Question

Jennifer Lincoln was back at work on her oncology nursing unit after a weeks’ vacation period as she read saved her report, she could hear moans of pain coming from the room of Leonard Wilson, at 28 year old male suffering firm the effects of messed attic bone cancer . This patient had been one of her favorites when he was hospitalized several months ago for chemotherapy. Now he was back to die. The metastatic grows in his spine were causing him excruciating pain at the same time as brainstem miss at tires were threatening death. The goal of Mr. Wilson's nursing care was to keep him as comfortable as possible. But as Mrs. Lincoln checked the chart of his narcotic order, she stared in disbelief she had called the head nurse; have Mr. Wilson really received 780 milligrams of morphine by continuous infusion during the last 8 hours, plus 20 milligrams boost booster every four hours, PRN? That was enough to cause respiratory depression, even in a 180-pound man the head nurse come from the dose and explained that Mr. Wilson tall tolerance was extremely high, probably because he had been addicted to heroin as a teenager give him another 20 milligrams booster, she told Mrs. Lincoln we have to relieve his pain. Mrs. Lincoln agreed that his pain should be relieved but she wondered whether she should give him another dose on top of the amount of medication that he had already received what if he stopped breathing after she gave him the booster? what should she do?

1---Think of a patient care situation in which you hesitated to give frequent or high doses of morphine to a patient. Why were hesitant to give the morphine in this situation?

Answer 1

1. Mrs.Lincoln and Morphine

Palliative care or End of life Care is a specialised area of health care that focuses on relieving and preventing the   suffering of the patients. As the patient Mr. Leonard Wilson was a heroin addict ay his teenage, he is well tolerant to Morphine and other opioids. Now he is in great distress with pain and the nurse Mrs. Lincoln's responsibility is to make him as comfortable as possible.  

The nurse can give him an additional dose of Morphine 20 mg booster to relieve his pain as the headnurse instructed her. Also she has the Doctor 's order for 20 mg of Morphine as PRN , whenever necessary. Morphine is a sfe drug for analgesia, that will not cause any premature death, when given orally. She can notify the physician also and record each and every thing related to Morphine administration, including Headnurse's instruction to give the dose.

1. Situation:

A five year old child with leukaemia, admitted in the Palliative care session of the Healthcare facility M. I was taking care of the child for the afternoon shifts. As per the report from the morning shift, the child received a dose of 0.5 mg/ kg at two times; one on morning 7 .00 AM and another on 12 PM as the child's pain level was increasing. Bya 3 .00 PM , again the child started to cry out of pain and his parents asked to him some of the pain killers and a co worker also asked me to give him some extra dose of Morphine/ with Acetaminophen . But I hesitated to give him as : he was a child and opiod overdose may cause Respiratory depression and the child is an ' Opioid naive' patient , that means he is new to opioids and he didn't develop any tolerance to opioids. So I didn't take a decision on administering morphine , instead tried to connect with physician to ask for guidance.