Question

PLEASE HELP IN Answer the following questions based on this case study

WHAT SHOULD BE MOST IMPORTANT TO CONSIDER FOR THIS PATIENT.

RJ is a 79 year old man who fell when he got out of bed to go to the bathroom at home. He arrived to the unit with Buck’s traction to his R lower leg, and now has had surgery for a right hip fracture two days ago. He lives alone since his wife died, and his children say he is active, but becoming a bit forgetful. They also say he is very proud and does not like to look weak or ask for help. He does admit that his R hip is a bit uncomfortable, but he’d like to wait for pain medication. The nurse comes to assess him and notes that he is restless in the bed and grimacing as he tries to adjust his position in bed. His vital signs are T 98.8, HR is 99, RR is 26, and BP Is 168/100, which is an increase compared to his baseline vital signs. He is not hungry and picked at his lunch and refused to order dinner. His physician prescribed: Morphine IV every 4 hours as needed for severe pain Hydrocodone and acetaminophen every 4 hours as needed for moderate pain Acetaminophen every 6 hours as needed for mild pain. RJ insists that the acetaminophen is all he needs and the nurse gives him the acetaminophen for pain that he reports as “just a little pain.” Upon reassessment, the vital signs and observations are unchanged and RJ is resistant to the nurse’s offer to help him get repositioned and refuses to get out of bed with physical therapy. What are the priority assessments with this patient? What is the significance of the patient’s behavior and change in vital signs? What should the nurse teach this patient about the benefits of using the pain medication ordered? Identify at least 3 different non-pharmacologic measures the nurse could use to reduce the patient’s pain in addition to the use of pain medication.

Answer 1

The most important thing to consider here is to manage his post operative pain with effective psychological support ,by making him understad that the need of a pain killer if for first few days of surgery.

The priority assessment to be done to this patient are

• Assess for the intensity of the pain
• Assess the surhuval site gor any bleeding
• Monitoring his vital signs to get the baseline data
• Mental status examination

The vital signs is directly proportional to one's behaviour when an individual is in anger,tension,aggressive ,the heart is the one organ first being targeted resulting in increased heart rate and elevated blood pressure. The same thing can be seen in a patient who is in severe pain.The pain is a neurological trigger for origin and relief and hence changes in vitals occurs because of it.

The nurse can teach the benefits of the pain killer in the following ways

• The pain can be managed effectively gives a comfort and relief
• Early mobilisation is possible
• Prevents complications like DVT due to lack of mobilisation out of pain

The non pharmacological measures to reduce pain are

• Relaxation therapy (music,videos )
• Mild physical therapy
• Change of position every second hourly