Question

Pain Case Study

RJ is a 79 year old man who fell when he got out of bed to go to the bathroom at home. He arrived to the unit with Buck’s traction to his R lower leg. He is no longer in traction and had surgery for a right hip fracture 2 days ago.

He lives alone since his wife died, and his children say he is active, but becoming a bit forgetful. He grew up in a family that valued being strong and never complaining and his family describes him as very proud. They say he does not like to look weak or ask for help. He does admit that his R hip is a bit uncomfortable, but he’d like to wait for pain medication. "It is better to just tough it out than to take pain medication."

The nurse comes to assess him and notes that he is restless in the bed and grimacing as he tries to change his position. His vital signs are T 98.8, HR is 99, RR is 26, and BP Is 168/100. His baseline VS were HR 74, BP 124/78, and RR 18. He is not hungry and picked at his lunch. Physical therapy has come twice to get the patient out of bed and he has told them to come back tomorrow and does not want dinner.

His physician prescribed:

• Morphine IV every 4 hours as needed for severe pain
• Hydrocodone and acetaminophen every 4 hours as needed for moderate pain
• Acetaminophen every 6 hours as needed for mild pain.

RJ insists that the acetaminophen is all he needs and the nurse gives him the acetaminophen for pain that he reports as “just a little pain.” Upon reassessment, the vital signs and observations are unchanged and RJ is resistant to the nurse’s offer to help him get repositioned. At this point in his recovery he is supposed to be out of bed to the chair at least three times a day and up walking in the hall, and he says he is just not ready.

Answer the following questions based on this case study (Please look at the available points and be thorough. You are the nurse caring for this patient and this is your opportunity to think about how you would deal with this patient.)

• What are the priority assessments the nurse should complete at this time? Identify at least 4 additional assessments the nurse should complete
• What do you believe is the significance of the patient’s behavior and change in vital signs?
• Describe how the nurse might try to get an accurate pain assessment from the patient.
• Based on the assessment data listed, which prescribed pain medication would be most appropriate at this time and why?
• What should the nurse teach this patient about the benefits of using the pain medication ordered? In other words, why should the patient be encouraged to take pain medication?

• Identify at least 3 different non-pharmacologic measures the nurse could use to reduce the patient’s pain in addition to the use of pain medication and explain the purpose of each.

Please be sure to include APA formatted resources/citations. The answers do not have to be written in APA formatting (running head, etc)

Answer 1

Intense Pain nursing analysis is characterized as an upsetting tactile and enthusiastic experience emerging from real or potential tissue harm or depicted regarding such harm ; unexpected or moderate beginning of any power from gentle to serious with an envisioned or unsurprising end and a term of under six (6) months.

The terrible sentiment of torment is exceptionally abstract in nature that might be experienced by the patient. Intense Pain serves a defensive capacity to make the patient educated and learned about the nearness of a physical issue or sickness. The sudden beginning of Acute Pain reminds the patient to look for help, help, and alleviation. The physiological signs that happen with Acute Pain rise up out of the body's reaction to torment as stressor.

Different factors, for example, the patient's social foundation, feelings, and mental or otherworldly inconvenience may add to the enduring with Acute Pain. In more established patients, evaluation of agony can be trying because of subjective disability and tactile perceptual shortfalls. Evaluation and the executives of the nursing analysis of Acute Pain are the fundamental focal point of this consideration plan.

Related Factors

Here are a few factors that might be identified with the nursing conclusion Acute Pain that you can use under the etiology part of your nursing care plan:

Torment originating from clinical issues

Torment emerging from enthusiastic, mental, profound, or social inconvenience

Torment because of indicative techniques or clinical intercessions and medicines

Agony rising up out of injury

Characterizing Characteristics

The nursing conclusion of Acute Pain is described by the accompanying signs and side effects. Utilize these abstract and target information under the "nursing evaluation" segment of your consideration plan:

Tolerant grumbles of agony

Craving changes

Self-centered

Guarding conduct, ensuring body part

Bigoted (e.g., changed time observation, withdrawal from social or physical contact)

Facial veil of agony

Autonomic reactions (e.g., diaphoresis, an adjustment in BP, HR, pupillary expansion; change in RR; whiteness; sickness)

Change in muscle tone: dormancy or shortcoming; unbending nature or snugness

Help or interruption conduct (e.g., pacing, searching out others or exercises)

