Case Study

itsmejuli · May 22, 2014

Give us your answers and then we'll provide input

mg1303 · May 22, 2014

Thank you for reading my questions, this is what I came up with:

I think one of the most important roles of a nurse is to administer medication and provide comfort to a patient, even more when in pain and in this case the IV med should be given as per doctor’s order , making sure the five Rights are met such as: Right patient, Right medication, Right doses, Right route, Right time. I firmly believe the other nurses from the morning shift were negligent and did not assist the patient efficiently according to their responsibility and duties, neither provided the patient with the required attention or follow the doctor’s order as it was indicate.

Also, I think the problem in this scenario is that since it is a new graduate nurse, she pays close attention to what the experienced nurses say and it should not be that way, I, personally, will guide the new graduate and encourage her to follow physician’s order unless she sees there is something wrong with the patient, the medication and/or the dosage, then call and verify with the physician. She has to advocate and provide the appropriate care for her patient, it does not matter what other people say.

I will advise her to check his vital signs every two hours, keep an eye on him, and document everything, and about those nurses who made some negative comments to her regarding her patient, she must speak with them and show the patient’s chart and see if their opinion changes, or take it to the nurse in charge. I would advise her to go by the EBP (evidence based practice) if the patient’s vital signs are changing because his level of pain is also changing, then the negative comment are worthless.

Esme12, ASN, BSN, RN · May 22, 2014

I think it's Ok. You should follow the patients assessment and NOT that the older nurses comments...in this instance....and medicate accordingly. You should follow policy and chain of command and attempt to educate the other nurses on this patients pain and his feelings about the day shift.

Now in real life patients can and do play shifts of one anther to gain control and manipulate the staff.

nurseprnRN, BSN, RN · May 22, 2014

Another thing the new grad could do is consult with the nurse manager, and if that doesn't result in an uptick in professionalism, a visit to the hospital ethics folks would be helpful. Another action would be to ask if the local expert pain management physician could do an inservice at some time later (removed from the immediacy of the situation) to discuss standards of care for someone with a high tolerance to opioids due to longterm use for whatever reason, and the difference between tolerance/habituation/addiction (they are all very different).

And here are some nice little attachments for your report... which the new grad should post in the lounge.

-- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC315480/

Prim Care Companion J Clin Psychiatry. 2002; 4(4): 125-131.

PMCID: PMC315480

Successful Pain Management for the Recovering Addicted Patient

Christopher D. Prater, M.D., Robert G. Zylstra, Ed.D., L.C.S.W., and Karl E. Miller, M.D.

-- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/

Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions

Exp Clin Psychopharmacol. Oct 2008; 16(5): 405-416.

doi: 10.1037/a0013628

PMCID: PMC2711509

Andrew Rosenblum,1,* Lisa A. Marsch,1 Herman Joseph,1 and Russell K. Portenoy