Question

Mr Rogers is 2 days postoperative of a thoracotomy of removal of a malignant mass in his left chest. His pain is being managed via epidural catheter with morphine. 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

Qn 1. What are benefits of epidural versus systemic administration of opioids?

Qn 2. The nurse monitors Mr Roger’s respiratory status and vital signs every 2 hours. What is the rationale for this frequent assessments?

Qn 3. The nurse monitors Mr Rogers for what other complications of epidural anelgesis?

Answer 1

1. The benefits of epidural versus systemic administration of opioids are as follow:-
-There is less of a chance of acquiring an infection.
- It is quickly and easily placed, and it is least invasive compared to systemic.
- 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 may lead to 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, like inappropriate place.
- 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.