Question

The nurse is admitting a 68-year-old patient with a history of ovarian cancer to the medical unit. She had surgery 3 months ago and has had pain ever since the surgery. She reports that she has been taking oxycodone at home, but that the pain is “never gone.”

1. The patient describes her pain as a “10” on a scale of 0 to 10, deep, occasionally cramping, and sharp or stabbing. She waves her hand over her chest and abdomen when asked to pinpoint the location of the pain. How should the nurse document this assessment of pain?

2. Discuss the impact of unrelieved pain on this patient and her family.

3. During a discussion with the pain resource nurse, it is suggested that the patient be given a Duragesic transdermal patch for pain management. She comments, “Oh, good! I know that will help make my pain go away quickly.” What is the best response to the patient’s comment?

4. After consideration of her history and her pain, the pain management specialist recommends patient-controlled analgesia (PCA); the PCA therapy is explained and an infusion is started with morphine as a basal infusion as well as interval self-dosing. What health teaching can you give to this patient?

5. Enlist any 2 nursing problems you identified in this patient?

6. The next morning while reviewing the infusion notes, the nurse sees that the patient dosed herself four times during the night. She is awake and states that her pain is now at a “5” and that she feels “a bit of relief now.” Later that afternoon during rounds after lunch, the nurse sees that she is asleep and has not touched her meal. Her respiratory rate is 12, but she does not answer immediately when the nurse calls her name. What is the priority nursing action? What additional actions should be taken?

7. During evening rounds, the patient is found to be unresponsive, with respiratory rate of 7 breaths/min. Her son, who was staying with her, said that he “pushed the button a few times” while she was asleep because earlier “she said she was hurting but wouldn’t push it herself.” What would be the priority nursing actions?

Answer 1

ANSWER 1.

Pain-

Pain is also known as 5th vital sign. As pain is the signal of nervous system which shows that something bad is happening with the body. It is an unpleasant feeling such as pricking, tingling, burn sensation. Location of the pain varies according to the site involved.

Cancer patients have severe pain in compare to any other patient.

Documentation of finding-

* As the assessment of the pain is done by mostly subjective finding, in this patient rate her pain 10 on pain scale 1-10.

* Her facial expressions also indicate that she has severe pain. As she is restless also.

* The nature of the pain sharp and stabbing.

* The location of the pain as told by the patient is over abdomen or chest, Patient can not locating the pain site exactly Because of severity of the pain.

ANSWER 2.

Pain in the cancer patients mostly is severe in nature and is not commonly relieved by NSAID, or other analgesic.

Cancer patient mostly required opoid analgesic for the relieving of pain.

As the pain is difficult to control on the cancer patients, it affect patient and her family member. Family member of the patient also can not see the patient in this unbearable condition. It affect them also seriously.

Unrelieved pain affect the patient and family member daily activities. Patient have trouble sleeping and eating. Patient can not focus any other than pain.

Patient may be irritable with the family member also because she is suffering from severe pain and that is not relieved.

Answer 3.

Duragesic tansdermal patch- these patch is Indicated for chronic pain in opioid-tolerant patients as this patient is recieving oxycodone at home but that doesn't helping in relieving of pain.

She has a pain that is severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

Patient respond on this management of pain is soo ecstatic. She thinks that applying this patch will relieve her pain completely as she told that "i know that it will help make my pain go away so quickly".

Nurse response her that this will not relieve the pain soo quickly because these patch required time to take action.

As these patch relieve drurg in the body slowly and continuesly.

Answer 4. Health teaching on patient control analgesanalgesia-

PCA Is the treatment of pain when patient have severe pain in nature. In this pain relieving techniques patient has controlled over the dose of medication which can be injected through infusion pump.

* Nurse should tell the patient when should ahe press the button-

• When your pain just starts to become uncomfortable.

Do not wait until the pain is bad.

• Before you do something that brings on the pain.

For example, take it before you do your physiotherapy.

• Before breathing and coughing exercises.

• Before you start to move or turn.

The medicine will take 5 to 10 minutes to work.

Press the button as often as you need to control your pain.

Nurse should telltthe patient that do not do this while using the PCA:

• Do not let visitors and family press the button. Only you should push the PCA button.

• Do not wait until the pain is bad before using your pain medicine.

• Do not use PCA when you are comfortable or sleepy.

• Do not use intravenous PCA for gas pain.

Anawer 5.

nursing problem or Nursing diagnosis for thia patient-

1. Severe pain related to disease process as evidenced by rating 10 on the pain scale(1-10).

2. Severe anxiety related to pain as evidenced by her pain in never gone after taking oxycodone.

3. Respiratory depression related to use of opoid analgesic as evidenced by using MORPHINE In PCA.