Question

Jennifer Lincoln was back at work on her oncology nursing unit after a weeks’ vacation period as she read saved her report, she could hear moans of pain coming from the room of Leonard Wilson, at 28-year-old male suffering firm the effects of messed attic bone cancer. This patient had been one of her favorites when he was hospitalized several months ago for chemotherapy. Now he was back to die. The metastatic grows in his spine were causing him excruciating pain at the same time as brainstem miss at tires were threatening death. The goal of Mr. Wilson's nursing care was to keep him as comfortable as possible. But as Mrs. Lincoln checked the chart of his narcotic order, she stared in disbelief she had called the head nurse; have Mr. Wilson really received 780 milligrams of morphine by continuous infusion during the last 8 hours, plus 20 milligrams boost booster every four hours, PRN? That was enough to cause respiratory depression, even in a 180-pound man the head nurse come from the dose and explained that Mr. Wilson tall tolerance was extremely high, probably because he had been addicted to heroin as a teenager give him another 20 milligrams booster, she told Mrs. Lincoln we have to relieve his pain. Mrs. Lincoln agreed that his pain should be relieved but she wondered whether she should give him another dose on top of the amount of medication that he had already received what if he stopped breathing after she gave him the booster? what should she do?

2--Do you continue to hesitate before giving frequent or high doses of morphine? why or why not?

Answer 1

1-) As the Jennifer Lincoln was at 28-year-old male suffering firm the effects of messed attic bone cancer. The metastatic grows in his spine were causing him excruciating pain at the same time as brainstem miss at tires were threatening death. The goal of Mr. Wilson's nursing care was to keep him as comfortable as possible. Mr. Wilson really received 780 milligrams of morphine by continuous infusion during the last 8 hours, plus 20 milligrams boost booster every four hours, PRN . That was enough to cause respiratory depression, even in a 180-pound man the head nurse come from the dose and explained that Mr. Wilson tall tolerance was extremely high, probably because he had been addicted to heroin as a teenager give him another 20 milligrams booster, she told Mrs. Lincoln we have to relieve his pain. Mrs. Lincoln agreed that his pain should be relieved but she wondered whether she should give him another dose on top of the amount of medication that he had already received

Morphine is considered the “gold standard” for relieving pain and is currently one of the most effective drugs available clinically for the management of severe pain associated with cancer. In addition to its use in the treatment of pain, morphine appears to be important in the regulation of neoplastic tissue. Although morphine acts directly on the central nervous system to relieve pain, its activities on peripheral tissues are responsible for many of the secondary complications. Therefore, understanding the impact, other than pain control, of morphine on cancer treatment is extremely important. The effect of morphine on tumor growth is still contradictory, as both growth-promoting and growth-inhibiting effects have been observed. Accumulating evidence suggests that morphine can affect proliferation and migration of tumor cells as well as angiogenesis. Various signaling pathways have been suggested to be involved in these extra-analgesic effects of morphine. Suppression of immune system by morphine is an additional complication

These patients were treated for a mean of 96 (range 1-1215) days. There was a wide variation in dose requirements, minimum daily dose ranging from 0.5 to 200 mg and maximum daily dose from 1 to 3072 mg. However, there was no clear trend to increasing dose as period of epidural morphine administration increased. The most frequent complications were pain on injection (12.0% incidence), occlusion of the portal system (10.9%), infection (8.1%) and leakage of administered morphine such that it did not all reach the epidural space (2.1%). In all but 1 case infections were limited to the area around the portal or along the catheter track. All infections resolved without sequelae following removal of the portal and/or administration of antibiotics.

I hesitate to giving this medication continuing because Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction.