A nurse in the emergency department is caring for a patient with a fractured tibia and fibula who admits to regular heroin use. Which factor should be used to determine the presence of pain and need for pain medication?
1. The patient has taken an opiate already today.
2. The shift report indicates the patient has been sleeping on and off.
3. The patient is angry about being in the hospital.
4. The patient reports pain in the leg of an intensity of 10 out of 10 on the numeric rating scale.
4
Rationale 1: A chronic opiate user/abuser will experience withdrawal symptoms if the usual or base dose of opiate is not given. The patient may require additional medication for pain.
Rationale 2: A patient in pain may appear asleep or have closed eyes, but the quality of sleep may be poor.
Rationale 3: Anger at the nursing staff does not reflect the presence or absence of pain.
Rationale 4: The nurse should accept all pain reports as valid but negotiate treatment goals early in care. The patient's own report of pain is the best means of assessing pain intensity.
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