Author Question: The patient has morphine sulfate ordered for pain every 4 hours prn. The patient complains of severe ... (Read 128 times)

soccerdreamer_17 · **on:** Jun 25, 2018

The patient has morphine sulfate ordered for pain every 4 hours prn. The patient complains of severe pain and usually requests more morphine an hour before it is due. The nurse should:

(Select all that apply.)
a. Request a placebo order from the physician.
b. Offer the patient medication around the clock instead of prn.
c. Offer the patient massage between medication doses.
d. Offer the patient a nonopioid medication between morphine doses if ordered.

Question 2

The nurse is turning a patient when she notices an area with nonblanchable redness over the patient's coccyx. The patient complains of pain at the site, and the site does feel cooler than the areas immediately around the site.

The nurse recognizes that this patient has developed:
a. a stage I pressure.
b. a stage II pressure.
c. an unstageable pressure.
d. deep tissue injury.

fffftttt · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

B, C, D
Some patients exhibit drug-seeking behaviors when in fact they are seeking pain relief. Occasionally, a physician will order a placebo to discredit a patient's report of pain. This is unethical and should be avoided. Timely administration before a patient's pain becomes severe is crucial to ensure optimal relief. Pain is easier to prevent than to treat. In most circumstances, administration of pharmacological agents around-the-clock rather than on an as-needed (prn) basis is preferable. Often a combination of nonopioids and opioids is effective in managing pain. Using an integrated approach that considers both pharmacological and nonpharmacological therapies in managing pain is recommended.

Answer to Question 2

A
The hallmarks of a stage I pressure ulcer are intact skin with nonblanchable redness of a localized area, usually over a bony prominence. The area may be painful, firm, soft, and warmer or cooler as compared with adjacent tissue. Stage II pressure ulcers are defined by partial-thickness loss that presents as a shallow open ulcer with a red or pink wound bed, without slough. They also may present as intact or open/ruptured serum-filled blisters. They usually present as shiny or dry shallow ulcers without sloughing or bruising. Unstageable pressure ulcers are characterized by full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore the stage, cannot be determined. Deep tissue injury usually is characterized by purple or maroon localized areas of discolored intact skin or blood-filled blisters caused by damage to underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, and warmer or cooler as compared with adjacent tissue. The wound may further evolve and become covered by thin eschar.