Question

R.D is a 62 year old man being evaluated for a change in his pain therapy for chronic malignant pain from metastatic cancer.

Subjective Data

• patient desires 0 pain level of 3 to 4 on a scale of 10

• the has been taking two percocet tablets q4hr while awake, but his pain is now usually at 4 to 5 with the medication.

• patient report that pain varies over 24 hours from 5 to 10.

• He always awakens in the morning with pain at 10 with nervousness, nausea, and a runny nose.

•when pain becomes severe, he stays in bed and concentrate on blocking the pain by emptying his mind.

• He is worried that increased pain means his disease is worsening.

•He is afraid to take additional doses or opioids because he fears addiction.

Objective Data

• Height: 6ft 0 in (183 cm)

•weight: 150 Ib (68 kg)

• Rigid posturing, slow gait.

Discussion questions

1. What additional assessment Data should the nurse obtain from R.D before making any decisions about his problem?

2. What data from the nursing assessment are characteristics of the affective, behavioral, and cognitive dimension of the pain experience?

3. Based on R.D's lack of pain control with his current dosage of opioids and his symptoms on arising in the morning, what changes are indicated in his medication regimen?

4. Priority Decision: what are the priority teaching needs that should be included in a teaching plan for R.D to titrate his analgesic dose effectively?

5. How could the nurse best help R.D overcome his fears of addiction to opioids drugs?

6. What additional pain therapy could the interproffessional team plan to help R.D manage his pain?

7. Based on the assessment data provided, what are the priority nursing diagnosis? Are there any collaborative problems?

Answer 1

1. The additional assessment data from the nursing assessment before making decision about his problem includes assessment for present chief complaints, past medical and surgical history / other medications intake, any history of surgery, radiation and chemo therapy, duration, frequency and site of onset of pain etc.

2. The feelings and emotions of patient are characteristic of affective, the facial expressions: frowning, sad, dull etc. Both verbal and non - verbal response of clients indicate behavioral , while in adultery patients dementia, confusion, depression, insomnia etc., indicate the cognitive impairement of patients. Mostly adultery patients suffer with chronic pain. The ideal way to know the characteristic of pain whether it is is mild, moderate or severe is the verbal response.

3. The changes indicated in his medications includes analgesics/ NSAIDS as patient is having fear of addiction to narcotics (opioids) to reduce severity of pain. To reduce nausea either ondonsetron or domperidone is to be added. To prevent running nose cetrazine is to be prescribed along with appetite stimulants and supplements to improve health.

4. Priority Decision: As R.D has fear of opioids the teaching to be given to the client about the use of analgesics their efficiency and fast intervention on reducing pain by adding it's dose thrice a day.

5. Fear of addiction to narcotics / opioids: The nurse has to explain the patient about the use of opioids and their efficiency in relieving pain, as the client is having fear of addiction of opioids , it is seen in only 1% people who is on continuous opioids for long duration with high dosages as the doctors had a criteria to prescribe the limited dosage of opioids and immediate withdrawal even lead to other diseases. So using the prescribed dosages with gradual limitation of dosage will not lead to addiction.

6. The additional pain therapy for R.D by the interprofessional team includes Health education, diversional therapy like reading newspapers, books and music therapy, or encouraging the client to improve his skills in which he is efficient. Psychological support on disease condition, Acupuncture technique use in relieving pain. Practice of yoga and exercises with the help of physiotherapist.

7. Priority nursing diagnosis:

pain related to the disease condition

Anxiety / Fear related to addiction of opioids

Knowledge deficit related to pain management

collaborative problems:

It includes dementia, depression, insomnia, confusion etc.

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