The emergency department nurse is caring for a client who has recently been prescribed methadone for chronic severe back pain. The client ingested extra tablets tonight because the pain returned. Which assessment findings during discharge require the client to be monitored longer in the hospital setting? Select all that apply.

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Quizplus · Accepted Answer

Methadone is a potent narcotic with a longer half-life than its duration of action due to its lipophilic properties. The risk for overdose exists as clients can inadvertently take too many tablets for additional pain relief even though fat cells will continue to release high amounts of the drug into circulation. Early signs of toxicity include nausea/vomiting and lethargy. A client who falls asleep with stimulation (ie, is obtunded) requires additional observation/monitoring. Sedation precedes respiratory depression, a life-threatening complication of severe toxicity (Options A and C). An acceptable pulse oximetry reading for a normal, healthy nonsmoking adult is considered 95%-100%. A reading of 90% is low and indicates inadequate depth or rate of respiration with possible respiratory depression (Option E). (Option B) Itching sensation (pruritus) is an expected finding with narcotic use, especially in opioid-naïve clients. It can be managed with an antihistamine. (Option D) Occasional premature ventricular contractions are a common, insignificant finding in most adults. The client should have cardiac monitoring in the setting of methadone use/overdose as there is a risk of QT interval prolongation (normal 0.34-0.43 sec, or less than half the RR interval), which can lead to cardiac arrhythmias (eg, torsades de pointes). Educational objective: Methadone is a potent narcotic with a long half-life. Early signs of toxicity include nausea/vomiting and lethargy. The nurse should monitor the client's respiratory rate, pulse oximetry, and electrocardiogram tracing. Respiratory depression and QT interval prolongation can lead to life-threatening complications.

The Emergency Department Nurse Is Caring for a Client Who