Question

Case Study, Chapter 12, Pain Management

2. Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)

What are benefits of epidural versus systemic administration of opioids?

The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?

The nurse monitors Mr. Rogers for what other complications of epidural analgesia?

Mr. Rogers complains of a severe headache. What should the nurse do?

Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?

Answer 1

1. The benefits of epidural versus systemic administration of opioids are as follow:-
-There is less of a chance of getting an infection.
- It is quickly and easily placed, and it is least invasive.
- In systemic administration of opioids there is a risk for a rapid infusion of the drug which can lead to the drug reaching toxic levels much faster in the patient.
- If this happens then the patient will have manifestations such as dizziness, angina, possible loss of consciousness which could lead to shock and cardiac arrest.

2. The rationale for these frequent assessments is as given follow-
- Morphine is being administered rather than Fentanyl which puts Mr. Rogers at a greater risk for respiratory depression.
- Morphine is preferred over Fentanyl for severe pain relief: which in this case is the thoracotomy.
- The risk for respiratory depression is the main reason why his respiratory status must be checked every two hours.
- If a decrease in respiratory status occurs, then the nurse needs to report them to the health care provider.
- Respiratory depression can occur 12 hours or longer post operative with morphine rather than Fentanyl.
- A low respiratory rate means that there is respiratory depression, which means vital signs need to be assessed frequently.

3. The nurse monitors Mr. Rogers following complications of epidural analgesia:-
- Complications that can occur during epidural analgesia are baselines can become incorrect and unreliable over time.
- Meningitis, nausea, vomiting, pruritus, high risk of bleeding if taking an anticoagulant (LWMH, Heparin, etc), urinary retention, and possible hematoma.
- If Mr. Rogers baselines become inaccurate, it would be difficult to truly know if he is within or outside his true normal baselines.

4. Mr. Rogers is complaining of a severe headache, this could be a sign of Cerebrospinal fluid leakage.
- The nurse should treat him by keeping him on bed rest or buy applying an epidural blood patch.
- An epidural blood patch is injecting the patients own blood back into the site of leakage to cause a clot so the leak can be sealed off.

5. A couple of interventions that should be included in Mr. Rogers plan of care to minimize constipation are as follow:-
- Start him on a diet of high fiber.
- Increase the amount of fluid he is drinking to about 2-3L a day.
- Get him to ambulate as soon as possible and as tolerated.
- Get a stool softener medication prescribed for him.