Which of the following actions would the nurse prioritize for the ...

[Tazate]

Which of the following actions would the nurse prioritize for the patient who is experiencing chronic back pain that interferes with activities of daily living (ADLs)?
 
  a. Maintain a pain journal to document quality of his pain experience.
  b. Meet with the healthcare team to discuss a pain management plan.
  c. Attempt to take only analgesic medication when absolutely needed.
  d. Suggest use of a deep-pressure back massage with effleurage technique.

Question 2

The patient reports pain after surgery, ranking it 6 on a scale of 1 to 10 . She tells the nurse, I don't want to be all doped up. My family is coming to visit and I want to be alert enough to visit with them.
 
   Which of the following medications would likely be most effective for postoperative pain relief without excessive sedation?
  a. Fentanyl IV
  b. Morphine IV
  c. Ibuprofen PO
  d. Hydrocodone PO

[brbarasa]

Answer to Question 1

B
With complex pain management that has been unsuccessful in the past, it is important to collaborate with other members of the team to consider alternative approaches. A pain journal is a useful assessment tool for collection of patient subjective and objective pain experiences, which would aid the healthcare team in developing a collaborative pain management plan with the patient. Taking a prescribed analgesic is important for keeping the pain threshold at a tolerable level. Once the patient gets behind on managing pain, it is more difficult to achieve control. The goal of pain management is that chronic pain does not prevent the patient from performing activities of daily living. Although massage has been shown to be effective in reducing pain by providing cutaneous stimulation and relaxing the muscles, the priority is to develop an effective, comprehensive pain management plan that might also include nonpharmacological interventions, such as massage. However, in the case of chronic back pain, the patient should consult the provider before seeking deep massage therapy. Effleurage, or the use of slow, long guiding strokes, is used for obstetrical patients during labor.

Answer to Question 2

C
Ibuprofen is a nonsedating analgesic. This would be the best choice but the nurse should instruct the patient to call if the pain is not tolerable because a stronger analgesic may be needed. If the patient desires to be alert, an opioid analgesic would not be the best choice because it produces drowsiness. Hydrocodone and fentanyl are opioid agonists and, based on the patient's request to be alert, would not be the best choice.