case study 12

Case Study, Chapter 12, Pain Management

1. Mr. Will, a 67-year-old patient, is postoperative day 2 after a coronary artery bypass graft operation to revascularize his coronary arteries that were significantly blocked. He has a midline incision of his chest and a 7-inch incision on the inner aspect of his right thigh where a saphenous vein graft was harvested and used to vascularize the blocked coronary artery. The surgeon ordered Oxycodone 5 mg every 4 hours PRN for moderate pain and Oxycodone 10 mg every 4 hours PRN for severe pain.  Considering the patient’s age, what medication administration considerations should the nurse incorporate into the pain management plan and why? What measures should the nurse provide the patient to prevent adverse effects of analgesic agents from occurring? What nonpharmacologic pain management methods should the nurse teach to Mr. Will to assist with pain management?

2. Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). 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.  What are benefits of epidural versus systemic administration of opioids? The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments? The nurse monitors Mr. Rogers for what other complications of epidural analgesia? Mr. Rogers complains of a severe headache. What should the nurse do? Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?