Question

Daniel Watkins is a 53-year-old man who was admitted to the hospital because of severe abdominal pain. A bowel resection was done to relieve an obstruction. By his fourth postoperative day, he is ambulating and tolerating oral intake. He has been taking both injections and oral medication for pain. The following medications are currently ordered:

• Meperidine (Demerol®), 50 to 75 mg IM every 4 hours PRN      for pain
• Acetaminophen with oxycodone (Tylox®),1 or 2 capsules PO every 4 hours PRN
• Acetaminophen (Tylenol®), 650 mg PO every 4 hours PRN for headache and fever

Mr. Watkins is complaining of pain around his incision following a dressing change and removal of surgical drains. He is very anxious and upset. He is requesting pain medication. He had his last dose of meperidine 6 hours ago. He took 1 capsule of Tylox® 2 hours ago for mild pain after ambulating.

1.      What assessment data does the nurse need to decide how to intervene at this time?

2.      The nurse decides to administer meperidine (Demerol) 50 mg IM. What assessment should be done to monitor for adverse effects of the meperidine?

3.      What should the nurse document in the client's medical record about the pain management?

4.      Mr. Watkins complains that the drugs do not always help when he has severe pain. What is the nurse's appropriate action for this situation?

5.      What measures can the nurse teach Mr. Watkins to promote more effective pain management?

6.      When Mr. Watkins complains of a headache, what medication would be most appropriate for the nurse to administer?

Answer 1

1, Assess the effects of drugs based upon the onset of action for meperidine and Tylox drugs. using analgesics along with opioids allows only less dose of opioids for adequate pain control. Patient pain level should be reassessed directly and initiate the fixed-dose drug schedule.
2, Meperidine is a opioids agonist for acute pain. we need to monitor the patient for any mood changes, delirium, tremor, dry mouth, tachycardia, bradycardia, syncope, urinary retention, skin rashes, flushing, sweating, hypotension.
3, It should include the assessment, intervention, and reassessment to improve patient care. Pain management documentation changes with pain severity, side effects, etc. Ongoing evaluation of pain-related outcomes should be included in the patient medical record. It should cover the area of analgesia, activity of daily living, adverse effects and drug-related behavior.
4, Listen to the patient and help the patient to become more comfortable. Teach the patient about the relaxation techniques. nondrug technique and cognitive technique improve patient mental and physical function. massage therapy reduces the pain, applying heat and cold therapy improves pain intensity and function.