An older client with a history of hypertension and osteoarthritis ...

[Pineappleeh]

An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse?
 
  a. I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night.
  b. I heard that meditation may help me deal with the pain without taking all that Tylenol.
  c. Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-the-clock and my pain is gone.
  d. I make sure that I take my Tylenol with breakfast when I first get up.

Question 2

An older adult with gastric cancer with bone metastases is being discharged from the hospital after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan?
 
  a. The development of a plan to prevent constipation
  b. Bene-fits of grief counseling
  c. In-creasing calories in the diet
  d. Pre-venting pressure ulcers

[joewallace]

Answer to Question 1

ANS: C
The maximum dose for Tylenol is 4 g per 24-hour period; two extra strength Tylenol tablets every 4 hours would mean that the client is taking 6 g and would need further evaluation. Herbal tea may have a relaxing effect and help her sleep. Meditation is one of the alternative modalities that help some patients deal with pain. The practice of taking Tylenol with breakfast upon waking is acceptable.

Answer to Question 2

ANS: A
Side effects of opioids are significant to older adults and include constipation. Because constipation is almost universal when opioids are used, the nurse should ensure that an ap-propriate bowel regimen is taken at the same time as the opioids.. The remaining options are not specifically related to the management of the client's pain or the effects of opioid treatment.