Nursing care plan help

It is obvious the amount of pain Mr Bee is in and the scenario is not saying that the man is using opioids for the wrong reason so you becoming crazy is not understood why this conclusion was made. I thought when anyone was prescribed these sorts of drugs, that the physician would have considered a bowel softener for constipation but often this is not done. So if a n SSRI such as amitriptyline was prescribed for Mr Bee how does this wean him from his oral MS COntin and over what timeframe should this occur. Is this what is causing his pain and loss of sensation in the soles of his feet and in his joints? What are the priorities for a nurse in caring for Mr Bee? Firstly it is to review his medications and make adjustments to incorporate neuropathic medication. In educating Mr Bee about this how would a nurse go about this? Exactly what should be included in this education and how?

Welcome to AN! The largest online nursing community!

First.....What semester are you? What is your focus this semester? YOu need to have a complete understanding of the disease processes before you can make determination of your plan of care. Your plan of care is ALL about the patient assessment and what the patient needs. The proper use of terminology, and spelling, is imperative as similar word/spelling can have completely different meanings.

The reason GrnTea addressed this with you was to explain your question....

Is he addicted to Morphine so much now that it has no effect

and was NOT

becoming crazy

You asked why this patient was having excessive pain in the presence of excessive pain medication usage.

Now....this patient is probably experiencing pain due to diabetic neuropathy. However this scenario is complicated due to the fact the patient has had fem-pop bypass to restore circulation.

Your first nursing priority should be assuring that the patient isn't experiencing a complication from the surgery and is suffering from an acute occlusion/failure of the graft from the surgery. Proper assessment of BOTH limbs is necessary to ensure circulation is not impaired. As a previous poster stated.....MendedHeart

What is really important is his assessment , neurovascular specifically--5 P's

-Pulses

-Pallor-color of skin and area around groin site, is it soft?

-paresthesia

-paralysis-movement bilaterally/strength

-pain

If your assessment proves that your patient has no impaired circulation your second consideration should be that these patient can experience intense pain from re-perfused tissue muscles and nerves.....oxygenated blood getting to tissues that were denied oxygen wake up and can cause the patient unbelievable pain, tingling,and feelings of numbness/pins and needles.....which can mimic the pain of diabetic neuropathy and is neuropathy pain from PAD (peripheral artery disease)....and thereby causing a hyperalgesia state

Hyperalgesia (/ˌhaɪpərælˈdʒiziə/ or /-siə/; 'hyper' from Greek ὑπέρ (huper, “over”), '-algesia' from Greek algos, ἄλγος (pain)) is an increased sensitivity to pain, which may be caused by damage to the peripheral nerve

There are several causes of hyperalgesia

• Primary hyperalgesia describes pain sensitivity that occurs directly in the damaged tissues.
  
• Secondary hyperalgesia describes pain sensitivity that occurs in surrounding undamaged tissues.
  

Opioid-induced hyperalgesia may develop as a result of long-term opioid use in the treatment of chronic pain. Various studies of humans and animals have demonstrated that primary or secondary hyperalgesia can develop in response to both chronic and acute exposure to opioids. This side effect can be severe enough to warrant discontinuation of opioid treatment.

A patient building a tolerance to a medicine as GrnTea pointed out is NOT assuming they are addicted....they are very different animals...building a tolerance to the effectiveness of the medicine because of chronic use is NOT addiction. Some patients will develop this from the med itself even after one dosage of the med and is a sensitivity reaction similar to an allergice response

Hyperalgesia is induced by platelet-activating factor (PAF) which comes about in an inflammatory or an allergic response. This seems to occur via immune cells interacting with the peripheral nervous system and releasing pain-producing chemicals

Because this patients pain is reported to be worse at night it helps you decide....AFTER assuring proper circulation is present.....that neuropathy is present. Neuropathy can be caused by many things including poor circulation, diabetes, and meds.

Now what is neuropathy and how is it treated?

Peripheral neuropathy is a disorder of the peripheral nerves—the motor, sensory and autonomic nerves that connect the spinal cord to muscles, skin and internal organs. It usually affects the hands and feet, causing weakness, numbness, tingling and pain. Peripheral neuropathy’s course is variable; it can come and go, slowly progressing over many years, or it can become severe and debilitating

Neuropathy: Neuropathy, Peripheral Neuropathy Peripheral neuropathy - MayoClinic.com

It is common that opioids (narcotics) alone are seldom effective for this type of pain. The use of SSRI/tricylic antidepressants and certain anti-seizure meds are used to treat this type of pain to assist in the decrease usage of opioids and not withdraw/weaning of these meds.Peripheral neuropathy: Treatments and drugs - MayoClinic.com

Now according to Maslows hierarchy of needs.....tell me what you think is a priority in Mr. Bee's care?

[h=3]Five Levels of the Hierarchy of Needs[/h] There are five different levels in Maslow’s hierarchy of needs:

1. Physiological Needs
   These include the most basic needs that are vital to survival, such as the need for water, air, food, and sleep. Maslow believed that these needs are the most basic and instinctive needs in the hierarchy because all needs become secondary until these physiological needs are met.
   
   
2. Security Needs
   These include needs for safety and security. Security needs are important for survival, but they are not as demanding as the physiological needs. Examples of security needs include a desire for steady employment, health care, safe neighborhoods, and shelter from the environment.
   
   
3. Social Needs
   These include needs for belonging, love, and affection. Maslow described these needs as less basic than physiological and security needs. Relationships such as friendships, romantic attachments, and families help fulfill this need for companionship and acceptance, as does involvement in social, community, or religious groups.
   
   
4. Esteem Needs
   After the first three needs have been satisfied, esteem needs becomes increasingly important. These include the need for things that reflect on self-esteem, personal worth, social recognition, and accomplishment.
   
   
5. Self-actualizing Needs
   This is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested fulfilling their potential.