A client who had surgery has extreme postoperative pain that is ...

[nautica902]

A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. What intervention for pain management does the nurse include in the client's care plan?
 
  a. As-needed pain medication after therapy
  b. Client-controlled analgesia with a basal rate
  c. Pain medications prior to therapy only
  d. Round-the-clock analgesia with PRN analgesics

Question 2

A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia. The client scores a zero. What action by the nurse is best?
 
  a. Assess physiologic indicators and vital signs.
  b. Do not give pain medication as no pain is indicated.
  c. Document the findings and continue to monitor.
  d. Try a small dose of analgesic medication for pain.

[kjohnson]

Answer to Question 1

ANS: D
Severe pain related to surgery or tissue trauma is best managed with round-the-clock dosing. Breakthrough pain associated with specific procedures is managed with additional medication. An as-needed regimen will not control postoperative pain. A client-controlled analgesia pump might be a good idea but needs basal (continuous) and bolus (intermittent) settings to accomplish adequate pain control. Pain control needs to be continuous, not just administered prior to therapy.

Answer to Question 2

ANS: A
Assessing pain in a nonverbal client is difficult despite the use of a scale specifically designed for this population. The nurse should next look at physiologic indicators of pain and vital signs for clues to the presence of pain. Even a low score on this index does not mean the client does not have pain; he or she may be holding very still to prevent more pain. Documenting pain is important but not the most important action in this case. The nurse can try a small dose of analgesia, but without having indices to monitor, it will be difficult to assess for effectiveness. However, if the client has a condition that could reasonably cause pain (i.e., recent surgery), the nurse does need to treat the client for pain.