Name: Jude Elmer N.

Panlaan Block: NF

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.

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 The nurse should explain first the benefits of taking morphine and that it is not addictive.

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Showing the symptoms of pain such as grimaced and high pulse rate, the nurse should

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try to convince that morphine can help manage the pain and discomfort he is currently
experiencing. Still if the patient refuses, the nurse should not give morphine since they

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have the right to refuse.
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2. What would your reaction be to RJ in regard to his restlessness, grimacing, and refusal
to breathe deeply and cough?
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 I should make action by checking his vital signs. Since all mention above are symptoms
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of pain, I should ask him if he is feeling any pain and discomfort. As soon as he states
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the presence of pain, I would do intervention.

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

 The change in pulse rate(increasing) is a symptom of pain.
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4. What classic side effects if opioid analgesics should the nurse assess?
 Constipation, Drowsiness and Nausea & Vomiting.
5. What are some possible nonpharmacologic measures that might be helpful in alleviating
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RJ’s pain?
 For non-invasive methods, these are helpful nonpharmacological measures:
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Meditation
Progressive Relaxation
Dreaming
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Rhythmic Respiration
Biofeedback
Therapeutic Touching
Transcutaneous Electrical Nerve Stimulation (TENS)
Hypnosis
Musical Therapy

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 Acupressure
Cold-Hot Treatments
For invasive methods, this is a helpful nonpharmacologic measures:
Acupuncture

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?

 The doctor prescribed another drug because RJ is taking morphine 8 times already and
may cause depression of respiratory rate, dependency and constipation.
Acetaminophen with codeine is a combination drug that also relieves moderate to
severe pain but less potent.
7. RJ does not want to ambulate. What is an appropriate nursing response?
 The nurse should assess the reason why he refuses to ambulate. The nurse should
identify the problem by asking if he is experiencing any pain which could be a reason

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for him to refuse in walking.

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MEN’S HEALTH AND REPRODUCTIVE DISORDERS
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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
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accomplished violinist in the school orchestra. His father states that he also was a “late
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bloomer”, but both parents are concerned about MT’s increasing social withdrawal and seem
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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?

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 The delayed state of puberty and lack of sexual maturation is the primary complaint.
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2. What is concerning MT’s parents?

 Both parents are concerned about MT’s increasing social withdrawal.
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3. What information must be included in the history and physical examination?

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 His father states that he also was a “late bloomer”, this shows a history of genetics.
Asses if the patient is experiencing hypogonadism.
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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.

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  The nurse should educate the parents the possible risk in having the therapy. The nurse
should also educate the parents the proper administration of medicine and the side
effects.

5. MT asks why he will be treated for 4 months. What will the nurse reply?
 The nurse should reply that 4 months is already considered to be a short term therapy
and considered to be effective to his age which requires only small dosage.

6. About what adverse effects do MT and his parents need to be educated?

 Sexual side effects are the most well-recognized adverse effects from this therapy which
includes loss of libido, erectile dysfunction and hot flashes.

7. What physical and psychosocial parameters will be assessed at MT’s monthly visits?
 The nurse should asses possible adverse effects of the therapy. Assess the liver
function and arrange to discontinue the drug at any sign of hepatic dysfunction. Assess

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the effectiveness of the drug in his social life, such as his confidence.

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8. What special hygiene needs does MT have while on this regimen?

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 Skin hygiene to decrease the severity of skin acne.

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9. When should MT have x-rays taken? Explain your answer.
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 Skeletal maturation must be monitored every 6 months by radiography of the hand and
wrist. Because accelerated bone maturation can lead to premature closure of bone
epiphyses and short stature, androgen therapy should be used cautiously in children
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and only by specialists aware of the adverse effects on bone maturation.

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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?
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 Numerous studies provide evidence of the possible dangers associated with them,
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including increased risk of heart disease and increased estrogen concentrations in men.
Thus, it appears that the risks far outweigh the benefits.
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