please help.. I am stuck with this..

Thank you so much.!!

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  • Experts

This patient had Acute Pain. Did you care plan for this? Did you have an intervention that assessed for the side effects of the medication the patient was being given for the pain? Wouldn't the low respiratory rate be a cxomplication of that medication? I'd care plan for it under the Acute Pain.

  • Author

Well yes, I have some other nursing dx, including acute pain, and the oxycodone under that one. So you think that the RR should be also under Acute pain as an effect of the oxycodone?

And also.. should I just ignore the fact that he had a RR=10 when he was sleeping (no pain) the second day?

Thank you so much D... I have seen your posts on other threads and they have helped me with previous work.. you are very helpful and I am sure many other people think the same.

ineffective breathing pattern cuz theyre hypoventilating

  • Author

Thank you so much. I just have one question.. although the pt. has bradypnea (RR=10), his O2 sat was still 95 on RA. Is that considered hypoventilation?

Thanks again.

:specs:To Nsg. DX. for RR=4. Good observations. I wonder what were thevital signs before pain med. Is he on other sedating and poss. RR reducing meds. Could an alt. pain med be tried? Let me know. Keep up good work and asking questions. We are here.

I wouldnt worry about 10 too much as a RR if cognition was good, but I definitely wouldnt give more pain meds until I determined that enough time has elapsed and the client was alert and able to maintain airway and breathing. If the pt already went down to 4 once, there is definitely a risk for future respiratory depression.

And I always tell my awake patients to take some deep breaths if their sats are low to see if that resolves it.

  • Experts
well yes, i have some other nursing dx, including acute pain, and the oxycodone under that one. so you think that the rr should be also under acute pain as an effect of the oxycodone?

and also.. should i just ignore the fact that he had a rr=10 when he was sleeping (no pain) the second day?

thank you so much d... i have seen your posts on other threads and they have helped me with previous work.. you are very helpful and i am sure many other people think the same.

with a rr of 4, the doctor should have been called and the medication or medication dose changed.

one of the nursing interventions under the acute pain diagnosis should have been a management intervention that went something like this:

  • notify the surgeon if the patient has any of the following side effects (of the oxycodone): _____

another way this could have been handled was in a nursing intervention to monitor for certain specific side effects of the oxycodone and notify the surgeon if they occurred.

there are 4 types of nursing interventions that should be included in care plans. they are:

  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
  • care/perform/provide/assist (performing actual patient care)
  • teach/educate/instruct/supervise (educating patient or caregiver)
  • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

  • Author

MD was def. called and oxycodone was changed to dilaudid.

To answer another question.. the only other med pt. was taking was atenolol, which he usually takes for his HTN.

I will put that assessment under acute pain (below oxycodone). I would like to know how this sounds as well related to the same issue...

Ineffective breathing pattern r/t side effect of narcotic

and fatigue.

-Pt. RR baseline 16-20

-Pt. RR=4 on reassessment after Oxycodone/Acetaminophen

5/325 PR given 4/18 at 0100 for pain. D/c on 4/18

-Pt. RR=10 while asleep after ambulating approx. 150’ at

1200 on 4/19. Pt. was easily aroused.

I am sorry if all this doesn't sound right.. Believe me, I am trying my best in here!!

  • Experts

It is redundant and confusing to address the same problem in two different nurssing diagnoses. Pick one diagnosis and address it in that diagnosis and don't monkey around with it in a second diagnosis. It like the nurse has schizophrenia.

Also, you are addressing a complication/side effect of a medical treatment. Be professional. In one case you would be planning for handling it as a side effect. In another way you are waving a flag and kind of saying, "take a look at what this doctor did to this patient". I would opt for the subtle approach.

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