At 2 a.m. a 58 year old patient with metastatic breast cancer is admitted to the hospital with severe neck pain. Over 2 weeks the patient's pain has increased and she is now unable to move her head, due to the pain. Percocet, in ever-increasing dosages has not been effective, even when taking 2 Percocet every 4 hours. The on-call MD wrote these orders:
MSO4 10-15 mg orally, every 4-6 hours prn severe pain
Tylenol # 3, 1-2 tabs orally, every 6 hours prn moderate pain
Diagnostic x-rays ordered to rule-out spinal cord compression.
Eight hours after admission, the patient remains in severe pain, with no improvement. The x-rays have not been able to be done, because of the patient's severe pain. Upon checking the chart, you find there have been multiple one-time verbal orders for 2 mg. IV morphine. When you ask the night-shift RN, she states the on-call MD stated he was afraid of increasing any of these medications, for fear the patient would suffer respiratory depression.
what 4 problems do you see with these orders?