Question

PN 200 Fundamentals of Nursing 200 Surgical Pain - Morphine RI. a 70. old man underwent abdominal surgery for resection of his colon. His physician prescribes morphine 10 mg every 3.4 hours PRN after surgery. RJ did not ask for pain medication after surgery because he worried he might become addicted. A day after the surgery. his une more he was restless and grimaced whenever he moved in bed. He refused to breathe deeply or cough when instructed to do so. The nurse compared RJ's vital signs to his baseline findings and noted an increased pulse rate and a drop in systolic blood pressure of 6 mmHg. 1. Should the nurse give morphine? Explain your answer. 2. What would your reaction be to RJ in regard to restlessness, grimacing, and refusal to deep breath and cough? 3. What is the significance in a change in vital signs? 4. What classic signs of opioid analgesics should the nurse assess? 3. What are some of the nonpharmacologic measures that might be helpful in relieving RJ's pain? The second day postoperatively, RJ begins to ask for morphine every 3 hours. On the 5th day postoperatively, the physician discontinues R's morphine and orders acetaminophen with codeine. 6. Why was the opioid analgesic changed? 7. RJ does not want to ambulate. What is an appropriate nursing response? 8. State the antidote for morphine sulfate. Reviewed 9/19

Answer 1

1. Yes, the nurse should give him morphine as he is clearly in distress due to pain. She should do so after throughout counselling RJ about the benefits of morphine and why it is so beneficial for him. She should also try to alleviate his fear of addiction.
2. The patient is clearly in pain (on the basis of his vital signs and physical condition). One should first ask RJ if he is in pain. He replies in affirmative, intervention should be done.
3. The change in vital signs is an indicator of physical distress that RJ is experiencing post-op.
4. Respiratory depression, drowsiness, dizziness and constipation are some of the side effects of opioid use which need observation. All of these subside with termination of use except constipation which might persist.
5. Cold packs, meditation, distraction ( reading a book) etc might help with pain.
6. Opioid use is only recommended for acute severe pain. Opioids are infamous for their addiction potential. Thus, as and when the pain slightly subsides, the doctor shifts RJ to weaker analgesics like Acetaminophen.
7. The nurse should calmly explain to RJ that the sooner he starts to mobilize, the better his recovery will be. She should encourage him to start slowly and reassure him that he will be alright.
8. Naloxone is the antidote of morphine sulfate.