Author Question: The client is prescribed morphine sulfate (MS Contin) for chronic back pain resulting from ... (Read 129 times)

jeatrice · **on:** Jul 23, 2018

The client is prescribed morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated?

Standard Text: Select all that apply.
1. Use the prn order of docusate (Dulcolax) routinely every night.
2. Ask the dietary department to add bran cereal to the client's breakfast trays.
3. Ask the health care provider to write an order for an indwelling urinary catheter.
4. Review the trending of the client's hemoglobin and hematocrit levels.
5. Check the medical record for a prn order for an antiemetic.

Question 2

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

Standard Text: Select all that apply.
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?

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

Answer to Question 1

Correct Answer: 1,2,4,5
Rationale 1: One of the adverse effects of morphine therapy is constipation. The nurse should be proactive by giving the docusate every night.
Rationale 2: Intake of additional fiber, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine.
Rationale 3: While morphine may promote urinary retention, other methods of controlling this adverse effect should be used initially.
Rationale 4: Morphine should not be administered to those who are hypovolemic due to the risk of hypotension.
Rationale 5: Nausea and vomiting are adverse effects of the use of morphine. Until the client becomes tolerant of this effect, an antiemetic may be necessary.
Global Rationale: One of the adverse effects of morphine therapy is constipation. The nurse should be proactive by giving the docusate every night. Intake of additional fiber, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine. Morphine should not be administered to those who are hypovolemic due to the risk of hypotension. Nausea and vomiting are adverse effects of the use of morphine. Until the client becomes tolerant of this effect, an antiemetic may be necessary. While morphine may promote urinary retention, other methods of controlling this adverse effect should be used initially.

Answer to Question 2

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 client is willing to tolerate.
Rationale 2: Knowing what the client likes to do and when it is important for the client 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 clients are already concerned about becoming addicted and the nurse should not reinforce this myth.
Rationale 4: Some clients 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.
Global Rationale: 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 client is willing to tolerate. Knowing what the client likes to do and when it is important for the client to be most awake and alert helps the nurse create a pain management plan. Some clients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences. Nonpharmacologic pain relief strategies should also be investigated. Addiction is not a concern at the end of life. Many clients are already concerned about becoming addicted and the nurse should not reinforce this myth.