Nurse Fatimah
Dr. Goh, this is Staff Nurse Fatimah calling from Ward 56 about Mr. Chen Wei in Bed 3. Are you able to take a handover now?
Dr. Goh
Yes, go ahead Fatimah. I'm listening.
Nurse Fatimah
Situation: Mr. Chen is a 72-year-old palliative patient with advanced gastric cancer. He has become acutely confused and agitated in the last 30 minutes. He's pulling at his IV lines and trying to climb out of bed.
Nurse Fatimah
Background: He was started on a morphine infusion at 2 milligrams per hour this morning for increasing abdominal pain. His last blood tests showed a creatinine of 180, up from 120 two days ago. He also had a urinary catheter inserted yesterday for poor output.
Nurse Fatimah
Assessment: My concern is this could be opioid-induced neurotoxicity given the rising creatinine and new morphine infusion. His renal function is declining which may be causing morphine metabolite accumulation. However, I also want to rule out urinary retention, infection, or hypercalcemia as possible causes.
Nurse Fatimah
Recommendation: I think we should reduce or pause the morphine infusion, check urgent bloods including calcium and renal function, and consider a stat dose of haloperidol 0.5 milligrams subcutaneously for the acute agitation. Would you be able to come and review him?
Dr. Goh
Excellent assessment, Fatimah. Yes, please reduce the morphine infusion to 1 milligram per hour for now, draw the urgent bloods, and give the haloperidol 0.5 sub-cut. I'll be there in about 10 minutes. In the meantime, please ensure bed rails are up and maintain a calm environment around him.