Question

• The nurse is caring for a client who has just been admitted to the surgical unit from the postanesthesia care unit. The client, a 40-year-old man, has had a surgical repair of a small bowel perforation. His medical history includes depression, for which he takes an antidepressant medication, as well as chronic lower back pain. He has taken both opioid and nonopioid pain medications regularly for the past 10 years for his back pain. He also has a history of chronic renal insufficiency. He has a nasogastric (NG) tube connected to suction and is ordered to be NPO (nothing by mouth) at present. He has the following medications prescribed for pain management
• • Oxycodone 20 mg, crush and administer via NG tube every 12 hours
  • Hydrocodone/acetaminophen, crush and administer via NG tube every 4 hours as needed for mild to moderate pain
  • Meperidine IV every 3 hours as needed for severe pain

1. The nurse has reviewed the pain medications that have been prescribed for the client. Discuss any questions that the nurse should raise with the prescribing physician, along with the rationale for raising each question.
2. Describe the issues that may impact pain management in this client

Answer 1

QIESTIONS THAT THE NURSE SHOULD RAISE WITH THE PRESCRIBING PHYSICIAN:

• As already patient is on opiod drugs previously ,how the dose adjustment should be done at present as to avoid withdrawl symptoms.
• High dosage of opiods may cause withdrawl symptoms with sudden stoppage.Long term use may cause resistance to the drugs .so how to prevent these.
• Constipation is the major side effect of opiods.As the patient had bowel surgery how to manage constipation and ileus in this patient.
• Does usage of opiods can deteriorate the renal function as the patient already having renal insufficiency.

ISSUES WHICH HAVE IMPACT ON PAIN MANAGEMENT IN THIS CLIENT:

• Having history of depression and usage of antidepressants have effect on levels of pain.
• History of back pain also have effect on levels of pain in post operative period.
• Pain management should be done accordingly.