Question

PN 200 Fundamentals of Nursing I Preventing Medication Errors-Analgesics Date Name: 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. 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? 1. 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. What do you think has happened? What should Mr. Downs do? 2. 3. 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.I would expect the physician to order morphine which is the best choice of a strong opiod according to the third level of WHO palliative pain medication.since oxycodone is available only in oral form and the Ms down instead of taking it every 6 hourly doesn't have pain relieve .then we should move to the next level of palliative pain medication.which is a strong opiod .Half life of morphine is 4 hours and it's highly potent .the physician can order an adjunct therapy with NSAIDS like acetaminophen.The physician may order fentanyl which is also a strong opiods .

2.Ms Down has got the opiod drug overdose due to excess accumulation.All the strong opiods have side effects of drowsiness, respiratory distress.

3)Mr down should take her to emergency room as soon as possible before loss of consiusness and respiratory depression.

4)This problem can be avoided by starting the patient on a opiod low dose patient controlled analgesia with a lock out period if 20 mins .And a maximum dose per 24 hours should be locked out .this will prevent overdose and symptoms associated in the future.Drug morphine should be used instead of fentanyl due to the respiratory depression caused by fentanyl.Mr down also should be educated in the use of PCA .The other option is to use of morphine patch which makes it easier and which will lead to slow release of drug.