5.1 Pain Management Case Study

Answer the following questions for A and B using APA formatting, integrating four evidence-based resources to include clinical practice guidelines.

You are working in an acute care setting.

Jason Tyler is a 65-year-old male admitted to the hospital with history of chronic cancer pain using Morphine SR 60 mg PO q8h. On admission, morphine 2 mg IV q4h was ordered. The patient reports his pain only went from a 9 to an 8 after the morphine dose and is asking for more pain medication. The staff begins to question the motivation of the patient and if addiction is present. The resident decides to start a PCA for his pain. In a few hours, the patient is comfortable, resting in bed.

A: Answer the following questions and provide your rationales for your choices.

  1. J.T.’s behavior is best described as: (Please provide the definition for your choice and your rationales)
    1. Tolerance
    2. Addiction
    3. Pseudo addiction
    4. Dependence
  2. During his hospital stay, J.T. went into acute renal failure. He is increasingly lethargic and is experiencing confusion and some hallucinations. The physician believes the morphine metabolites may be responsible and would like to convert to an alternative regimen. What would be your recommendation?
    1. Change opioid to fentanyl patch 50 mcg q72h.
    2. Decrease morphine SR dose to 60 mg PO q8h.
    3. Switch to hydromorphone 8 mg orally q4h as needed.
    4. Add haloperidol 1 mg PO q6h.
  3. Tolerance will not develop to which adverse opioid effect?
    1. Respiratory depression
    2. Sedation
    3. Constipation
    4. Nausea

B: What pieces of the holistic assessment are missing from this scenario: (Answer the following questions and provide your rationales)

  1. As a healthcare provider, what else do you need to understand about this patient related to pain management?
  2. In your response please provide the teaching you would provide to JT.
  3. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.