Question

PN 200 Fundamentals of Nursing II Preventing Medication Errors - Analgesics Name: Date You are the home health nurse assigned to care for a patient who is in the terminal phase of cancer. Mrs. Downs is 48-years-of-age and underwent a bilateral mastectomy last year with lymph node involvement. Recently she has been diagnosed with metastasis to the bone. She has been taking oxycodone-one 5 mg tablet every 6 hours - and not being able to sleep well through the night and now has increasing pain to the point that her quality of life has decreased significantly. She wants to stay at home through her terminal phase of her illness but also must have adequate and safe pain control. Her husband of 18 years is very supportive. They have no children and both are college graduates. Mrs. Downs's recent increase in pain has been attributed to bone metastasis to the area of the lumbar spine. At this time the oxycodone is not beneficial and you as her nurse must now advocate for the patient to her physician to receive adequate pain relief. 1. When discussing her pain medication with her physician, what type of medication would you expect to be ordered to relive the bone pain and what is the rationale for this medication? Mrs. Downs visits her physician and receives a different opioid medication that is to be given around the clock, plus an immediate-release opioid to help with any breakthrough pain. After one week Mr. Downs finds Mrs. Downs awake but lethargic and speaks with slurring her words. 2. What do you think has happened? 3. What should Mr. Downs do? Mrs. Downs is taken to the local emergency room and is treated for overdose. Her physician is contacted and her medication dosages are adjusted to a lower dose. 4. How can this problem be prevented in the future? Reviewed 9/18

Answer 1

1. Corticosteroids like dexamethSone as they Decrease spinal cord edema and exert beneficial effect on bone that is affected by tumor

2. Opioid overdose may have occured as it causes confusion, lessen alertness, loss of consciousness , slurred speech.

3. Mr downs should take her to hospital immediately.

4. To prevent overdose in future

• Take your medicine exactly as prescribed by your health care provider. Do not take more medicine at once or take medicine more often than you are supposed to.
• Never mix pain medicines with alcohol, sleeping pills, or illegal substances
• Store medicine safely where children or pets can't reach it. Consider using a medicine lockbox. Besides keeping children safe, it also prevents someone who lives with you or visits your house from stealing your medicines.
• Dispose of unused medicine promptly
• If at high risk for an overdose, ask health care provider about whether you need a prescription for naloxone.