An older adult patient who has cancer and Alzheimer's disease is crying but shakes her head "no" when asked about pain
The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?
a. Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses.
b. Give 2 mg of morphine for pain to avoid increasing this patient's level of confusion.
c. Request an order for a nonopioid analgesic or an antidepressant adjuvant analgesic.
d. Withhold any analgesic at this time and reassess the patient in 30 to 60 minutes.
ANS: A
Older adult patients often are undertreated for pain, because assessing pain is difficult in patients with cognitive impairment and because practitioners often believe that reduced dosages are necessary to alleviate side effects. This patient does not verbalize pain, but her nonverbal cue (crying) indicates that pain is present. The nurse should give the higher dose, especially because the dosing interval has already been exceeded, and then monitor the patient's response to the medication. Giving 2 mg to avoid side effects is not indicated; patients with Alzheimer's disease will continue to have confusion unrelated to the opioid. Nonopioid analgesics and antidepressants are not indicated. Withholding pain medication is not appropriate, because this patient shows nonverbal signs of pain.
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