A practical nurse (PN) is caring for a 78-year-old client who was admitted with a fractured femur and is receiving scheduled doses of oral oxycodone for pain management. During the night shift, the PN finds the client newly agitated, picking at the bedsheets, and unable to recognize family members. The client's vital signs are blood pressure 102/68 mm Hg, heart rate 94 beats/min, respiratory rate 11 breaths/min, and oxygen saturation 89% on room air. The client's family requests the next dose of pain medication to calm the client. Which action should the PN take first?
- Withhold the oxycodone, apply supplemental oxygen, and promptly report the findings to the registered nurse (RN).Cevap
- BAdminister the prescribed oxycodone to manage the pain that is likely causing the client's severe agitation.
- CExplain to the family that nighttime confusion is an expected response in older adults and administer the medication.
- DAccept a verbal order from the on-call provider to administer an intravenous push dose of lorazepam to ensure safety.
Cevap
The correct action is to withhold the oxycodone, apply supplemental oxygen, and promptly report the findings to the registered nurse (RN).
The client is demonstrating signs of significant respiratory depression (11 breaths/min) and resulting hypoxia (89% oxygen saturation), which are life-threatening adverse effects of opioid analgesics like oxycodone. Acute confusion and restlessness in an older adult are frequently the primary, early signs of hypoxia. The safest and most appropriate action within the PN scope of practice is to withhold the respiratory depressant, intervene by applying oxygen to address the immediate breathing compromise, and escalate the critical situation to the RN immediately.
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Anahtar Kavram
Opioid safety, recognition of hypoxia-induced delirium, and PN scope of practice.