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
Initiating an opioid rotation is the appropriate action for this patient.
The symptoms observed in the patient, including somnolence and involuntary jerking movements, suggest possible opioid toxicity or inadequate pain control, necessitating an adjustment in the opioid regimen through rotation to a different opioid.
This choice is the best option as opioid rotation can help manage side effects and improve pain control in patients experiencing toxicity or inadequate response to their current opioid therapy. Switching to a different opioid may provide better symptom relief while minimizing adverse effects.
While naloxone is used to reverse opioid overdose, the patient exhibits symptoms of opioid-related side effects rather than respiratory depression or altered consciousness requiring reversal. Administering naloxone may not address the underlying issue of inadequate pain management.
Increasing the morphine infusion could exacerbate the patient's current symptoms and lead to further sedation and toxicity. The presence of somnolence and decreased bowel sounds indicates that the current dosage may already be excessive, making this option inappropriate.
Although the involuntary jerking movements could suggest seizure activity, there is insufficient evidence to indicate seizures in this context. The primary concern is likely related to opioid effects rather than a seizure disorder, making this choice less relevant.
In this scenario, initiating an opioid rotation is the most suitable intervention to address the patient's symptoms effectively. The identified side effects signal a need for reevaluation of the opioid regimen to enhance symptom management while reducing the risk of toxicity. Other options either do not target the root problem or could potentially worsen the patient's condition.
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