CRITICAL THINKING CASE STUDY

ANALGESICS

RJ, a 79-year-old man, underwent abdominal surgery for resection of his colon.
After the surgery, his physician prescribed morphine 10 mg every 3 to 4 hours as
needed. RJ did not ask for pain medication because he is worried he might become
addicted. A day after the surgery, RJ’s nurse noted that he was restless and grimaced
whenever he moved in bed. He refused to breathe deeply or cough when instructed to
do so. The nurse compared RJ’s vital signs to his baseline findings and noted an
increase pulse rate and a drop in systolic blood pressure of 6 mm Hg.

1. Should the nurse give morphine? Explain your answer.

The nurse should give morphine to Mr. RJ because he is experiencing
signs and symptoms of pain such as increased pulse rate, grimaced, and
restlessness. But before giving the patient morphine, nurse must explain properly
the need for pain management and that morphine will not cause him addiction
since he will be using it only when he is experiencing pain All medication
information should clearly explained and questions of patient must be entertained
but if patient still refuses to take morphine after nursing interventions, nurse
should not force him yet still would record and report the signs and symptoms to
the physician.

2. What would your reaction be to RJ in regard to his restlessness, grimacing, and

refusal to breathe deeply and cough?
I would not act negatively and force RJ to do the things I asked him to,
instead I will check his vital signs and question him of what he is feeling such as
pain and discomfort to maintain a good relationship and be able to monitor
patient effectively.

3. What is the significance of the change in vital signs?

Increased pulse rate, restlessness, and grimaced expression suggest
feeling of pain for the patient which is significant in providing nursing intervention
to the patient.

4. What classic side effects if opioid analgesics should the nurse assess?
The common side effects of opioid analgesics are sedation, dizziness,
nausea, vomiting, and constipation.
 5. What are some possible non-pharmacologic measures that might be helpful in
alleviating RJ’s pain?
Relaxation techniques, aromatherapy, meditation, rhythmic respiration,
massage/therapeutic touching, acupressure, musical therapy, essential oils, hot
and cold treatments, biofeedback, imagery, and changing of positions are the
non-pharmacologic measures for the patient.

The second postoperative day, RJ began asking for morphine every 3 hours. On the
fifth day, the physician discontinued RJ’s morphine and prescribed acetaminophen with
codeine.

6. Why was the opioid analgesic order changed?

Too much dependence of morphine will cause him further adverse effects/
complications such as respiratory depression, apnea, circulatory depression, and
worst are respiratory arrest, shock and cardiac arrest. In the case of Mr. RJ he is
having morphine 3x a day.
7. RJ does not want to ambulate. What is an appropriate nursing response?
Nurse should ask patient for any concern in walking or moving around
especially if he is feeling any pain or discomfort. If patient specifies body part
feeling pain, assess that area and continue monitoring and checking patient.
MEN’S HEALTH AND REPRODUCTIVE DISORDERS

MT, age 16 years, is a high school senior who is 59.3 inches tall and weighs 126
pounds. He is having increased feelings of discomfort about not fitting in with the other
students at school because he has not yet begun sexual maturation. He is a good
student and an accomplished violinist in the school orchestra. His father states that he
also was a “late bloomer”, but both parents are concerned about MT’s increasing social
withdrawal and seem determined to seek medical intervention for him. The nurse at the
clinic assesses the needs and status of MT and his parents.

1. What is the patient’s primary complaint?

He is feeling discomfort about not fitting with other students in school due
to his condition which is his primary complaint; delayed state of puberty
and lack of sexual maturation.

2. What is concerning MT’s parents?

His parents are concerned of his increasing social withdrawal because of
the status and situation of MT.

3. What information must be included in the history and physical examination?

History of any allergy to testosterone or androgen for patient to avoid
hypersensitivity, hepatic dysfunction, cardiovascular disease, and prostate
cancer. Also patients weight, height, skin color, lesions, texture and hair
distribution, affect, orientation, peripheral sensation, testicular examination,
abdominal examination, serum electrolytes, serum cholesterol, liver function tests
should be done in the physical examination.

4. What education should the nurse prepare before the parents decide whether to
start their son on androgen therapy? The decision is made to prescribe
testosterone30 mg every 12 hours by buccal tablet (held inside the cheeks until it
dissolves). MT will be on this regimen for 4 months, during which time he is to
come to the clinic at monthly intervals.
The nurse should provide patient and family education with all the
information and guidelines regarding the medication prescribed such as; proper
amount of medication to give, proper administration, indications and
contraindications, food and drugs not to take with medication, what medication
does to the patient, how drug affects the patient, side effects with respective
interventions, and what to do if severe adverse effects occurs.

5. MT asks why he will be treated for 4 months. What will the nurse reply?
 The nurse will tell MJ that
6. About what adverse effects do MT and his parents need to be educated?
7. What physical and psychosocial parameters will be assessed at MT’s monthly
visits?
8. What special hygiene needs does MT have while on this regimen?
9. When should MT have x-rays taken? Explain your answer.
10. During a clinical visit, MT mentions that he heard that the use of anabolic steroids
might improve his chances of making the wrestling team. What should he be told
about the safety and efficacy of anabolic steroid use?