Case Study
Pain
Patient Profile Mrs. Cato is a 112-kg, 43-year-old Caribbean woman admied for an incision and drainage of a right renal abscess. Her renal function is not impaired. She has a history of low back pain and takes oxycodone, 5 to 10 mg, every 6 hours as needed.
Subjective Data
• Lives alone
• Desires 0 pain during therapy but will accept 1 to 2 on a scale of 0 to 10
• Reports incision-area pain as a 2 or 3 between dressing changes and as a 10 during dressing changes
• States sharp, throbbing pain persists 1 to 2 hours after dressing change
• Reports pain between dressing changes controlled by two oxycodone tablets
Objective Data
• Requires twice-a-day dry-to-dry dressing changes for 1 week
• Morphine, 2 to 15 mg intravenously, for every dressing change
• Oxycodone, 5 to 10 mg, for breakthrough pain between dressing changes
Discussion Questions
1. Initially, what dosage of intravenous morphine should be given?
2. Describe the assessment data that support the dosage selected in Question 1.
3. How long should the nurse wait after the intravenous morphine dose to begin the dressing change?
4. If an initial dose of 6 mg intravenous morphine reduces the pain to a 6 during the dressing change, what nursing action is indicated for the next dressing change? 5. What nursing action is indicated if Mrs. Cato has pain
5 hours after her dressing change?
6. When Mrs. Cato is discharged, needing dressing changes for 3 days at home, how would the home care nurse organize her care? (The nurse knows that Mrs. Cato has obtained adequate pain relief with 8 mg of intravenous morphine.)