Question

PN 200 Fundamentals of Nursing 200 Surgical Pain - Morphine RJ, a 79-year-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 nurse noted 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? 5. 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 RJ'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

Colon resection refers to a surgical procedure to treat disorders of colon that includes colon cancer. Postoperative pain occurs commonly after any surgical measures. Management of postoperative pain is a challenge for health care workers. Proper pain assessment techniques is essential to analyze the baseline data. Failure to control postoperative pain leads to risk for mortality.

1) Morphine is drug categorized under opioid analgesics. It control the pain stimuli interpretation in the brain. Nurse can administer morphine dose to RJ as the pain killers work to the best if it is administered at the first alarm sign of pain. Since patient got order of PRN, the nurse can administer morphine based on the change in vital parameters.

2) Encourage patient to verbalize the feelings, restlessness grimacing and refusal to deep breath are signs of severe pain. Assess patient pain intensity with visual analogue scale or numerical pain intensity scale. It is essential to make patient understand the morphine indications for pain management. It should be emphasized that morphine helps to relieve acute pain and it won't harm if it is taken under controlled doses as prescribed. Educate patient to support incision area with pillows while coughing or sneezing.

3) Vital signs is an essential parameters for assessing pain. The sympathetic nervous system is stimulated by the pain signals once it reaches the central nervous system. Pain signals triggers hypothalamus and pituitary to release adrenocorticotrophin hormone that in turn elevates adrenalin. Adrenalin stimulates the elevation of heart rate, pulse and blood pressure.

4) Nurse must be able to assess classical signs of opioids in order to understand the efficacy of drug to reduce postoperative pain. Using opioids to control postoperative pain does not increase the dependence or addiction in patients. The classical sign of opioid use disorder the nurses should be aware includes: nausea,vomiting,constipation.respiratory depression, postoperative respiratory complications, retention of urine.

5) Non pharmacological measures includes the measures to reduce pain with out usage of drugs. Relaxation techniques initiated that includes guided imagery,biofeedback technique,deep breathing exercises, relaxation techniques. Acupuncture involves in placement of thin needles at specific place int he body in order to decrease pain. Massage techniques plays as an important measure to reduce the pain.