Question

A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse should

a- request the physician order different basal and bolus rates.
b- question the client about how he/she has been using the button on the pump.
c- check the IV pump to ensure the basal rate is set correctly.
d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.

Answer 1

The nurse should initially check the IV pump to ensure the basal rate is set correctly. This action takes priority and is followed by documenting the event and discussing with the healthcare team to adjust the PCA settings.

Step-by-step explanation:

When the nurse finds that a postoperative client with a morphine PCA pump is stuporous, hard to arouse, and has a respiratory rate of 6 breaths/minute, it is indicative of opioid overdose. After the immediate treatment and stabilization of the client's condition, the nurse's priority should be to check the IV pump to ensure that the basal rate is set correctly. This step is crucial because it ensures that the pump is delivering the correct dose of medication. Additionally, the nurse should document the incident and communicate with the healthcare team, including the surgeon, nurse, and anesthesia professional, about the incident to review and possibly adjust the PCA settings.

However, depending on the facility's policy and the clinical judgment of the medical team, the nurse might also take other actions such as requesting the physician order different basal and bolus rates or asking to discontinue the PCA and consider alternative pain management strategies.