Pain case study Flashcards
Upon this assessment, the nurse observes the client is difficult to arouse, has shallow breathing, and VS reveals: T 98.2-HR 100-RR 8 BP 128/80 SpO2 89%
had gotten too much opioid
Allows patient some control of pain administration at need
Less sedation, less opioid consumption, decreases post-op complications
Better pain control
What are benefits of a PCA pump for administration of pain relief?
Others pushing the control button
Abuse- Cannot leave unit without health care worker
Cognitive problems-pt. cannot control (Not suitable for children and older adults with impaired cognition)
Pt with hypoventilation syndromes
What are the risks?
Ask the wife if she has been pushing the control button of PCA
Time when the patient became difficult to arouse
What further data should the nurse gather?
Over medicated
What is the problem?
Client will demonstrate effective breathing pattern as soon as possible
Increase oxygenation; reverse decreased respiration
What is the short-term expected outcome?
Stop the administration of the PCA
Increase O2
Attempt to arouse the patient
Consider Narcan if difficult to arouse, O2 sats drop
Instruct wife on correct use of PCA
Respirations and lack O2 biggest issues in pat
What are the priority interventions that will help meet the goal?
Assess respiratory rate, breathing pattern, and oxygen saturation. The goal RR is 12 or above and the goal oxygen saturation is 92% or greater
How should the nurse evaluate if the expected outcome has been met?
History of cerebrovascular accident (prevent further cardiovascular events from occurring)
Why is A.M. prescribed aspirin?
Gabapentin
Which medication is prescribed to treat diabetic neuropathy?
Acetaminophen. This is the safest choice and a first-line treatment according to the WHO ladder.
If A.M. complains of a headache, which medication should the nurse administer first?
Ibuprofen. Ibuprofen is an anti-inflammatory medication which will help with pain related to inflammation such as osteoarthritis.
If A.M. complains of knee pain, which medication should the nurse administer first?
The nurse should be concerned about the amount of acetaminophen administered in 24 hours. Since the client has an order for acetaminophen and oxycodone with acetaminophen, the amount administered in 24 hours could easily be overlooked. Acetaminophen should not exceed 4 grams in 24 hours.
The nurse should be concerned about administering gabapentin and oxycodone together. Both medications have the possibility of causing central nervous system depression.
The nurse should be concerned about administering aspirin and ibuprofen together. Both medications are NSAIDs. The nurse should avoid giving the PRN ibuprofen on a regular basis to the client.
What potential drug-drug interactions is the nurse concerned about?
The nurse should be concerned about NSAIDs including aspirin and ibuprofen as these can cause nephrotoxicity worsening A.M.’s kidney disease.
Note: The nurse should notify the primary care provider of this new diagnosis and report the client’s use of NSAIDs. The PCP will likely discontinue the ibuprofen; however, the PCP may NOT discontinue the aspirin due to the aspirin’s low dose and the risk for CVD (this would be handled on a case-by-case basis).
A.M. leaves the facility for an appointment with a nephrologist. Upon return, the nurse receives a patient summary for A.M. which reveals stage 3 chronic kidney disease. Which medication(s) is/are concerning the nurse given this new diagnosis?
