An older adult client has a history of osteoarthritis. The nurse cares for the client in the postoperative period after a below-the-knee amputation for complications of peripheral vascular disease. Which finding most concerns the nurse?

Question

1. The client has a history of depression and anxiety, treated with a selective serotonin reuptake inhibitor.
2. The client takes acetaminophen (Tylenol) instead of prescribed pain medication as needed for osteoarthritis.
3. The client's spouse visits the hospital occasionally, usually to assist with the morning meal and bathing.
4. The client is irritable, reports moderate generalized pain, and states that he cannot "put a number on it."

Answer 1

2. The client takes acetaminophen (Tylenol) instead of prescribed pain medication as needed for osteoarthritis.

Explanation: 1. Depression and anxiety can worsen with undertreated, persistent pain. The fact the client is already being treated for this is a positive finding.
2. A history of undertreated, chronic pain is often related to musculoskeletal disorders. The client has not been taking medications that might have helped the pain. This can result in hyperalgesia, an increased sensitivity to pain that leads to an exaggerated pain response.
3. Ideally, the client would have more continuous in-hospital support, but the client does have a support person. The spouse may be busy with work, family, or other responsibilities.
4. Older clients sometimes are vague with pain reports, particularly when there are multiple pain sources, such as chronic musculoskeletal pain and acute surgical pain. It is not uncommon for someone in moderate to severe pain to demonstrate frustration with, or refusal to use, the pain scale.