Expressive conduct (e.g., eagerness, groaning, crying)

Sadness

Watched proof of torment utilizing normalized torment conduct agenda

For those unfit to impart; allude to the proper appraisal instrument (e.g., Behavioral Pain Scale, Neonatal Infant Pain Scale, Pain Assessment Checklist for Seniors with Limited Ability to Communicate)

Situating to stay away from torment

Defensive signals

Intermediary announcing agony and conduct/action changes (e.g., relatives, parental figures)

Self-report of force utilizing normalized torment power scales (e.g., Wong-Baker FACES scale, visual simple scale, numeric rating scale)

Self-report of agony attributes (e.g., hurting, consuming, electric stun, a tingling sensation, shooting, sore/delicate, wounding, pounding) utilizing normalized torment scales (e.g., McGill Pain Questionnaire, Brief Pain Inventory)

Intense Pain Nursing Assessment

Legitimate nursing evaluation of Acute Pain is basic for the improvement of a powerful agony the board plan. Medical attendants assume a urgent job in the evaluation of agony, utilize these methods on the most proficient method to survey for Acute Pain:

Survey torment attributes:

Quality (e.g., consuming, sharp, shooting)

Seriousness (size of 0 or no agony to 10 or most extreme torment)

Area (anatomical portrayal)

Beginning (continuous or abrupt)

Length (to what extent; irregular or ceaseless)

Encouraging or diminishing elements

Survey for signs and indications identifying with torment.

Evaluate to what degree social, natural, intrapersonal, and intrapsychic elements may add to torment or help with discomfort.

Evaluate the patent's expectation for relief from discomfort.

Evaluate the patient's eagerness or capacity to investigate a scope of methods planned for controlling torment.

Torment Assessment

Agony is regularly alluded to as the "fifth indispensable sign," and ought to be surveyed normally and as often as possible. Agony is individualized and abstract; in this way, the patient's self-report of agony is the most solid measure of the experience. On the off chance that a patient can't impart, the family or parental figure can give input. Utilization of mediator administrations might be important. Parts of agony evaluation include: a) history and physical evaluation; b) utilitarian appraisal; c) psychosocial evaluation; and d) multidimensional evaluation.

History and Physical Assessment

The appraisal ought to remember physical assessment and the frameworks for connection to torment assessment.

Regions of center ought to incorporate site of the torment, musculoskeletal framework, and neurological framework. Other parts of history and physical appraisal include:

• Patient's self-report of agony

• Patient's practices and motions that demonstrate torment (for example crying, guarding, and so on.)

• Specific parts of agony: beginning and length, area, nature of torment (as depicted by persistent), power, irritating and mitigating factors

• Medication history

• Disease or injury history

• History of relief from discomfort measures, including drugs, supplements, work out, knead, reciprocal and elective treatments

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Useful and Psychosocial Assessment

Segments of the practical and psychosocial appraisal include:

• Reports of patient's earlier degree of capacity

• Observation of patient's practices while performing utilitarian assignments

• Patient or family's report of effect of agony on exercises of every day living, including work, self-care, exercise, and relaxation

• Patient's objective for torment the board and level of capacity

• Patient or family's report of effect of torment on personal satisfaction

• Cultural and formative contemplations

• History of torment comparable to misery, misuse, psychopathology, synthetic or liquor use

• Impact of torment on patient's intellectual capacities

Test Yourself

Segments of history that are required as a major aspect of evaluation include:

Clinical history

History of meds

History of substance misuse

Multidimensional Assessment

Numerous devices are accessible for a top to bottom, multidimensional torment evaluation. This is especially significant with patients that have interminable torment, blended agony (both intense and constant), or complex circumstances, (for example, different sickness forms). Normal instances of these devices include:

• Brief Pain Inventory: Provides understanding contribution to portraying agony and impacts, including psychosocial segments.

• McGill Pain Questionnaire: Patients can utilize descriptors for their torment, which gives data about the experience and force.

Normal Pain Scales

There are an assortment of agony scales utilized for torment evaluation, for patients from neonates through propelled ages. The three most basic scales suggested for use with torment appraisal are:

• The numeric scale

• The Wong-Baker scale (otherwise called the FACES scale)

• The FLACC scale

Torment meds - opiates

Opiates are likewise called narcotic torment relievers. They are just utilized for torment that is serious and isn't helped by different sorts of painkillers. At the point when utilized cautiously and under a medicinal services supplier's immediate consideration, these medications can be compelling at diminishing agony.

