A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation.The patient continues to grimace and fight the ventilator.What nursing intervention would be appropriate?

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Even though opiates can cause respiratory depression,the goal in palliative care is to alleviate pain and suffering.A bolus dose of morphine (2-10 mg IV)and a continuous morphine infusion at 50% of the bolus dose per hour is recommended.Because many critical care patients are not conscious,assessment of pain and other symptoms becomes more difficult.Gélinas and colleagues recommended using signs of body movements,neuromuscular signs,facial expressions,or responses to physical examination for pain assessment in patients with altered consciousness.

A Patient Was Admitted Several Weeks Ago with an Acute