An older client recovering from surgery is prescribed IV morphine sulfate 2 to 6 mg every four hours prn for pain. What approach will the nurse take to manage this client's pain?

Question

1. Begin by administering 2 mg IV every four hours as needed.
2. Administer 4 mg of morphine every time the client requests pain relief.
3. If the 2 mg dose is not effective within 15 minutes, administer another 2 mg.
4. Offer a 6 mg dose of morphine for reports of moderate to severe pain.

Answer 1

1. Begin by administering 2 mg IV every four hours as needed.

Explanation: 1. Older clients usually have more sensitivity to opioid analgesics, and most often these clients are started on smaller doses to avoid toxicity. The dose is then titrated upward until effective pain relief is achieved without adverse effects.
2. The nurse does not know how effective the lowest dose will be. Narcotics like morphine are started low and titrated to achieve comfort. If the 2 mg dose is not effective, the nurse offers 4 mg for the next dose.
3. A PRN dose can only be administered as prescribed. If the nurse thinks it is urgent to give the client additional pain medication before the next dose is prescribed, then the nurse places a call to the health care provider to request an additional, one time dose.
4. An older adult client may achieve adequate relief from severe pain with a 2 mg dose of morphine. The nurse must start with the lowest dose and assess pain management needs on an ongoing basis.