Data

Opiates work by official to receptors in the mind, which hinders the sentiment of agony.

You ought not utilize an opiate medicate for more than 3 to 4 months, except if your supplier educates you in any case.

NAMES OF COMMON NARCOTICS

• Codeine
• Fentanyl - accessible as a fix
• Hydrocodone
• Hydromorphone
• Meperidine
• Morphine
• Oxycodone
• Tramadol

TAKING NARCOTICS

These medications can be mishandled and propensity shaping. Continuously accept opiates as endorsed. Your supplier may recommend that you take your medication just when you feel torment.

Or on the other hand, your supplier may recommend taking an opiate on a standard calendar. Permitting the medication to wear off before taking a greater amount of it can make the torment hard to control.

Contact your supplier immediately on the off chance that you believe you are dependent on the medication. An indication of enslavement is a solid longing for the medication that you can't control.

Taking opiates to control the agony of malignant growth or other clinical issues doesn't itself lead to reliance.

Store opiates securely and safely in your home.

You may require an agony master to assist you with overseeing long haul torment.

Symptoms OF NARCOTICS

Tiredness and weakened judgment frequently happen with these meds. When taking an opiate, don't drink liquor, drive, or work substantial apparatus.

You can mitigate tingling by lessening the portion or conversing with your supplier about exchanging prescriptions.

To help with stoppage, drink more liquids, get more exercise, eat nourishments with additional fiber, and use stool conditioners.

In the event that sickness or spewing happen, have a go at taking the opiate with food.

Withdrawal side effects are regular when you quit taking an opiate. Manifestations incorporate powerful urge for the medication (hankering), yawning, a sleeping disorder, anxiety, state of mind swings, or the runs. To forestall withdrawal indications, your supplier may suggest you slowly bring down the measurements after some time.

OVERDOSE RISK

Narcotic overdose is a significant hazard on the off chance that you take an opiate sedate for quite a while. Before you are endorsed an opiate, your supplier may initially do the accompanying:

Screen you to check whether you are in danger for or as of now have a narcotic use issue.

Show you and your family how to react on the off chance that you have an overdose. You might be endorsed and educated how to utilize a medication called naloxone on the off chance that you have an overdose of your opiate tranquilize.

At the point when somebody is determined to have a genuine, dangerous sickness, one of the primary things they are probably going to stress over is torment. Actually, it's just about the most well-known inquiry patients and their guardians pose. There are compelling medicines for torment, and you can set up those treatment prepares of time. It's likewise imperative to realize that meds are not by any means the only choice accessible to treat torment with regards to palliative consideration. For instance, radiation treatment can here and there be useful in rewarding agony from tumor development and in facilitating bone torment identified with malignant growth.

Non-Drug Options for Easing Pain

There are various non-medicate instruments for adapting to torment. They can be utilized all alone or in mix with tranquilize treatments.

A portion of the choices patients have discovered supportive include:

Back rub. Many individuals discover alleviation from delicate back rub, and some hospice organizations have volunteers who are prepared in rub treatment. A few investigations have discovered that back rub is powerful in easing torment and different side effects for individuals with genuine disease.

Unwinding strategies. Guided symbolism, entrancing, biofeedback, breathing methods, and delicate development, for example, judo. Unwinding procedures are frequently successful, especially when a patient - or a parental figure - is feeling on edge.

Needle therapy. A few examinations have discovered that needle therapy can be useful in calming torment for individuals with genuine sicknesses, for example, malignancy.

Exercise based recuperation. On the off chance that an individual has been dynamic previously and is presently bound to bed, even simply moving the hands and feet a tad can help.

Pet treatment. On the off chance that you have episodes of torment that last 5, 10, or 15 minutes, attempting to discover something wonderful - like petting a creature's delicate hide - to occupy and loosen up yourself can be useful.

Gel packs. These are basic packs that can be warmed or chilled and used to ease limited torment.

Ask the palliative consideration group or hospice in your general vicinity on the off chance that they can give you a referral to any of these types of agony the board.

Keeping up an open to, loosening up environment around the patient goes far toward facilitating torment.