Access over 20 million homework & study documents

Case study focus who analgesic ladder pain and surgery

Content type
User Generated
Rating
Showing Page:
1/1
Case Scenario:
Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and
COPD. She had a posterior spinal fusion of L4-S1 today. She had an estimated blood
loss (EBL) of 675 mL during surgery and received 2500 mL of Lactated Ringers (LR).
Pain is currently controlled at 2/10 and increases with movement. She was started on a
hydromorphone patient-controlled analgesia (PCA) with IV bolus of 0.1 mg and
continuous hourly rate of 0.2 mg. Last set of VS in post-anesthesia care unit (PACU) P:
88, R: 20, BP: 122/76; requires 4 liters per n/c to keep her O2 sat >90%. You are the
nurse receiving the patient directly from the PACU.
Questions:
1). Determine which precise step of the WHO Analgesic Ladder is being
pharmacologically handled in the case of Ms. Dalton. Justify your position.
Answer: Hydromorphone is an opioid analgesic drug similar to morphine, fentanyl and
oxycodone. If we are going to base on the 4 step ladder, we are in the step 4 or the top
of the ladder where strong opioids are given to the patient. If we are going to base on
the 3-step ladder, we are on the third step.
2). Identify at least one non-pharmacological pain intervention you can offer to her case
as a post-operative nurse assigned to her care, and explain why it is appropriate for her
situation.
Answer: Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief
involving the use of a mild electrical current. A TENS machine is a small, battery-
operated device that has leads connected to sticky pads called electrodes. You attach
the pads directly to the patient’s skin. When the machine is switched on, small electrical
impulses are delivered to the affected area of the patient’s body, which she might feel
as a tingling sensation. The electrical impulses can reduce the pain signals going to the
spinal cord and brain, which may help relieve pain and relax muscles. They may also
stimulate the production of endorphins, which are the body's natural painkillers. There
was a study published in 1985 where TENS is used for pain control after spinal fusion.
They found out that patients using TENS received fewer doses of several commonly
prescribed pain medications than patients who did not use TENS devices. I also found a
blog of a woman where she claims that after using TENS post-operatively, it didn’t make
her pain go away, but it did help reduce it to a more tolerable level. When TENS is
applied pre-incisionally and postoperatively, it reduces the postoperative opioid
requirement and provides sufficient analgesia.

Sign up to view the full document!

lock_open Sign Up
Unformatted Attachment Preview
Case Scenario: Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had a posterior spinal fusion of L4-S1 today. She had an estimated blood loss (EBL) of 675 mL during surgery and received 2500 mL of Lactated Ringers (LR). Pain is currently controlled at 2/1 ...
Purchase document to see full attachment
User generated content is uploaded by users for the purposes of learning and should be used following Studypool's honor code & terms of service.

Anonymous
Excellent! Definitely coming back for more study materials.

Studypool
4.7
Trustpilot
4.5
Sitejabber
4.4