43. A hospice patient with metastatic ovarian cancer is on a continuous morphine infusion at 100 mg/hour with a bolus of 30 mg every 15 minutes as needed. During assessment, the nurse notices somnolence, abdominal distention, decreased bowel sounds, and involuntary jerking movements of the upper extremities. The nurse should obtain an order for
Answer: A
Initiating an opioid rotation
In this case, the patient is displaying signs of opioid toxicity, including somnolence and involuntary jerking movements, which indicate that the current morphine regimen may be too high or not well-tolerated. Initiating an opioid rotation can help manage these symptoms effectively.
A) initiating an opioid rotation
This option is correct as it involves switching the patient from morphine to a different opioid with a better side effect profile or a lower dose, which may alleviate the symptoms of toxicity observed, such as somnolence and involuntary movements. Opioid rotation is a common practice to improve pain management and minimize side effects when a patient becomes intolerant to a particular opioid.
B) administering naloxone
While naloxone is an opioid antagonist that can counteract the effects of opioid overdose, the signs exhibited by the patient do not suggest a life-threatening overdose requiring immediate reversal. Naloxone may not be appropriate here as the goal is to manage the patient's symptoms rather than reverse opioid effects entirely.
C) increasing the morphine drip
Increasing the morphine drip would likely exacerbate the patient's symptoms of toxicity, such as somnolence and decreased bowel sounds, rather than provide relief. This option is incorrect as it fails to address the current adverse effects the patient is experiencing.
D) adding an anticonvulsant
Adding an anticonvulsant may be considered if the involuntary jerking movements are indicative of seizures. However, the primary issue appears to be related to opioid toxicity rather than seizure activity. Therefore, this option does not address the root cause of the patient's symptoms.
Conclusion
Initiating an opioid rotation is the most appropriate intervention for this patient, as it directly addresses the signs of opioid toxicity and aims to improve the patient's comfort and safety. The other options either do not effectively resolve the issue or could potentially worsen the patient’s condition. Thus, opioid rotation is essential in managing the patient’s symptoms while maintaining adequate pain control.