Exhibits

The nurse is reviewing provider orders for Mrs. Thompson who is in the end- of-life stage. Match each provider order with its appropriate category: anticipated, nonessential, or contraindicated. Select the correct category for each given order.

A. SaO₂ 94%. An oxygen saturation of 94% is within the normal range and does not indicate respiratory depression, which is a primary concern with morphine. A more significant drop in oxygen saturation would be a greater cause for concern.
B. Respiratory rate 8/min. This is an adverse effect of morphine. Opioids like morphine can cause respiratory depression, and a respiratory rate below 12 breaths per minute is considered concerning. A rate of 8 breaths per minute requires immediate intervention, such as administering naloxone if necessary.
C. Sleepy, but arousing when her name is called. Mild sedation is an expected side effect of morphine. As long as the client easily wakes up to verbal stimuli, this does not indicate significant opioid toxicity. However, if sedation deepens to unresponsiveness, it would be a concern.
D. Pain level of 6 on a scale from 0 to 10. This indicates that the morphine has not fully relieved the client’s pain, but it is not an adverse effect. The nurse may need to reassess pain management, but the priority is monitoring for respiratory depression.

A. "You will be able to administer pain medication to yourself by pressing the PCA button whenever you need it." PCA allows the client to self-administer pain medication by pressing a button, giving them control over their pain relief. However, it is important to educate the client to press the button only when experiencing pain, not on a routine schedule.
B. "The PCA system is designed with safety features to prevent you from receiving too much medication." PCA pumps are programmed with a lockout interval to prevent overdosing, ensuring the client cannot receive medication too frequently. This safety mechanism reduces the risk of respiratory depression and other opioid-related complications.
C. "The PCA system is programmed to deliver a specific dose of medication each time you press the button." The PCA pump is preset to deliver a controlled dose of medication when activated. This prevents errors and ensures that the client receives a safe and effective amount of analgesia.
D. "Family members should press the PCA button for you if you are unable to do so yourself." This is incorrect because only the client should press the PCA button. Allowing family members or staff to activate the PCA pump, known as "PCA by proxy," can lead to overmedication and serious complications, including respiratory depression.
E. "You should avoid using the PCA system if you feel that the pain is manageable without medication." While it is important to use the lowest effective dose of pain medication, avoiding the PCA system entirely may lead to unnecessary discomfort. Clients should be encouraged to use the PCA when needed to maintain optimal pain control and prevent pain from becoming severe.