Reference no: EM133396974

Question: Bold responses to the two case study questions below.

- Do you agree or disagree with the answer? Why or Why not?

- Do you have another perspective on how each question should be answered? How did you come to that conclusion?

- Provide detailed explanation and one reference for each response

- References could include: Lewis Medical-Surgical Nursing book or related book, article, Nursing Central, EVOLVE Learning, etc.

Multiple Patients with Pain Overview:

You are caring for patients on a medical-surgical unit on the day shift. Your patients are listed below:

- 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.

Mr. L. calls for pain medication. He describes the pain as "the worst pain I have ever had". He is crying, diaphoretic, and pacing around the room. What is your priority action? Why? Priority would be safety and getting him to sit or lay down. He is on a PCA pump and the medication side effects could cause dizziness or hypotension. Also, he may be dehydrated d/t the nausea and vomiting which can cause hypotension and tachycardia and the additional pacing can exacerbate those issues. He is a high fall risk so I would want to ensure he is safe before I assess him and address his pain.

Ms. J. is receiving continuous opiates to control her pain. Which side effect is your major concern? Provide the rationale.

My major concern would be constipation. Some of the side effects of pain medication may diminish over time but not constipation. Pain medication especially opioid slows down the movement of stool in the intestines. It gives the bowel more time to take the water out of stool and makes it hard and difficult to pass. If constipation is not treated properly, it can lead to increased pain and may also lead to fecal impaction and paralytic ileus. Providing stool softer and increasing fiber in the diet can help while patient is taking pain medication.