Jenny Alvers is a 38-year-old otherwise healthy female who has been admitted directly to the ICU after an automobile accident and emergency abdominal surgery. In addition to surgery, she has deep face, neck, and chest lacerations and contusions. Jenny is on a ventilator and somewhat disoriented and restless with elevated blood pressure and heart rate. She is unable to provide a report of pain but, based on her pathologic condition, the nurse assumes that Jenny has pain and consults with the surgeon about orders for a continuous IV opioid infusion. Knowing that Jenny will be subjected to painful procedures such as endotracheal suctioning and wound care during her stay in the ICU, the nurse also requests supplemental IV opioid doses to administer prophylactically. Jenny's sister reported that Jenny has no allergies but experienced severe nausea when she was given IV morphine following an appendectomy 3 years ago. The surgeon prescribes an IV infusion of hydromorphone at a dosage appropriate for an adult with moderate to severe pain and supplemental IV hydromorphone bolus doses every hour as needed. Scheduled doses of IV acetaminophen and IV ibuprofen are also ordered.
The nurse suspects that Jenny's restlessness could be related to unrelieved pain and therefore administers an IV hydromorphone loading dose before initiating the infusion. Infusions of IV ibuprofen followed by IV acetaminophen are also administered. An aqua pad circulating cool water is placed over Jenny's chest to provide additional analgesia. The nurse reduces the external stimuli in the room as much as possible and provides Jenny with calm reassurance and orientation while caring for her. Within 45 minutes of these interventions, Jenny is no longer restless, her vital signs are within normal limits and stable, and she appears to be resting comfortably.
Case Analysis
Pain assessment in Jenny is a challenge because she is unable to report pain using customary assessment tools. According to the hierarchy of pain measures, when self-report of pain cannot be obtained, clinicians should assume pain is present based on the existence of painful pathology. Behaviors, if present, may also be observed as possible indicators of pain. The nurse correctly suspected that Jenny's restlessness might be due to unrelieved pain and administered analgesia promptly. It is important to note that elevated vital signs, which often accompany restlessness, are not reliable measures of pain, but they are sometimes used to further support the assumption that acute pain may be present. When Jenny recovers enough to provide a report of pain, self-report tools such as the NRS or FPS-R will be introduced and used to assess her pain.
The type of pain is used to determine the appropriate treatment approach. Jenny has experienced surgery as well as significant trauma-related tissue damage, both of which yield nociceptive pain. The first-line analgesics for moderate to severe nociceptive pain include opioids and nonopioids, such as acetaminophen and NSAIDs. Because Jenny is on a ventilator, the analgesics are administered by the IV route. Fortunately, there are several opioid and some nonopioid analgesics available in IV formulation. Administration of a loading dose (IV bolus in this case) before initiation of the maintenance analgesic (IV infusion) is recommended to establish rapid analgesia. When Jenny is able to take oral fluids, analgesics will be given orally.
Please answer the following questions regarding the Case Study.
Question 1:
Multimodal analgesia is recommended for the management of all types of pain. Is Jenny’s pain being managed with multimodal analgesia? Explain your answer.
Question 2:
When Jenny is able to report pain, the plan is to use a self-report tool such as the NRS to assess her pain. Describe this tool and how to use it.
1, Yes, Jenny's pain managed with multimodal analgesia, it
combines a form of various groups of pain relievers like NSAIDs,
opioids, local anesthesia, alpha agonists and acetaminophen. she
received IV hydromorphone, ibuprofen, acetaminophen, NSAIDs,
opioids and nonopioids for her unrelieved pain through IV
formulation. These drugs improved pain relief, reduced opioids
requirement and opioid-related adverse effects. when she is
post-operative periods with unrelieved pain these multimodal
analgesia has a synergistic effect and relief pain and reduced
adverse drug effects and improves patient satisfaction.
2, Numeric rating scale(NRS) is a visual analog scale help patient
to rate their pain level. Inbetween 0-10, 0 indicates no pain,
10indicate worst pain. when the patient can able to self report
their pain, this tool help to identify their pain level. To use
this tool ask the patient to point the number, color or relative
location on NRS to identify the intensity of pain. It is easily
handled by verbally and used in a telephone interview.
Jenny Alvers is a 38-year-old otherwise healthy female who has been admitted directly to the ICU...
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