Author Question: The home hospice nurse is completing the initial assessment of a patient who is has terminal ... (Read 51 times)

Wadzanai · **on:** Jul 23, 2018

The home hospice nurse is completing the initial assessment of a patient who is has terminal congestive heart failure. The patient frequently has pain with breathing. What questions should the nurse ask?

1. How much pain are you willing to tolerate?
2. What do you like to do throughout the day?
3. Have you ever been addicted to a pain medication?
4. Are there any pain medications you would like to avoid?
5. What things besides drugs help with your pain?

Question 2

The patient has advanced cancer and is experiencing malignant pain. How should the nurse plan to manage this pain?

1. Use the intravenous route for pain medication administration.
2. Set up a dosing schedule that provides for around-the-clock doses.
3. Encourage the patient to wait 10 minutes after pain medication is required to ask for a dose.
4. Augment the patient's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain.
5. Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated.

atrochim · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 1,2,4,5
Rationale 1: It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the patient is willing to tolerate.
Rationale 2: Knowing what the patient likes to do and when it is important for the patient to be most awake and alert helps the nurse create a pain management plan.
Rationale 3: Addiction is not a concern at the end of life. Many patients are already concerned about becoming addicted and the nurse should not reinforce this myth.
Rationale 4: Some patients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences.
Rationale 5: Nonpharmacologic pain relief strategies should also be investigated.

Answer to Question 2

Correct Answer: 2,4
Rationale 1: Approximately 90 of cancer pain can be controlled by use of oral medications if they are dosed appropriately.
Rationale 2: Often the problem in controlling pain of any type is that the patient gets behind the pain rather than medicating for it before it gets severe. Around-the-clock dosing helps to prevent playing catch-up to the pain.
Rationale 3: This plan would allow the pain to worsen before medication is given and would result in the patient getting behind the pain.
Rationale 4: Breakthrough pain is expected and may require additional pharmaceutical or nonpharmaceutical measures.
Rationale 5: While it is true that some cancer patients develop intractable pain, many are able to control pain to a level that is very tolerable.