A 91-year-old nursing home resident has been receiving meperidine (Demerol) injections for right shoulder pain. During the morning assessment, the nurse finds the resident irritable and jumpy. Which nursing actions and rationales is appropriate?
a. Administer a dose of Demerol because the patient is exhibiting signs of withdrawal.
b. Administer a dose of Demerol because these are symptoms of pain in an older adult patient.
c. Notify the registered nurse (RN) or physician that the resident may be experiencing toxic effects of Demerol.
d. Assess the patient's pain level before determining the appropriate dose of Demerol to administer.
ANS: C
The RN or physician should be notified and a different analgesic ordered. Meperidine (Demerol), when broken down in the body, produces a toxic metabolite called normeperidine. Normeperidine is a cerebral irritant that can cause adverse effects ranging from dysphoria and irritable mood to seizures in the older adult. A. B. C. Administering a dose of Demerol will worsen the symptoms.
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