What safety measures or instructions would you give W.R. before ...

[BRWH]

What safety measures or instructions would you give W.R. before you leave his room?
 
  What would be an ideal response?

Question 2

At 2000, you phone Dr. A.'s partner, who is on call. She prescribes morphine sulfate 4 to 10 mg IV push (IVP) q1h prn for pain (burning, pressure, and angina).
 
  Explain two reasons for this order.
 
  What special precautions should you follow when administering morphine sulfate via IVP?
 
  The pharmacy supplies morphine for injection in vials of 5 mg/mL only. For the first dose,
  you will be giving 4 mg of morphine. How many milliliters will you give for this dose? Mark
  the syringe with your answer.
 
  What will you do with the rest of the morphine in the vial?
  a. Discard it.
  b. Save it for the next dose.
  c. Return it to the pharmacy.
  d. Discard it with a second witness.

[tennis14576]

Answer to Question 1

 He should press the nurses' call light as soon as he starts to experience any uncomfortable feelings
(the word pain might be misunderstood), becomes nauseated, or experiences more indigestion.
 Inform him of his activity statusfor example, The doctor has placed you on bed rest with
bathroom privileges. That means if you need to use the bathroom, you need to turn on your call
light and someone will assist you. Do not try to get up by yourself.
 It is against hospital policy for him to smoke in the hospital. Have his wife take his cigarettes and
lighter or matches home.
 It is very important that he let you know whether he has to have a bowel movement because
during a bowel movement the Valsalva maneuver (you might have to explain this) can contribute
to sudden death.

Answer to Question 2

 Morphine sulfate, an opioid analgesic, will decrease pain and help reduce his stress.
 Morphine sulfate functions to dilate pulmonary vessels and decrease preload on the heart.
 Morphine sulfate dilates the coronary arteries to increase blood flow and oxygen delivery and
promote tissue perfusion.
 Relieving pain will help decrease myocardial oxygen demand.

 Ask about prior allergy, hypersensitivity reaction to morphine sulfate, or impaired liver function.
 Assess VS, especially respirations (do not administer if respirations are less than 10 breaths/min);
level of consciousness with opioid use; and location and intensity of pain before and 30 to 60
minutes after administration.
 Administer IVP over 4 to 5 minutes (for 15 mg or less).
 Start with smallest dose ordered and titrate to eliminate pain.

0.8 mL

Answer: d
Morphine is a Schedule II drug, and any drug that is not used needs to be wasted with a second
witness documenting that the drug was discarded.

[BRWH]

Gracias!

[sarah_brady415]

TYSM