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You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of three or so. You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patients pain?
- A. Treat the patient on the basis of objective signs of pain and reassess him frequently.
- B. Call the physician for new orders because it is apparent that the pain medicine is not working.
- C. Believe what the patient says, reinforce education, and reassess often.
- D. Ask the family what they think and treat the patient accordingly.
Correct Answer: C
Rationale: As always, the best guide to pain management and administration of analgesic agents in all patients, regardless of age, is what the individual patient says. However, further education and assessment are appropriate. You cannot usually treat pain the patient denies having if the orders are PRN only. The scenario does not indicate the present pain-management orders are not working for this patient. The familys insights do not override the patients self-report.
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The wife of a patient you are caring for asks to speak with you. She tells you that she is concerned because her husband is requiring increasingly high doses of analgesia. She states, He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasnt just raised and raised. What would be the nurses best response?
- A. I didnt know that. I will speak to the doctor about your husbands pain control.
- B. Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief.
- C. Cancer is a chronic kind of pain so the more it hurts the patient, the more medicine we give the patient until it no longer hurts.
- D. Does the increasing medication dosage concern you?
Correct Answer: B
Rationale: Much pain associated with cancer is a direct result of tumor involvement. Conveying patient/family concerns to the physician is something a nurse does, but is not the best response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a family member that you are going to keep increasing the dosage of the medication until it doesnt hurt anymore. The family member is obviously concerned.
The mother of a cancer patient comes to the nurse concerned with her daughters safety. She states that her daughters morphine dose that she needs to control her pain is getting higher and higher. As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management?
- A. The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction.
- B. Frequently, female patients and younger patients need higher doses of opioids to be comfortable.
- C. The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment.
- D. There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.
Correct Answer: D
Rationale: Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an inevitable risk.
The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching?
- A. Self-care and safety
- B. Autonomy and need
- C. Health promotion and exercise
- D. Dependence and health
Correct Answer: A
Rationale: The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.
You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patients history, the patients pain has not responded to conventional approaches to pain management. What treatment would you expect might be tried with this patient?
- A. Intravenous analgesia
- B. Long-term intrathecal or epidural catheter
- C. Oral analgesia
- D. Intramuscular analgesia
Correct Answer: B
Rationale: For patients who have persistent, severe pain that fails to respond to other treatments or who obtain pain relief only with the risk of serious side effects, medication administered by a long-term intrathecal or epidural catheter may be effective. The other listed means of pain control would already have been tried in a patient with persistent severe pain that has not responded to previous treatment.
You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do?
- A. Use a pain scale to assess the patients pain, and let the patient know ibuprofen is available every 6 hours if she needs it.
- B. Do a complete assessment, and give pain medication based on the patients report of pain.
- C. Check for allergies, use a pain scale to assess the patients pain, and offer the ibuprofen every 6 hours until the patient is discharged.
- D. Provide medication as per patient request and offer relaxation techniques to promote comfort.
Correct Answer: C
Rationale: One way preventive pain measures can be implemented is by using PRN medications on a more regular or scheduled basis to allow for more uniform pain control. Smaller drug doses of medication are needed with the preventive pain method when PRN medications are given around the clock. Offering the medication is more beneficial than letting the patient know ibuprofen is available.