As we are concerned with Juanita Nelson’s consistent severe pain and lack of a scheduled pain medication regimen we would first contact her physician.
Situation
- This is a
third year nursing student from Surgery 5000 and I am calling about Juanita Nelson in room 5050. The
problem that I am calling about is Mrs. Nelson’s consistent pain that
seems to be significantly increasing her anxiety and is having negative effects on her both physically and mentally. She has not yet been able to be free of
pain while being on prn morphine and does not have any other pain medications ordered.
- Although she is unable to rate her pain level, she continually demonstrates moaning, grimacing, and guarding. I have been working with her for a couple of days now and
it is becoming a trend.
- I have just assessed the patient
personally and her vital signs are: Blood Pressure: 149/88, Pulse: 122 Respirations: 32 and Temperature is 36.5°C.
Background
- Mrs. Nelson is a 69 year old female who was
first admitted to RUH with acute pancreatitis on Dec 28, 08; she was treated
until Jan 15 and then transferred to her small town hospital. She was
readmitted on Jan 22, 09 with obstructive jaundice.
- In these past few days she has been
noted to be increasingly agitated, anxious and weepy.
- She describes her pain as a “sharp pain” in her
abdomen. Throughout daily assessments pain is consistently present. It is only occasionally relieved for a
couple hours when she receives her prn morphine.
- Currently her only pain medication
prescribed is morphine 1-5mg q1-2 hr prn.
- The patient has a long standing history
of hypothyroidism and this has been shown to increase the patient’s
sensitivity to analgesics (http://books.google.com/books?id=QMavPTjZwEkC&pg=PA42&lpg=PA42&dq=hypothyroidism+increased+sensitivity+analgesic&source=bl&ots=EIcIG0jYcm&sig=pLw3_BEgLCrKIu6A6xz4Dkzvlec&hl=en&ei=EwG2SbifCZGksQOi4bTjCA&sa=X&oi=book_result&resnum=1&ct=result).
- I think the problem is an inappropriate pain management regime. Mrs. Nelson's pain is poorly controlled and has been unrelieved.
Recommendations
- I would like to see a scheduled pain
management regime developed for Mrs. Nelson as evidence has shown that consistent pain is best managed with an
round-the-clock pain management regime.
- I am requesting a referral to palliative care in order to have Mrs. Nelson's pain thoroughly assessed. This assessment will allow Mrs. Nelson and her family to discuss possible pain interventions and will direct the development of a specific pain regime. At this time it would also be useful for both a physician and nurse to be present to discuss the assessment with palliative care.
