Comprehensive Nursing Pharmacology Q 284
Mrs. Jane Gately has been dealing with uterine cancer for several months. Pain management is the primary focus of her current admission to your oncology unit. Her vital signs on admission are BP 110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are BP 92/60, pulse 66, respirations 10, and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your action should be to
A. Give her the next ordered dose of MS.
B. Give her a back rub, put on some light music, and dim the lights in the room.
C. Report your findings to the MD, requesting an alternate medication order to be obtained from the physician.
D. Call her daughter to come and sit with her.
Correct Answer: C. Report your findings to the MD, requesting an alternate medication order.
Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified. FDA-approved usage of morphine sulfate includes moderate to severe pain that may be acute or chronic. Most commonly used in pain management, morphine provides significant relief to patients afflicted with pain.
Option A: Respiratory depression is among the more serious adverse reactions with opiate use that is especially important to monitor in the postoperative patient population. The efficacy and therapeutic index of morphine are assessable with a combination of subjective and objective findings. Controlling pain, which is usually the first symptom evaluated in patients, is the ultimate goal of morphine use.
Option B: Extreme caution must be used with severe cases of respiratory depression and asthma exacerbation since morphine can further decrease the respiratory drive. Other essential parameters requiring monitoring include mental status, blood pressure, respiratory drive, and misuse/overuse. Although it may seem intuitive, it is also important to monitor what other medications a patient is taking. This list includes but is not limited to prescription medications.
Option D: Morphine can potentially be a lethal medication when not used properly. It causes a host of symptoms related to depression of the CNS. Severe respiratory depression is the most feared complication of morphine in cases of overdose. Immediate injection of naloxone is required to reverse the effects of morphine. All patients taking morphine should understand the need to avoid any other substances that could lead to respiratory depression. These medications include but are not limited to alcohol, additional opioids, benzodiazepines, and barbiturates. Patients can become apneic at lower doses if combining morphine with any of these substances.