A 78-year-old female patient is admitted to a medical–surgical floor with left lower extremity pain and discoloration of the extremity

Question

The following serum laboratory values are documented for this patient: Glucose = 110 mg/dL Potassium = 6.5 mEq/L Blood urea nitrogen (BUN) = 60 mg/dL creatinine = 3.2 mg/dL Which of the following statements by the nurse represents a clear understanding of this patient's pain management needs? 1. "This patient may need more pain medication because of acute renal failure.".
2. "This patient may need less pain medication because of diabetes mellitus.".
3. "This patient will need potassium replacement before pain treatment begins.".
4. "This patient may need less pain medication because of acute renal failure.".

Answer 1

4

Rationale: The elevated BUN, creatinine, and potassium levels in this scenario strongly suggest the presence of acute renal failure. Renal failure diminishes the patient's ability to eliminate opioids from the blood stream, which can precipitate overdose or drug toxicity. Also, older individuals are at higher risk for drug toxicity than younger individuals for a number of reasons. These factors support the use of lower pain medication doses in this scenario. The serum glucose level is normal, and a medical diagnosis of diabetes mellitus has not been established. The abnormally elevated potassium level contraindicates potassium replacement and is also a sign of acute renal failure.