School of Nursing and Allied Medical Sciences

Holy Angel University

Angeles City

Case Study
Module 10: Pain Medications
Ildee Marie B. Briton Jarah Maica Ilagan
Sheena Lane Ayson Franze Alessandra Isip
Jannelle Joy Balingit Berlon Sebastian Lacson
Angelica Joy Costales Aina Beatriz Manalo
Ryan Jordan David Eldlaine Charlotte Pascual
Ayumie Reigne Dungca Jean Nicole Soriano
Edsel Francis Garcia Jredd Lance Togonon
Princess Jane Gobiana
NCM106 – Pharmacology

Scenario: You are a group of ward nurses receiving a newly admitted patient from the ER.
During patient hand-off, the nurse emphasized that she already administered a total of 10mg of
Nalbuphine (Nubain) via SIVP in the past 30 minutes. The patient still requests an additional
dose of the drug but the physician specifically ordered to give the next dose of Nubain after 4
hours.

Ten minutes after you left the room, the patient presses the call bell and tries to convince you to
give him another 'shot' because he is in 'so much pain' and a pain scale of 10/10. However his
assessment cues tells otherwise. He sits comfortably, watches the television, and chats with his
daughter.

1. How would you address this request for additional pain medication?

Answer:

I would kindly acknowledge the patient's request for additional pain

medication and empathetically explain that the physician has prescribed a specific
dosing schedule for Nubain which is typically administered every four hours,
because overdose of this drug may be fatal as it manifests symptoms such as slow
breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy
skin, pinpoint pupils, and fainting. I would reassure the patient that the doctor has
their best interests in mind and is following established guidelines to manage pain
effectively and safely. I would then implement independent nursing interventions
to alleviate pain, such as applying hot or cold compresses, providing massages,
 offering emotional support, and using distractions such as music. If the pain
persists or becomes more intense,I would notify the physician to discuss
alternative options or adjustments to the pain management plan. Open
communication is key to ensuring the patient feels heard and cared for while
adhering to medical guidelines. It is also important to document the interaction
between me, as the nurse, and the patient.

You return to the station, and your colleagues suggest you try giving a placebo dose, using PNSS
of the same quantity.

2. Will you consider the suggestion? Justify.

Answer:

I cannot agree with giving a placebo, even if it's just normal saline without
the patient’s general consent. Obtaining the patient’s consent in using placebo
respects the autonomy of the patient and strengthens the trust the patient has with
the physician and the rest of the healthcare team. It is not necessary to specify as
to when the placebo will be administered as long as the patient understood the
effect of the placebo and gave his/her consent in administering the said
medication. Only when verbal consent was given shall administering placebo be
considered. To address the patient's concerns about pain, I would talk openly with
the physician as well as the patient, so they will be involved in the
decision-making and effectively address their concerns and current pain
management if it is effective or alternatives should be done. Keeping
communication open and honest not only keeps the patient safe from any potential
harm but also helps build trust and therapeutic connection with their healthcare
provider.
 References

AMA Code of Medical Ethics. (n.d.). Use of Placebo in Clinical Practice.

https://code-medical-ethics.ama-assn.org/ethics-opinions/use-placebo-clinical-practice#:~
:text=In%20the%20clinical%20setting%2C%20the,Enlist%20the%20patient's%20cooper
ation

Department of Health & Human Services. (n.d.). Pain and pain management – adults. Better
Health Channel.
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pain-and-pain-manag
ement-adults

Nalbuphine Uses, Side Effects & Warnings. (n.d.). Drugs.com.

https://www.drugs.com/mtm/nalbuphine.html#:~:text=What%20happens%20if%20I%20
overdose,%2C%20pinpoint%20pupils%2C%20and%20fainting.