Drugs to Treat Pain Assessment
Content
Daniel De La Rosa Fara Griggs Tammy Smith Flortie Schouten
1. If you were the ED nurse, how would you respond to the patient’s request? (25pts) “Sir Dilaudid is a drug that needs to be administered slowly at least between 3-5 minutes if it is administered too quickly you could stop breathing” In response to the patient’s request for another dose. “You have already received your dose an hour ago. You have to wait at least 3 hours more before receiving another dose of Dilaudid, however I will notify the doctor and see what he recommends” 2. Provide a scientific rationale for your decision. Discuss how the multidimensions of pain are seen in the patient. (25pts) Dilaudid, a controlled substance schedule II drug, has the potential to be a very addicting substance. As a nurse though, we have an obligation to our patients. We have to forget all judgment and discrimination and believe the patient pain is real. If a doctor orders the medicine and the pain reports the pain, then we will administer it. However, Dilaudid must never be pushed fast when directly administered. The drug should slowly be pushed in a 3 to 5 minute time frame. The nurse should also always use the port most distal to the patient due to the rapid onset of only 15 minutes. Another option is to dilute the drug with normal saline. If Dilaudid is administered to rapidly, drug toxicity can occur and possible put the patient into respiratory arrest. 3a. What factors about the patient did you consider before making your decision? Be sure to include in your answer how the emergency room setting may determine the care the patient will receive. The main factor behind the decision was the adverse effect another dose of dilaudid and diphenhydramine could have on the client. The max dose of dilaudid IV is 5mg q4-6 hrs. Giving this only an hour after the last dose could lead to respiratory depression or a severe drop in blood pressure. The patient could stop breathing or pass out. Also the diphenhydramine has an additive effect on the dilaudid so the effects would be increased. The risk factors listed previously only become more real because the patient is “already appearing to be quite sedated”. The patient asking for these drugs to “be pushed fast” indicates a possible drug seeker. This patient should be monitored for possible misuse or abuse of drugs, and should have his record pulled to see if he’s had treatment at any other hospitals recently. Typically the emergency room sees many “frequent flyers” and although this patient may be drug seeking we are still required to give him what is prescribed as is prescribed without judgment. However being in the emergency room setting the patient may be neglected and pushed aside as a drug seeker rather than an ill-informed patient in pain. 3b. Also discuss the nurse’s legal-ethical responsibilities in the situation. What biases might health care providers have against this patient that might affect the care received? (25pts)
Daniel De La Rosa Fara Griggs Tammy Smith Flortie Schouten
The healthcare provider may be biased about the patient's age, race, and attitude about receiving the medication. The patient is a teenager so that could lead one to think thy may have recreational experience with drugs. The patients attitude suggest that he wants to be knocked out completely for reasons other than pain. The legal and ethical obligation of the healthcare provider is to assess the situation first. The provider is also responsible for listening and believing the patient's report. The report is to be treated in a timely manner. The treatment may include teaching, prescribing new medications, and taking action without challenging the patient.
4. What other nursing interventions may be appropriate at this time? (25pts) Assess the client for the effectiveness of the drugs by using pain scale Assess the client’s vital signs for possible adverse effects of the drugs Ensure patient safety. Initiate fall precautions as necessary. Encourage client to use non-pharmacological pain relieving measure such as listening to music, watching TV or other relaxation techniques that a client preferred to use to relieve pain.
1. If you were the ED nurse, how would you respond to the patient’s request? (25pts) “Sir Dilaudid is a drug that needs to be administered slowly at least between 3-5 minutes if it is administered too quickly you could stop breathing” In response to the patient’s request for another dose. “You have already received your dose an hour ago. You have to wait at least 3 hours more before receiving another dose of Dilaudid, however I will notify the doctor and see what he recommends” 2. Provide a scientific rationale for your decision. Discuss how the multidimensions of pain are seen in the patient. (25pts) Dilaudid, a controlled substance schedule II drug, has the potential to be a very addicting substance. As a nurse though, we have an obligation to our patients. We have to forget all judgment and discrimination and believe the patient pain is real. If a doctor orders the medicine and the pain reports the pain, then we will administer it. However, Dilaudid must never be pushed fast when directly administered. The drug should slowly be pushed in a 3 to 5 minute time frame. The nurse should also always use the port most distal to the patient due to the rapid onset of only 15 minutes. Another option is to dilute the drug with normal saline. If Dilaudid is administered to rapidly, drug toxicity can occur and possible put the patient into respiratory arrest. 3a. What factors about the patient did you consider before making your decision? Be sure to include in your answer how the emergency room setting may determine the care the patient will receive. The main factor behind the decision was the adverse effect another dose of dilaudid and diphenhydramine could have on the client. The max dose of dilaudid IV is 5mg q4-6 hrs. Giving this only an hour after the last dose could lead to respiratory depression or a severe drop in blood pressure. The patient could stop breathing or pass out. Also the diphenhydramine has an additive effect on the dilaudid so the effects would be increased. The risk factors listed previously only become more real because the patient is “already appearing to be quite sedated”. The patient asking for these drugs to “be pushed fast” indicates a possible drug seeker. This patient should be monitored for possible misuse or abuse of drugs, and should have his record pulled to see if he’s had treatment at any other hospitals recently. Typically the emergency room sees many “frequent flyers” and although this patient may be drug seeking we are still required to give him what is prescribed as is prescribed without judgment. However being in the emergency room setting the patient may be neglected and pushed aside as a drug seeker rather than an ill-informed patient in pain. 3b. Also discuss the nurse’s legal-ethical responsibilities in the situation. What biases might health care providers have against this patient that might affect the care received? (25pts)
Daniel De La Rosa Fara Griggs Tammy Smith Flortie Schouten
The healthcare provider may be biased about the patient's age, race, and attitude about receiving the medication. The patient is a teenager so that could lead one to think thy may have recreational experience with drugs. The patients attitude suggest that he wants to be knocked out completely for reasons other than pain. The legal and ethical obligation of the healthcare provider is to assess the situation first. The provider is also responsible for listening and believing the patient's report. The report is to be treated in a timely manner. The treatment may include teaching, prescribing new medications, and taking action without challenging the patient.
4. What other nursing interventions may be appropriate at this time? (25pts) Assess the client for the effectiveness of the drugs by using pain scale Assess the client’s vital signs for possible adverse effects of the drugs Ensure patient safety. Initiate fall precautions as necessary. Encourage client to use non-pharmacological pain relieving measure such as listening to music, watching TV or other relaxation techniques that a client preferred to use to relieve pain.
