An older patient with renal disease and advanced cancer pain asks ...

[strangeaffliction]

An older patient with renal disease and advanced cancer pain asks for stronger pain medication. What does the nurse need to take into consideration when determining which prescribed pain medication to provide to this patient?
 
  1. Methadone is a viable option for this patient.
  2. Meperidine is the most versatile opioid available.
  3. Oral morphine may be a starting point to be considered for this patient.
  4. Fentanyl is often the first opioid tried because of the low incidence of side effects.

Question 2

A terminally ill older patient with ongoing pain is prescribed an increased dose of morphine. What should the nurse consider when providing this dose of pain medication to the patient?
 
  1. The ultimate goal for the patient is to control pain.
  2. The organization's attorney should be made aware of the physician's order.
  3. The nurse may be charged with a crime for administering the medication dose.
  4. It is more important to ensure the patient does not experience respiratory depression.

[jesse.fleming]

Answer to Question 1

3
Rationale: Methadone has a long half-life, which may result in toxic accumulation of the drug in the person with hepatic or renal impairment. Methadone should be initiated and titrated cautiously to manage persistent pain in the older patient, and only prescribed by clinicians experienced in its use.
Rationale 2: Meperidine has the potential to cause confusion or seizures due to buildup of a toxic metabolite.
Rationale 3: Morphine is a commonly used and versatile opioid for the treatment of moderate to severe pain. Short- and long-acting formulations exist, and the drug can be delivered via many routes including oral form.
Rationale 4: Fentanyl is not a medication that should be considered for persons who have never been exposed to opioids.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Answer to Question 2

1
Rationale: Management of pain in terminal conditions may call for higher doses of opioids; however, pain should be treated aggressively to maximize comfort, even if the unintended effect of treatment results in the hastening of death.