Reference no: EM133396935
Case Scenario:
The patients below are being cared for on a medical-surgical unit during day shift:
- Mr. L., a 35 year old man with a history of kidney stones, reports severe back and flank pain intermittently (range 3-8 out of 10). Night shift reports episodic nausea and vomiting with hematuria and dysuria. Mr. L. was admitted through the ER. He is on a PCA pump.
- Mr. H., a 28 year old man, is currently in the OR for an inguinal hernia repair. He should return from the OR later in the shift.
- Ms. J., a 65 year old woman with end stage multiple myeloma, is receiving palliative pain management; the family is considering hospice care. She has been on the unit for 2 weeks. Her physician signed the DNR order 3 days ago.
- Mr. A., a 40 year old man, has been on the unit for 3 weeks. He is receiving IV antibiotics for bacterial pneumonia. He has a history of IV drug abuse and is HIV positive. Mr. A's oxygen saturations were decreasing the night shift.
Questions:
1) You decide to round on all the patients. List the priority order to briefly check on these patients. Why did you choose the order?
2) Mr. H. is given a dose of pain medication. One hour later he is anxious and appears uncomfortable and asks, "What's the matter? Is something wrong? I'm still hurting." What action should you take first? Why?
3) Ms. J. is having severe pain and admits to it; however, she becomes very anxious when certain family members come and go and refuses to take pain medication. Which adjunct medication would be most useful to Ms. J. to help her manage these episodes? Why?