Adjusting Hydromorphone Dosage for Pain Management

A 72-year-old patient with a history of chronic arthritis is admitted to the hospital for severe joint pain. The healthcare provider prescribes a dosage of hydromorphone (Dilaudid) for pain management. The provider orders hydromorphone 1 mg IV push every 4 hours as needed for pain. The nurse knows that hydromorphone is a potent opioid analgesic used for moderate to severe pain. After administering the first dose, the nurse monitors the patient's level of sedation and respiratory rate. To ensure safety, the nurse must remain aware that the ceiling effect of hydromorphone is significant and should adjust the dosing accordingly.

In a situation where the patient's pain is not adequately managed after two doses, the nurse anticipates the provider may consider increasing the dose to ______ mg to better manage the patient's pain based on patient response and current pain management protocols.