Question

Ms. G is a 62 year old woman who has been a patient for many years at the Primary Health Center. For the past 6 months, she has complained of increasingly severe upper abdominal pain and weight loss. An ultrasound revealed a mass highly suspicious for primary liver cancer. She receives Perocet 2 tabs every 4 hours and fentanyl patch every 3 days. 1. What type of pain is Ms. G. experiencing? 2. What should the home health nurse do before administering the pain medication? 3. Is there a risk for drug dependence? Explain 4. How should the Duragesic patch be applied?

Answer 1

Cancer of the liver is also known as hepatocellular carcinoma. it is a primary cancer of the liver .Hepatocellular carcinoma is is often associated with chronic liver disease including chronic hepatitisB or C. A high percentage of patient with primary cell carcinoma have cirrhosis of liver. The liver is a common site of metastatic growth because of its high rate of blood flow and extensive capillary network.

Answer q no 1

The patient experience right upper quadrant abdominal pain,Usually dull or aching and may radiate to the right shoulder.The pain can sometimes extend in to the back and lower right portion of the rib cage. The pain may arise from the tumour in the liver, capsule stretching or from the enlarged liver putting pressure on the nerve under the diaphragm.

Answer q no 2

To ensure safe medication administration the nurse should be aware of the nursing standards called ten rights of medication administration.-Right client ,Right drug ,Right Dose ,Right route ,Right Time ,Right documentation ,Right assessment , Right education , Right Evaluation ,Right to refuse medication .Before administering the pain medication the nurse should check

Right client- To administer drug safely make sure that the medication is given to the right client.To identify the clients correctly,read the client name on the client chart and in the medication card. ask the patient to repeat her name.

Right drug- compares the label of the drug container with the medicine card. The nurse does this three times, Never prepare medicine from unmarked containers or container with illegible labels.

Right dose-The nurse should make sure that the dose ordered is appropriate for the client. after calculating the dosage of a drug ,prepare the medication by using standard measurement devices.

right route-Read the medication order to determine the route of administration.

Right time-the nurse must know why adrug ordered for a certain time of the day and whether the time sheduled can be altered.

Right documentation -record medication administration only after giving it.

Answer q no 3
The prolonged use of some medications may cause liver cancer , such as ingestion of hormones as in oral contraceptive, antibiotics like amoxicillin or clavulanate ,pain medication diclofenac ,zyloprim , anti convulsent drugs Azathioprine etc.Moreover the abuse of anabolic steroids used by the athletics to increase their performance or improve their physique through body building can cause liver cancer.

Answer q no 4

Before applying the duragesic patch should clean the skin with warm water to remove dirt and oil from the skin .pat skin completely dry.open the package carefully with the help of a scissors and take the patch from the packing ,patch has a clear plastic release liner that can be peeled off in two pieces.place the patch in such a way that the sticky side down on to the clean, skin hold the patch there for atleast 30 seconds to sticks well.