The nurse working in a surgical center is caring for a client who had an abdominal nevus removed. The client is complaining of intense pain. Which action by the nurse is the most appropriate?
1. Administer a nonnarcotic analgesic because the client had minor surgery.
2. Attempt to divert the client without administering an analgesic because the surgery was so minor.
3. Administer the stronger analgesic ordered by the primary care provider.
4. Notify the health care provider that the client's pain is excessive for the minor surgery performed.
3
Rationale 1: Clients who have minor surgery can still experience severe pain, and administering weaker analgesics when the client reports severe pain would not be responsible practice.
Rationale 2: Diverting the client most likely will not be effective alone, although diversion might be possible after administering the analgesic.
Rationale 3: Pain perception is what the client says it is, and the nurse should medicate the client based on the client's description of the pain, not what the nurse anticipates. If the client reports severe pain, the nurse should administer strong analgesics.
Rationale 4: There is no need to notify the health care provider unless the nurse's assessment indicates there is something unusual occurring.
Global Rationale: Pain perception is what the client says it is, and the nurse should medicate the client based on the client's description of the pain, not what the nurse anticipates. If the client reports severe pain, the nurse should administer strong analgesics. Clients who have minor surgery can still experience severe pain, and administering weaker analgesics when the client reports severe pain would not be responsible practice. Diverting the client most likely will not be effective alone, although diversion might be possible after administering the analgesic. There is no need to notify the health care provider unless the nurse's assessment indicates there is something unusual occurring.
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