Question

The nurse is admitting the patient to a medical unit. She is 68 years of age and has a history of ovarian cancer. She had surgery 5 months ago and has had pain ever since the surgery. She reports that she has been taking oxycodone hydrochloride/acetaminophen (Tylox) tablets at home but that the pain is "never gone." The patient describes her pain as a "10" on a scale of 0 to 10, deep, occasionally cramping, and sharp or stabbing. She waves her hand over her chest and abdomen when asked to pinpoint the location of the pain. 1. How should the nurse document this assessment of pain? During a discussion with the pain management nurse, it is suggested that the patient be given a fentanyl acetate (Duragesic) transdermal patch for pain management. She comments, "Oh, good! I know that will help make my pain go away quickly." 2. What would be the best response by the nurse? After consideration of her history and her pain, the pain management specialist recommends that the patient should receive patient-controlled analgesia (PCA). After discussing PCA therapy with her, an infusion is started with morphine as a basal infusion as well as interval self-dosing. The next morning while reviewing the infusion notes, the nurse sees that the patient dosed herself four times during the night. She is awake and states that her pain is now at a "5" and that she feels "a bit of relief now." Later that afternoon during rounds after lunch, the nurse sees that she is asleep and has not touched her meal. Her respiratory rate is 12, but she does not answer when the nurse calls her name. 3. What would the priority action by the nurse be? 4. What additional actions should be taken? During evening rounds, the patient is found to be unresponsive, with respiratory rate of 7 breaths/min. Her son, who was staying with her, said that he "pushed the button a few times while she was asleep because earlier she was complaining of hurting but wouldn't push it herself. 5. What would be the priority actions by the nurse?

Answer 1

1.The nurse shoud document the pain as severe pain with the nature of pain(frequency,intensity,duration,type)

The patient has a severe pain which is sharp and cramping on the chest and abdomen (pain score=10)

2.The statement of patient indicates that the patient is in a very severe pain and already knew about th patch (could have gained idea from internet sources possibly)The nurse best response should be, it is a medication which releases medication slowly and controls pain effectively depending upon how the patient and the patient conditions responds.

3.Morphine though an effective pain reliever in cancer patient, it may lead to respiratory distress.The priority care to be done by the nurse are

• Stop the infusion
• Check oxygen saturation and immediately start nasal oxygenation
• If the patient is in respiratory depression, resuscitation can be started
• Antidote naloxone to be administered immediately
• Inform the physician immediately

4.The additional actions to be done are

• Initiating a code blue or rapid response team
• Observe the patient for response,if doesn't respond in 1 to 2 minute repeat the naloxone fose up to 0.8 mg
• One patient is aroused encourage the patient to breath deeply
• A repeat dose of antidote has to be kept ready ,because it is usually administered in another 30 minutes to stabilise the patient and decrease the overdose of the medication
• Monitor vital signs every 15 minutes for first 1 hour ,then every 1/2hour for second hour and one hourly for next 4 hours

5.The patient has landed up in respiratory depression

• Stop infusion
• Resuscitate
• Administer naloxone
• Initiate code blue