A morphine PCA order is changed to hydromorphone, and the new bag concentration does not match the current pump program. Which action should the nurse take?
1Keep the pump stopped, verify the order, drug, concentration, and program, and complete an independent double check before restarting.✓ Correct answer
2Attach the hydromorphone bag and allow the smart-pump drug library to convert the morphine settings automatically.
3Use the existing morphine program because both medications are opioids and provide comparable analgesic effects.
4Restart the PCA with the current settings, observe the first dose, and contact pharmacy if the client becomes sedated.
Explanation
Hydromorphone and morphine are not dose-equivalent, and a drug or concentration change is a high-alert checkpoint. The PCA remains stopped until the order, medication, concentration, and pump parameters are reconciled and independently double-checked according to policy. A smart pump does not infer the bag concentration or safely convert one opioid program to another.
Clinical reasoning Hydromorphone is potent and can cause fatal respiratory depression if the wrong drug, concentration, or PCA program is used. Barcode scanning and a drug library do not replace verification.
Decision rule When the opioid or concentration changes, pause therapy, reconcile every order and pump parameter, perform the required independent double check, and reassess respiratory status after restart.