Question

Case 2

A nursing student is working with an experienced nurse. One of the patients in their assignment is Mrs. Rite Syde, a 58-year-old patient. Mrs. Side has a history of breast cancer, a colon resection 4 years ago, depression, a lumbar fusion 6 years ago, and fibromyalgia.

Mrs. Syde has also had abdominal pain on and off for 2 years. All diagnostic workups thus far have been negative. Mrs. Syde has tried multiple pain management regimens with poor success. One year ago, her husband died suddenly from an MI. Since his death, Mrs. Syde has had anxiety and panic attacks, which have exacerbated her ongoing pain issues.

The nursing student tells the nurse that she will do a thorough pain assessment while taking the patient’s vital signs. The nurse replies, “Don’t bother, this patient is just drug seeking. I’ll offer some complementary therapies instead of pain meds.”

• How would you classify this patient’s pain?

• What factors are influencing Mrs. Syde’s pain?

• What are the barriers to effective pain management in Mrs. Syde?

• How could pain management be ethically and effectively delivered to Mrs. Syde? Brainstorm two ways her pain could be ethically managed, and two ways her pain could effectively managed.

Answer 1

Ans) Pain is most often classified by the kind of damage that causes it. The two main categories are pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A third category is psychogenic pain, which is pain that is affected by psychological factors.

- Barriers to effective pain management in residential aged care facilities include patient beliefs and attitudes towards pain, communication deficits and cognitive impairment, frailty and its effect on pharmacotherapy, and limited evidence of compre-hensive pain management strategies for people with dementia.

- Mrs. Syde has had anxiety and panic attacks, which have exacerbated her ongoing pain issues.

- The unemotional, transparent principles of ethics may be useful in such cases to provide guidelines for better, more effective pain treatment. The ethical principles of autonomy, beneficence, nonmaleficence, and justice should guide all health professionals when they make assessment and treatment decisions.

-Pain management faces a number of difficult ethical questions, which are perhaps too numerous to elucidate. The questions include: What importance does pain have in medicine? What role does pain management play in the clinical care of patients? What duties do health care professionals have concerning the pain of their patients? What other duties must be balanced against the duty to provide adequate analgesia?