Pain Management Case

Section A

1. T.’s behavior is best described as: (Please define your choice and rationales).
2. Tolerance
3. Addiction
4. Pseudo addiction
5. Dependence

Jason’s behavior can be described as tolerance. He is used to taking higher amounts of morphine in his body and thus feels uncomfortable while the nurse administers a low dose. However, the nurse reported that Jason relaxed after the medication she administered to him. Through a patient-controlled analgesia conducted by the nurse, Jason was able to manage pain and relax.

2. During his hospital stay, J.T. went into acute renal failure. He is increasingly sedentary and is experiencing confusion and some hallucinations. The physician believes the morphine metabolites may be responsible and would like to convert to an alternative regime. What would be your recommendation?
3. Change opioid to fentanyl patch 50 mcg q72h.
4. Decrease morphine S.R. dose to 60 mg P.O. q8h.
5. Switch to hydromorphone 8 mg orally q4h as needed.
6. Add haloperidol 1 mg PO q6h.
7. Tolerance will not develop to which adverse opioid effect?
8. Respiratory depression
9. Sedation
10. Constipation
11. Nausea

According to research studies, nurses have established that tolerance to different opioid effects develops at different rates. Therefore, tolerance to Sedation, Nausea, and respiratory disease occur rapidly. Whereas, Constipation responds slowly to tolerance.

B.

1. As a healthcare provider, what else do you need to understand about this patient related to pain management?

According to the health care system, pain management is a process that health care practitioners administer to manage pain. While pain is complex, doctors apply the best method to ensure that the patient is relieved from adverse pain (Ranniger, 2019). According to Jason Tyler’s case, healthcare practitioners are aware of his illness and his regular medication. Pain is also categorized as an emotion that may lead to sensory feelings; thus, as an APN, one should be aware of how emotions contribute to pain. As a nurse, engaging with a patient and understanding their turmoil would help relax a patient. Another available option for Jason’s case will be to evaluate his medication behavior and his response to drugs. In this case, when the nurse administered a dose lower than his regular dose, he felt the need to take extra medication. However, due to his addiction to excessive morphine to reduce pain, he can barely stand the pain he is experiencing. Therefore as a nurse, one should be able to administer the correct amounts of medicine to manage pain while at the same time monitoring the patient and his response to the treatment.

2. In your response, please provide the teaching you would provide to J.T.

As a nurse taking care of JT., my first lesson would be to help him understand his situation and the effects of drugs on his body. While drugs help us manage pain, there are more and better ways of pain management techniques. Regarding that J.T. Is going through a chronic disease, he might be in denial, which might be the reason he is in too much pain. I would advise JT. to take the much-required rest while undergoing the medication (Bazinski et al., 2021). Another lesson I would provide to JT. would be to make him aware of the consequences of being drug tolerant. Concurrent administration of alternative receptor-mediated analgesics is advised once tolerance to the opioid’s analgesic action has been noticed to prevent unnecessarily further development of tolerance.

3. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.

The Federal Comprehensive Drug Abuse Prevention and Control Act of 1970 enacted drug scheduling which is referred to as the Drug Enforcement Administration DEA. Thus, drug scheduling is a process that classifies chemicals and medicine regarding their level of control and availability to the general public (Somerville, 2018). The drug scheduling act was established to protect people’s public health and safety and was signed into law by President Nixon. However, the drug enforcement administration is divided into five categories. The division of these categories is grouped regarding how useful a drug is in treating diseases and how harmful a drug can be to a human body if abused. The subdivided categories are;

• Schedule I, This category consists of drugs that are likely to be abused and cause addiction to the people taking them.
• Schedule II, Drugs in this category have been classified as drugs that are likely to be used for medical purposes in some cases. Still, they can be abused if taken in large amounts, thus causing addiction to the users.
• Schedule III, The classification of these drugs, is only available under prescription from a medical practitioner.
• Schedule IV, in this category, we have reliable drugs that can be used for sustaining medical purposes and have low chances of being abused or misused.
• Schedule V, Drugs in this category have the lowest risks of abuse as compared to drugs in class IV. Thus, drugs in this category are solely used for medicinal purposes.

Drug scheduling is done for every drug that is entering the market to ensure that the Drugs Enforcement Administration establishes the risks and the value that each drug has on people’s public health and safety.

References

Somerville, C. (2018). The Drug Enforcement Administration. Mason Crest.

Bazinski, M. A., Quinlan-Colwell, A., Booher, L., & Drew, D. (2021). Let us introduce you to ways clinical nurse specialists impact pain management in Healthcare Systems. Pain Management Nursing, 22(2), 238. https://doi.org/10.1016/j.pmn.2021.02.040

Ranniger, C. (2019). Acute care: Pain management. DeckerMed Pain Management. https://doi.org/10.2310/pm.4347

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Pain Management Case

Value: 100 points

Due: Create your initial post by Day 3 and reply to at least two of your classmates by Day 7.

Grading Category: Discussions

Initial Post

Answer the following questions for A and B in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook.

As an Advanced Nurse Practitioner (ANP), you are working in an acute care setting.

Jason Tyler is a 65-year-old male admitted to the hospital with history of chronic cancer pain using Morphine SR 60 mg PO q8h. On admission, morphine 2 mg IV q4h was ordered. The patient reports his pain only went from a 9 to an 8 after the morphine dose and is asking for more pain medication. The staff begins to question the motivation of the patient and if addiction is present. The resident decides to start a PCA for his pain. In a few hours, the patient is comfortable, resting in bed.

A: Answer the following questions and provide your rationales for your choices.

1. T.’s behavior is best described as: (Please provide the definition for your choice and your rationales)
   1. Tolerance
   2. Addiction
   3. Pseudo addiction
   4. Dependence
2. During his hospital stay, J.T. went into acute renal failure. He is increasingly lethargic and is experiencing confusion and some hallucinations. The physician believes the morphine metabolites may be responsible and would like to convert to an alternative regimen. What would be your recommendation?
   1. Change opioid to fentanyl patch 50 mcg q72h.
   2. Decrease morphine SR dose to 60 mg PO q8h.
   3. Switch to hydromorphone 8 mg orally q4h as needed.
   4. Add haloperidol 1 mg PO q6h.
3. Tolerance will not develop to which adverse opioid effect?
   1. Respiratory depression
   2. Sedation
   3. Constipation
   4. Nausea

B: What pieces of the holistic assessment are missing from this scenario: (Answer the following questions and provide your rationales)

1. As a healthcare provider, what else do you need to understand about this patient related to pain management?
2. In your response, please provide the teaching you would provide to JT.
3. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.