I was called to the carpet by the day shift nurse I gave report to on a person who fell last night. She was suffering from extreme abdominal pain. The morphine wasn't helping and the percocet on its own wasn't helping. I gave morphine and percocet together when I could and while it helped, it only helped a little while. I called the doctor and got an order for increasing morphine and one more percocet. I gave those later when she was in pain. She fell four hours later slipping off the commode.
Her BP was like 65/43. It came up to mid 80s systolic and occasionally went higher but not much. I called the doc and he just said to watch.
Was I wrong to give her percocet and morphine together? She was in severe pain and my thinking was that the morphine could be for immediate pain control while the percocet will stay in her system a little longer, thus she will have longer lasting pain control. Is my thinking wrong?
My other patient developed respiratory problems out of the blue. His pH was 7.13, bicarb is 4.4 and CO2 13.3!!! That is severe metabolic acidosis, but if his co2 is compensating down to the bicarb, why is the pH still off? Is it that the bicarb is so low he can't compensate? He was intubated and they are still working this up.
I had a horrible night and despite me feeling like I did everything I could, I feel upset that the patient fell from the pain meds. Thanks and appreciate your comments.
It frustrates me that your fellow nurse called you to the carpet for doing the best you could in a tough situation. It's so easy to have all the answers after the fact. Offering suggestions is one thing, but calling someone out after a night from hell doesn't help anything.
I doubt the low BP was caused by an OD of pain meds, which is more likely to cause resp depression first. You don't give enough info as to whether the pt was post op and perhaps suffering internal bleeding leading to volume depletion, or whether they were getting septic. Low BP is a later sign, what about what their heart rate, RR, etc? The cardinal sign of narc OD is resp depression.
i don't think this pt od'd on narcs.
but i suspect her bp might have bottomed out.
compound that with the "buzz" one may have when taking narcs.
doesn't happen to everyone but still, falling is a risk w/any sedating med.
MzMouse
295 Posts
Gosh, what an awful night.
It frustrates me that your fellow nurse called you to the carpet for doing the best you could in a tough situation. It's so easy to have all the answers after the fact. Offering suggestions is one thing, but calling someone out after a night from hell doesn't help anything.