Apply the concepts you learned from this chapter to the following patient scenario.
Joe is a 68-year-old male who was recently diagnosed for colon cancer last week and underwent a colon resection three days ago. See Figure 11.15 for an image of Joe. In the change of shift report, you hear that he is receiving morphine by PCA pump for pain, but he is not using it very often. Staff reports he “needs much encouragement” to get out of bed and participate in self-cares. He has crackles in his lung bases and his oxygen saturation is 88% on room air.
- What additional assessments (subjective and objective) will you perform on Joe?
- List the top three priority nursing diagnoses for Joe.
- Joe states, “I don’t want to use morphine. I am afraid I will become addicted to it like my friend did after he came home from the war.” How will you respond to therapeutically address his concerns, yet also teach Joe about good pain management?
- What are common side effects of opioids and how will you plan to manage these side effects for Joe?
- Emotional issues could also be affecting Joe’s perception of pain. What will you further physically assess and therapeutically address?
- After providing patient education about morphine and the PCA pump, you check on Joe later in the day and notice he has had five self-doses every hour with 15 attempts in the past hour. The pump is set for a maximum of 6 doses per hour. What further assessments will you perform?