The nurse is completing a home care visit of an older adult client who is dying of end-stage renal failure and dementia
The client has been taking narcotic medication for the treatment of chronic arthritic pain. During the visit, the family tells the nurse that the client seems more restless and is grimacing and crying. Which action by the nurse is appropriate?
A) Teach the family alternative methods for pain relief instead of administering pain medication to this client.
B) Tell the family that the client may be in pain and an adjustment to the pain medication or administration schedule is needed.
C) Encourage the family to continue to administer the pain medication as needed.
D) Realize the client is being uncooperative because of a personality disorder.
Answer: B
Clients with dementia may not be able to accurately express their pain. Other behavior changes, such as agitation, restlessness, and grimacing, often indicate ineffective management of pain. Therefore, adjustments to the pain medication or schedule are warranted. Personality disorders with the presence of dementia are difficult to identify and to differentiate the source of the behavior. Although alternative measures augment pain relief, medications and their administration should be examined as a priority of the assessment.
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