Online Case Studies Learning Activity #1: Opioids and Pain Management Assignment
Assignment Outline
This assignment will give you the opportunity to apply your knowledge related to opioids and pain management. You will be asked to complete preparation work prior to watching a case study video, and follow the activity with knowledge application questions. To complete this activity, please download this worksheet and complete the fillable spaces. Please submit your completed document to Dropbox by midnight Friday February 17th, 2023. You will be evaluated based on your responses on the worksheet. This assignment is worth 5% of your overall theory mark.
Patient Information
John, an adult male, has undergone rotator cuff surgery on his shoulder for the second time. He has a history of adverse reactions to pain medication and sleep apnea.
Case Study Preparatory Work- Mini Drug Cards (1.5 marks)
| Morphine | Classification: Schedule II Narcotic anelgesics |
| Indication: any condition that causes pain, relief for moderate to severe acute and chronic pain | |
| Assessment required: Respiration before and during administrations, level of counsciousness and BP | |
| Contraindication: acute or severe asthma and breathing problems | |
| Hydromorphone (Dilaudid) | Classification: Schedule II Narcotic anelgesics |
| Indication: Moderate to severe or chronic pain | |
| Assessment required: Respirations, level of counsciousness, cyanosis and dyspnea | |
| Contraindication: Brain tumors, respiratory disease, hypotension | |
| Naloxone | Classification: Opiod antagonist |
| Indication: block or reverse effect of opiod overdoses | |
| Assessment required: level of counsciousness, respiratory depression and shock | |
| Contraindication: Hypersensitivity |
Learning Resources
Please review the following resources to assist you in completing the assignment:
- Case study video found at the following link: https://youtu.be/dH9agqZRdXw
- PCA Information
- o Anesthesiology and Pain Management (March 2017). Managing your pain with patient controlled analgesia (PCA). University Health Network. pdf (uhn.ca)
- WHO Pain Management Ladder
- o Anekar AA, Cascella M. WHO Analgesic Ladder. [Updated 2021 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554435/
You are encouraged to procure any additional resources that you find useful for completing the worksheet.
Assignment Questions
- John’s pain is initially managed using a morphine Patient-Controlled Analgesia (PCA).
- a) Which considerations should be included in determining appropriate PCA use?
(1 mark)
The effectiveness of pain management should be considered
- b) What information should be included by the nurse when providing teaching to a patient using a PCA pump? (1 mark)
The nurse should include the importance of using the pump when feeling pain and avoiding waiting until pain is too much.
- John was experiencing some adverse effects while he was using the (PCA) pump. Identify the adverse effects was John experiencing. (1 mark)
Nausea and vomiting
- John was switched from a morphine PCA to oral hydromorphone (Dilaudid) tablets.
- a) What are the key nursing assessments that must be completed prior to hydromorphone (Dilaudid) administration? (1 mark)
Consciousness level and vitals(respirations)
- b) What should the nurse re-assess following administration of PO (oral) hydromorphone? How long should the nurse wait before returning to assess the patient? (1 mark)
The nurse should reassess the respiratory rate as well as the level of counsciousness
- In reviewing John’s history, what pertinent information may have contributed to his adverse reaction. Discuss your rationale. (1 mark)
the sleep apnea of john may have contributed to this reaction since some of the side effects of a PCA pump include nausea vomiting, respiratory depression, sedation, confusion or urinary retention
- As John’s condition changed, what were the key assessment findings that indicated John’s condition was deteriorating and required further intervention? (1 mark)
Is unability to wake up in addition to is excessive amount of sleep
- Using the World Health Organization Pain Management Ladder to inform your answer, how might John’s pain have been managed differently? (Hint: consider medications ordered and alternatives that could have been used) (1 mark)
If John’s sleep apnea was identified earlier a different method to manage pain could have been used for instance a method involving IV
- Naloxone is an opioid antagonist used in situations of suspected opiate overdose.
- a) How does Naloxone work? (0.5 marks)
Block the effcts of opiods by taking them off receptors in the brain
- b) Would administration of Naloxone have been helpful in this case? Why or why not? (1 mark)
Yes, since his condition became worse after receiving pain medication
Reflection and Application of Learning
- How might this situation have been handled differently? Which key nursing assessments were missed that might have led to a different outcome? (2 marks)
The situation could have been handled differently by putting John’s sleep apnea into perspective prior to administering his pain medication. The key nursing assessment that was missed was reassessment of john’s vitals.
- Did the mini drug card preparation assist you in critically thinking through opiate use for this patient? Why or why not? If not, how could you better prepare yourself for medication administration? (1 mark)
Yes it was helpful it helped me better understand the effects and consequences of these medications.
- What are two pieces of learning that you will take away from this case study? (1 mark)
The importance of getting a complete history. This case study showed mewhat could go wrong without the full information and what problems can be avoided.
References
Please include your APA formatted references here if you have incorporated additional references into your learning.
M;, M. M. C. M. D. K. (n.d.). Patient-controlled analgesia in the management of postoperative pain. Drugs. Retrieved February 17, 2023, from https://pubmed.ncbi.nlm.nih.gov/17181375/#:~:text=The%20most%20observed%20adverse%20effects%20of%20opioid-based%20PCA,routes%20have%20extensively%20been%20described%20in%20the%20literature.
Patient Education Improving health through education. (n.d.). Managing your pain with patient controlled analgesia (PCA) – uhn. Patient Education Improving health through education. Retrieved February 18, 2023, from https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Managing_Your_Pain_with_PCA.pdf
Total /15 marks