An older client living at home with cancer reports having to take twice as much pain medication over the last 24 hours. What should the nurse do with this information?
1. Double the current dose of narcotic pain medication.
2. Discuss options to prevent and treat breakthrough pain.
3. Use non-pharmacological methods for pain relief instead of pain medication.
4. Advocate for a medication change because the client has opioid tolerance.
2. Discuss options to prevent and treat breakthrough pain.
Explanation: 1. The client may be experiencing breakthrough pain and a different pain management approach may be needed. Titrating the medication dose upward is a reasonable option, but doubling the dose is too drastic and can lead to adverse effects.
2. If the client experiences breakthrough pain on a consistent basis, the nurse should notify the client's provider so that the dose of the long-acting, sustained-release preparation can be increased to more effectively control the pain. Immediate-release doses are also used to better manage breakthrough pain.
3. Alternative methods of pain relief may or may not be effective with breakthrough pain. The nurse could implement these in conjunction with, but not instead of, better pharmacological pain management.
4. There is no evidence to suggest that the client has opioid tolerance. Opioid tolerance does not occur over the period of one day, but rather takes a days, weeks, or months to create a problem.
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