Help with case study

[RaptorsFan]

I am a nursing student and I have to do a case study but I am stuck on one of the questions and I am hoping someone can help me. Here is the case study:

Client Profile

Mrs. C. is a 112-kg (280-pound) 48-year-old woman, admitted for an incision and drainage of a right renal abscess. Her renal function is not impaired.

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 change

*States sharp, throbbing pain persists 1 to 2 hours after dressing change

*Reports pain between dressing changes controlled by two Percocet ® tablets

*Reports morphine 2 mg IV barely touches pain during dressing changes

Objective Data

*Requires bid dry-to-dry dressing changes for 1 week

*Morphine 4 to 15 mg IV q dressing change

*Percocet ® 1-2 tablets for breakthrough pain between dressing changes

I have to determine the answer to the following question, but I'm not sure about determining the appropriate dose:

1.Initially, what dose of IV morphine should be given? Describe the assessment data that supports the dose selected.

[roser13, ASN, RN]

Show us your work. What do you think the dose should be?

You likely have tools at your disposal (textbook, class notes) that will help you approach this question. We are not likely to give you answers to your homework without your effort and input.

[chelynn]

For one why has she been getting 2mg when the order stated 4-15mg? Also tell us what you would guess and why and then we are more likely to help you from there.

[RaptorsFan]

I thought maybe 6-8mg . I say 6-8 because i think the dose should be titrated up gradually to something similar to the dose of the percocets (I was told the 5 mg tablets were the most common dose and I read that percocet and mrphine are equianalgesic) which have been effective for her??? Im not sure if im completely off base.

[Silverdragon102, BSN]

Moved to the General Nursing Student Discussions forum

[canesdukegirl, BSN, RN]

You probably already know that pain is mostly experienced when skin or muscle around an incision is affected. Has anyone thought of another route of pain relief? As in Lidoderm patches around the skin? When was she admitted and how much MSO4 did she receive the last time she had a dsg change? What was the outcome? Was the entire 15 mg of MSO4 administered? Was she snowed, and if so, did she have airway obstruction (which would be expected in an overweight pt)?

Explain to the pt that she should expect that the dsg change will be painful, and 0 pain is not realistic, but that you have meds available right there at the bedside and you will give her the ordered doses at intervals to alleviate her pain. She will be scared, and her anxiety will be "driving the bus". Tell her everything that you are doing BEFORE you actually do it so that she can mentally brace herself. We tend to be more accepting of things when we know what is going to happen. Remember that the fear of the unknown is the biggest fear that pts report.

You should start out with 4mg MSO4 IV 15 minutes prior to dsg change, considering the airway as your first priority relative to potential airway obstruction. If she is unable to tolerate pain when you attempt the dsg change, go up by 1mg, reassess in 2-3 minutes. Keep doing this until she can tolerate the dsg change. Have some Narcan at the bedside, along with an oral airway and some suction. Make sure you have a full tank of O2 in the room and a non-rebreather mask just in case. Watch her closely after the dsg change if you have to administer more than 10mg MSO4. Overweight pts can tank their sats pretty quickly.

I hope this helps some, and gives you things to consider.

[RaptorsFan]

Thanks so much!

That was very helpful!