1. Why may Mrs. Campana be slow to respond?

Mrs. Campana is an 80-year-old woman who has received an opioid analgesic in the
PACU and is on a morphine sulfate PCA. Older adults tend to metabolize opioids
slowly, so she may need to have her morphine dosage adjusted to a lower dosage.
Additionally, she may be experiencing delayed renal clearance of operatively
administered anesthetic agents based on her age.

2. what are your priority assessments at the time considering Mrs. Campana’s
current decreased responsiveness? What do you need to do if you discover any
unexpected or abnormal assessment findings?

You should check vital signs, including pulse oximetry, immediately to verify that she is
not hypoxemic. You need to complete a focused neurological examination, including
level of orientation,
pupil response, presence of gag reflex, and movement of all extremities to rule out a
neurological event as the cause for her decreased responsiveness. You may have to
decrease the dose of PCA or hold the medicine until Mrs. Campana is more arousable.
Notify the charge nurse and Mrs. Campana's surgeon immediately if you discover any
unexpected or abnormal assessment findings.

3. Mrs. Campana’s daughter enters the room and is very concerned about her
mother’s slowness to awaken. What do you tell her?

Give the daughter factual information regarding the results of her mother's vital signs,
oximetry, and any available laboratory tests. Explain the rationale for the normal
sleepiness in patients after surgery related to the anesthetic administered in the
operating room and opioids in the PACU. Give instructions on the use of the PCA to
both Mrs. Campana and her daughter, with instructions that the medication is for patient
administration only. Even if her daughter fears that her mother may be in pain, it is
important that only Mrs. Campana use the button. Explain to her daughter that you may
need to hold the PCA until the patient is more alert.