A patient with end-stage heart failure is experiencing considerable dyspnea. Appropriate pharmacological management of this symptom includes:
a. administration of 6 mg of midazolam (Versed) and initiation of a continuous midazolam infusion.
b. administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion.
c. hourly increases of the midazolam (Versed) infusion by 100% dose increments.
d. hourly increases of the morphine infusion by 100% dose increments.
B
Morphine is an excellent agent to control the symptom of dyspnea. A 5-mg IV bolus and initiation of a morphine drip is an appropriate initial intervention to control dyspnea. Initial dosing of midazolam should be 2 to 4 mg, and more is indicated for anxiety. The morphine dose should be titrated incrementally by 50% dose increases. Midazolam is indicated for management of dyspnea and is titrated incrementally by 50% dose increases.
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