An older patient with renal disease and advanced cancer pain asks for stronger pain medication. What does the nurse need to take into consideration when determining which prescribed pain medication to provide to this patient?
1. Methadone is a viable option for this patient.
2. Meperidine is the most versatile opioid available.
3. Oral morphine may be a starting point to be considered for this patient.
4. Fentanyl is often the first opioid tried because of the low incidence of side effects.
3
Rationale: Methadone has a long half-life, which may result in toxic accumulation of the drug in the person with hepatic or renal impairment. Methadone should be initiated and titrated cautiously to manage persistent pain in the older patient, and only prescribed by clinicians experienced in its use.
Rationale 2: Meperidine has the potential to cause confusion or seizures due to buildup of a toxic metabolite.
Rationale 3: Morphine is a commonly used and versatile opioid for the treatment of moderate to severe pain. Short- and long-acting formulations exist, and the drug can be delivered via many routes including oral form.
Rationale 4: Fentanyl is not a medication that should be considered for persons who have never been exposed to opioids.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.
You might also like to view...
A woman who is 33 weeks pregnant is admitted to the obstetric unit because her membranes ruptured spontaneously. What complication should the nurse closely assess for with this patient?
a. Chorioamnionitis b. Hemorrhage c. Hypotension d. Amniotic fluid embolism
A mother is worried about her three children developing an inherited medical condition because many members of her family have died from this disease. To start an assessment of this family, which tool should the nurse choose?
A. Ecomap B. Genogram C. Problem list D. Quantitative tool
A 58-year-old with a longstanding diagnosis of diverticulitis has been admitted to the hospital due to an acute exacerbation in her symptoms. The care team has deemed surgery unnecessary, but is pursuing aggressive medical treatment
What pathophysiological process is contributing to this woman's health problem? A) Proliferation of bacteria in the woman's large bowel has eliminated her normal flora. B) Food and bacteria have accumulated in a herniated area of the patient's colon. C) Uncoordinated peristalsis has resulted in irritation of the colon and stagnation of the bowel's contents. D) Stenosis of the ileocecal valve has created an infected obstruction.
A 68-year-old woman tells the nurse that her breasts are sagging, she no longer menstruates, and sexual intercourse is sometimes uncomfortable. What information should the nurse include in responding to this client?
a. The client should see a physician because these are not normal changes associated with aging. b. Suggest that the client try using a water-soluble lubricant before intercourse. c. Cessation of menses is normal, but the other changes are not. d. Sexual intercourse at this age is not necessary; avoid it if it is uncomfortable.