Module 3: Pain Management in Palliative Care

You are performing a pain assessment on Matilda. Your assessment reveals that Matilda has pain rated as a 5 in her left hip that worsens with movement. She has been having this pain off and on for the last three years. Which of the following pain assessment components have you not addressed in your assessment?

Alleviating factors

Which of the following individuals would be at highest risk for the under-treatment of pain?

An 87-year-old male with osteoarthritis

During your assessment, you notice Robert, who has a diagnosis of dementia, rubbing his right shoulder. What should you do next?

Ask Robert if he is in pain.

Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000mg every six hours. She rates her pain at a 4 every time you ask. What do you think an appropriate next step would be at this time?

Ask Yolanda what an acceptable pain score is for her.

You are caring for a 76-year-old patient who is unresponsive and close to end of life from a massive stroke. The patient has a history of breast cancer and had been experiencing severe bone pain in her left hip prior to her stroke. How do you assess her pain now that she is unresponsive?

Assume she continues to have pain and assess for evidence of wincing or facial grimacing.

Mr. T's wife tells the nurse she doesn't want him to take the morphine the doctor ordered for his cancer pain because she heard from a friend that he could stop breathing because of it. Your best response would be:

Breathing problems are rare when these medications are used as ordered.

Joey is a 3-month-old who has a serious illness and will probably die in the next few months. His mother is concerned that he looks like he is in pain whenever she has to change his diaper. Your best response to her is:

Can you explain to me what Joey looks like that makes you concerned he is in pain?

You are talking with the parents of a 2-year-old boy diagnosed with leukemia about pain management. Which statement indicates an understanding about pain management in children?

He needs to be assessed carefully so that he gets enough pain medication.

What is the most common adverse effect related to the use of acetaminophen?

Liver dysfunction

Which of the following patients should never be given an opioid medication?

Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work

During your pain assessment, Randall describes his pain as a burning pain in his lower extremities. What type of pain does this describe?

Neuropathic

What type of pain are antidepressants and anticonvulsants most beneficial for?

Neuropathic pain

During your pain assessment, Lenora describes her pain as an aching and cramping pain in her lower abdomen. What type of pain does this usually describe?

Nociceptive pain

John is admitted to the hospital for a pain crisis from his sickle cell disease. He usually takes morphine 30mg every 12 hours by mouth. He states his pain is a 10 on a 0-10 scale. You tell your colleague that his pain can't be that bad because he is watching television and talking on the phone. Which important principle of pain management are you violating?

Pain is a subjective experience and is what the patient reports it is.

You are caring for Ms. P, a 55-year-old woman with cancer. She received pain medication less than two hours ago. A nursing assistant reports that Mrs. P is complaining of pain again. The nursing assistant says, "She can't be hurting as much as she says she is." What is the most appropriate response?

Pain is whatever the patient says it is. Let's assess her further.

Mr. Jones is taking two oxycodone/acetaminophen 5/325 mg tablets every four hours for bone pain related to metastatic cancer. His pain is a constant 6 on a 0 to 10 scale. Since the current regimen is not meeting his goals, and is keeping him from moving, you decide to call his physician. The doctor suggests increasing the medication to two tablets every three hours around-the-clock. What would your action be?

Question the safety of the total daily dose of acetaminophen that Mr. Jones would be taking.

Mr. F has advanced prostate cancer with bone metastasis. He is unresponsive and is being cared for at home by his daughter. You are teaching the daughter about assessing her father's pain. Which statement by the daughter indicates an understanding of her father's pain status?

Since he was in pain when he was conscious, I assume he's still in pain.

You are teaching a patient how to take her new prescription for morphine, an opioid pain medication. Which of the following teaching statements reflects an understanding of potential adverse effects?

This medication causes constipation, so you need to take a laxative to prevent that.

Mr. Johnson tells you that taking one tablet of his opioid medication was no longer controlling his pain so he increased it to two tablets. He states that taking two tablets provides much better pain relief than one tablet did. What behavior does this represent?

Tolerance

Mr. T. is taking an NSAID for bone pain. Which of the following statements suggests he may be experiencing a worrisome side effect from the NSAID?

Yesterday I had an episode of black, tarry stools.