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?

Riseupandnurse

658 Posts

Specializes in Medical Surgical.

Why are they on it, and how long have they been on it? Personally if that's the only information they give you I would go with the magnesium.

Be_Moore

264 Posts

Specializes in Pulmonary, MICU.

This question is beast. For so many reasons. You could argue either answer, but here is mine. I would see the patient on the cont. Mg++ drip first. My logic is that typically patients on a continuous Morphine infusion are dying anyway, and the morphine is titrated to keep breathing from being agonal. It keeps the dying patient comfortable/anxiety free and also depresses the respirations, making the family more comfortable and anxiety free. A Mg++ gtt can be used for many things, but all in cases where you are trying to kep the patient alive. Granted that a patient should be able to call when they start feeling s/s of hypermagnesmia, you would still want to check on them.

So in summation...if the patient on a continuous morphine gtt dies, that was probably expected and it can wait 5 minutes. If the patient on a Mg++ dies, that was probably NOT expected.

The other possibility is that the patient with a morphine infusion is on a PCA with a basal rate? But those are usually not going to be high enough to actually stop someone from breathing on their own. So I still say the Mg++ gtt.

puppytrix

14 Posts

Although some morphine drips are used in hospice/comfort care patients, I have seen MANY more who were not in such a situation.

In my opinion, I would have to know more information. How long have they been on each? What is the reason? I've put many people on Mg drips for respiratory issues, not simply hypoMg. And, does the morphine pt have continuous oximetry? Our protocol is that they are on the continuous measurements, so I am very aware what their sats are without even going into the room.

Jess, RN, EMT-P

Roy Fokker, BSN, RN

1 Article; 2,011 Posts

Specializes in ER/Trauma.

A little history please! :)

But if you're asking strictly NCLEX type question:

I'd assess the Morphine drip before the Magnesium drip, because breathing takes priority over circulation.

Personally:

It depends greatly on the presenting symptoms (e.g.: If my mag drip patient is having runs of V-tach while my morphine drip patient has a respiratory rate of 10 but otherwise stable vitals, I'll see the mag drip first).

cheers,

qt2168

178 Posts

I agree with the poster above me. Morphine gtt first.

RNandRRT

398 Posts

ABC. It's got to be the morphine patient just based on the little info. given.

Need more info as it could be a pt on mag drip in labor and delivery...

UM Review RN, ASN, RN

1 Article; 5,163 Posts

Specializes in Utilization Management.

I'd see the Mag gtt first because MSO4 OD can be reversed with Narcan fairly rapidly, but the antidote for Mag OD can be more problemmatic.

Specializes in OR.

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.

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

Need more info as it could be a pt on mag drip in labor and delivery...

That was my first thought and it can be very scary if things go wrong here while Morphine is reversed quickly usually with Narcan.

I hate NCLEX.:down:

steph

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

That was my first thought and it can be very scary if things go wrong here while Morphine is reversed quickly usually with Narcan.

In fact something happened here recently re: a Mag drip that almost killed a not-in-labor patient.

So, those two things color my response!

I hate NCLEX.:down:

steph

I accidently "quoted" myself instead of hitting "edit". :D

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