How should the nurse plan to manage sedation and pain medication when a dying client is to be terminally weaned or extubated?

Question

1. Stop all ongoing sedative infusions at least an hour before extubation.
2. Observe the patient and adjust medication dosages every hour.
3. Provide an anticipatory dose of morphine and initiate an ongoing morphine infusion.
4. Initiate medication therapy to control dyspnea but plan to stop it in the event of hypotension.

Answer 1

3
Rationale 1: Anticipatory dosing of morphine sulfate is used prior to weaning or extubation. The usual dose is 5 to 10 mg IV or if the patient has been receiving morphine, two to three times the patient's usual bolus dose.
Rationale 2: If the patient is displaying symptoms indicative of discomfort then the morphine dose should be titrated up slowly every 5 to 15 minutes with the goal of eliminating tachypnea, coughing or choking, agitation, excessive movement of the head and torso, diaphoresis, and grimacing.
Rationale 3: Anticipatory dosing of morphine sulfate is used prior to weaning or extubation. The usual dose is 5 to 10 mg IV or if the patient has been receiving morphine, two to three times the patient's usual bolus dose. Initiation of an ongoing morphine infusion, usually at a rate of 50% of the bolus dose/hour, immediately following the anticipatory bolus dose.
Rationale 4: Hypotension and decreased level of consciousness are anticipated side effects and should not result in a reduction in the dose of morphine.