Nokea
You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?
- A. Teach the family the theory of pain management and the use of alternative therapies.
- B. Provide psychosocial family support during this emotional experience.
- C. Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
- D. Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.
Correct Answer: C
Rationale: If PCA is to be used in the patients home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered by PCA.
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You are the nurse caring for a postsurgical patient who is Asian-American who speaks very little English. How should you most accurately assess this patients pain?
- A. Use a chart with English on one side of the page and the patients native language on the other so he can rate his pain.
- B. Ask the patient to write down a number according to the 0-to-10 point pain scale.
- C. Use the Visual Analog Scale (VAS).
- D. Use the services of a translator each time you assess the patient so you can document the patients pain rating.
Correct Answer: A
Rationale: Of the listed options, a language comparison chart is most plausible. The VAS requires English language skills, even though it is visual. Asking the patient to write similarly requires the use of English. It is impractical to obtain translator services for every pain assessment, since this is among the most frequently performed nursing assessments.
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 nurse caring for a 79-year-old man who has just returned to the medicalsurgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurses management of the patients pain?
- A. The elderly may require lower doses of medication and are easily confused with new medications.
- B. The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
- C. The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication.
- D. The elderly may require a higher initial dose of pain medication followed by a tapered dose.
Correct Answer: A
Rationale: The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.
The nurse is caring for a male patient whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing nonpharmacological pain control interventions into the patients plan of care, the nurse should teach the patient which of the following?
- A. Nonpharmacological interventions must be provided by individuals other than members of the healthcare team.
- B. These interventions will not directly reduce pain, but will refocus him on positive stimuli.
- C. These interventions carry similar risks of adverse effects as analgesics.
- D. Reducing his use of analgesics is not the purpose of these interventions.
Correct Answer: D
Rationale: Patients who have been taking analgesic agents may mistakenly assume that clinicians suggest a nonpharmacolgical method to reduce the use or dose of analgesic agents. Nonpharmacological interventions indeed reduce pain and their use is not limited to practitioners outside the healthcare team. In general, adverse effects are minimal.
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.