Question

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). What are benefits of epidural versus systemic administration of opioids?

The epidural administration of opioids reduce the chances of infection when compared to the systemic administration. Epidural administration is also less invasive and the drug can be quickly placed. In systemic administration, the chances of drug toxicity is higher (particularly with the bolus dose) as the drug rapidly enter into the body.

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

Assessing the respiratory status and vital signs every 2 hours is important because morphine can be respiratory depression and depression of the central nervous system (so, depression of the vital systems) if the dose is higher than the therapeutic levels. In the given case, the patient had thoracotomy, so he is likely to have a breathing problem. So, the patient is at higher risk of respiratory depression, which necessitates the evaluation of vital signs every 2 hours.

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

The other possible complications of epidural analgesia include, meningitis, pruritus, increased risk of haemorrhage, urinary retention, nausea and or vomiting, and hematoma. So, the nurse monitor the patient for these complications.

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

During epidural anaesthesia, severe headache can be a sign of CSF leakage. So, the nurse should apply the epidural blood patch.

5). 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?

The chances of constipation can be reduced by increasing the fiber and fluid content in the diet.