Question

Scenario #1 TM, a 72 year old female was admitted to the medical-surgical floor for abdominal pain. The nurse is reviewing the orders and sees that the patient is scheduled for surgery (a laparotomy) in the morning. The nurse discusses post-op orders with the patient. The provider prescribes morphine 1. Why was morphine ordered? 2. What are the nursing considerations for patients who are prescribed morphine? What are your concerns? Explain your answer. 3. Would a PCA pump be appropriate for this patient? Explain your answer. What are the advantages of patient controlled analgesia? 4. Т.М asks if he can have aspirin for his headache- that's what usually helps at home. How would you respond? Explain your answer.

Answer 1

1. ANSWER

morphine is used because,

making the client relief from pain after surgery has a psychological effect and also it enhances the quick recovery of the patient, monitoring pain and applying all the quality measures to control postoperative pain is an important management, the goal and the objective is to reduce pain and the discomfort associated with it and also with no or very fewer side effects.

although the use of analgesia in postoperative patient is mainly opioids and also nonopioid, but traditionally opioid is used.

although a lot of advancement is done in medical settings but for the pain management after surgery like postoperative laparotomy is still the opioids, it binds with the central nervous system and peripheral tissues and works by modulating the nociceptors ( nerve involved in pain ).

there are various opioids available in the postoperative Pain management but morphine is the standard opioid that is used traditionally and widely., it has a peak effect and it lasts for 1 to 2 hours, while other opioids only last for certain time.

2. ANSWER

there are various side effects of opioids such as respiratory distress, hypoxia, low bowel motility, nausea, vomiting, and other problems,

the role of the nurse is

1. monitor respiration and oxygen saturation with pulse oximetry.

2. antidote like naloxone and oxygen is readily available during morphine administration.

3. do not depend on pulse oximetry for accurate reading initiate capnography to detect respiratory changes.

4. check the dose and the appropriate duration of drug administration.

5. patient and family should be informed regarding the use of postoperative analgesia.

6. follow strict protocol in administering opioids.

7. monitoring of pain should be done before starting morphine as analgesia.

8. be with the patient and record saturation of oxygen and the respiration.

3. ANSWER

A PCA pump is the most effective way of administering the drug, it delivers only the amount of drug you need at a time via a controlled mode.

a PCA pump is the pump used to deliver pain relief medication after surgery such as opioids, but sometimes other medicine can also be used, there is a tubing that is connected to the vein and the other end of tubing is connected to the PCA machine, when power or the button is turned on it delivers the medication in to the patient body,

and also when you feel the pain it delivers the dose prescribed by the doctor to relief from pain and also you cannot administer more amount of medicine as it is delivered only the amount which is Preset and also when needed.

USING PCA is the effective method of administering morphine in the postoperative patient as there is continuous use of morphine has various side effects.

4.ANSWER

USE OF ASPIRIN CAN ONLY BE DONE FOR SHORT TERM PAIN OR MILD PAIN SUCH AS HEADACHE ETC, USE OF ASPIRIN IN POSTOPERATIVE LAPAORATOMY WILL NOT BE VERY EFFECTIVE AND ITS ACTION IS ALSO FOR A SHORTER PERIOD OF TIME, WHEREAS TO CONTROL THE PAIN AFTER POST OPERATIVE LAPAROTOMY THE TRADITIONALLY USED OPIOID IS MORPHINE  AND ALSO IT LASTS FOR MORE THAN 2 HOURS, THE TYPE OF PAIN PATIENT EXPERIENCE AFTER POST OPERATIVE SURGERY IS A LOT MORE THAN A SHORT TERM HEADACHE.

5. ANSWER

ALTHOUGH THE EXACT MECHANISM OF ACETAMINOPHEN IS NOT KNOWN

IT BELONGS TO THE CLASS OF ANALGESICS ( PAIN RELIEVERS ) AND ANTIPYRETICS ( TO REDUCE BODY TEMPERATURE WHEN ELEVATED THAN NORMAL )

IT WORKS AS AN ANALGESIC BY REDUCING THE PRODUCTION OF PROSTAGLANDINS IN THE BRAIN, PROSTAGLANDINS THE CHEMICAL WHICH ARE RELEASED DURING PAIN AND INFLAMMATION, IT WORKS BY INCREASING THE THRESHOLD OF THE PAIN AND THE PERSON EXPERIENCE LESS PAIN AND ALSO IT REGULATE THE HEAT CENTER IN THE BRAIN THAT'S WHY THE BODY TEMPERATURE GETS LOWER BY ITS FUNCTION AS AN ANTIPYRETIC.  

6. ANSWER

NURSING CONSIDERATION AND PATIENT TEACHING FOR THE USE OF ACETAMINOPHEN

1. CHECK IF PATIENT IS ALCOHOLIC AND HAVING LIVER DISEASE.

2. PERFORM PROPER PHYSICAL EXAMINATION

3. DO NOT ADMINISTER MORE THAN PRESCRIBED DOSE.

4. AVOID MORE THAN 1 PREPARATION OF ACETAMINOPHEN.

5. TO AVOID GI UPSET GIVE DRUG WITH FOOD.

6. IF HYPERSENSITIVITY OCCURS DISCONTINUE THE DRUG

7. MONITOR SERUM LEVEL.

8. ALWAYS KEEP (N ACETYL CYSTINE ) ANTIDOTE OF ACETAMINOPHEN TO COUNTER OVERDOSE.

TEACHING INCLUDES

1. DO NOT OVERDOSE THE DRUG

2. DO NOT GIVE FOR MORE THAN 10 DAYS.

3. REPORT IF HYPERSENSITIVITY OCCURS.

4. TAKE ONLY WHEN IT IS NEEDED.

5. HEPATIC COMPLICATIONS MAY OCCUR SO AVOID TAKING HIGHER DOSES.