SUBMMITED BY:

GABIN, DANICA
GALVEZ, LOVELY JANE Y
GUANZON, HANNAH RACHEL M.
JACINTO, JOHNTER EDWARD U.
JOSE, CAREN B.
LUMERIO, LIUCAS
MISLANG, MA. IMELDA S
MONDRAGON, YLLANA S.
NOBLEZA GIA FHEY T.

PAIN IN ELDERLY

1 As the admitting hospice nurse, you recognize that 8 on the pain scale greatly impair Jane’s quality
of life. Using the WHO step approach, what would be your plan on intervention?
 As an admitted hospice nurse the first nursing intervention in severe pain scale of 8
is to evaluate pain relief at regular intervals. We Adjust medication regimen as
necessary. Inform client and so of the expected therapeutic effects and discuss
management of side effects. According to WHO step approach, a pain scale of 8 is
classified as a severe pain, thus adjusting medication is necessary to relieve pain..
2. Knowing that Jane probably has two types of pain due to the metastasis, what adjuvant might you
consider for the bone pain?
 Adjuvant analgesics are drugs that are not primarily used as analgesics but can
produce analgesia in certain types of pain. Bone pain is common in patients with
tumor cancer and can often be treated effectively with non-steroidal anti-
inflammatory drugs and corticosteroids. Corticosteroids are among the most
commonly used adjuvant analgesics for the management of metastatic bone pain.
Also Bisphosphonates (etidronate, clodronate, pamidronate derivatives), it is used
for the treatment or prophylaxis of cancer-related bone complications, including
pain, it produces analgesic effects in patients with bone metastases. The mechanism
of action is thought to be related to inhibition of bone resorption.
3. Looking to the future, what other comfort issues might Jane face as her metastasis impacts her life?
 Upon hearing a diagnosis of cancer, Jane is facing a multitude of issues. It generates
physical and emotional tiredness, stress and other health problems. Comfort care is
an essential part of medical care at the end of life. It is care that helps or soothes a
person who is dying. Jane already knows her future. That's why she accepts all
 situations that she experiences now so she refuses other treatment. Having a past
history in breast cancer 2 years ago has an impact on her family, especially lane.
Cancer pain may affect quality of life and ability to function even after treatment
ends. Pain that is severe or continues after cancer treatment ends increases the risk
of anxiety and depression. Feeling depressed or having anxiety can worsen cancer
pain and make it harder to control. Support, love and care from her family and the
people that surrounds her is the good thing that we can do to her in this situation
4. How could you keep Jane reach her goal of selected activities (e.g. shopping, lunch, church?)?
 As soon as the person ages, the only thing that can make her feel that she fulfilled all
her hopes in life is reaching her goal to make her feel satisfied and appreciate the
quality time of life that brings her joy and value. During the final stage Jane,
conversations about death and dying are difficult making all the emotions,
interpretations, and concerns increase which could cause emotional stress. However,
acceptance is a must, and doing things that could bring her joy at least in her
remaining life can make her feel better. As a nurse, we encourage Jane, her family,
friends, and her support system to make her feel comfortable, give her respect, be
present at times when she needs us, and most importantly is to let her do things she
wanna do such as shopping, family bonding such as lunch or dinner date, and going
to the church to increase her faith or as a source of her strength. Therefore, this role
we create is we communicate to the support system of Jane to provide comfort,
respect, and give happiness and not to give hope of life support but rather to make
the last remaining of her life meaningful and fulfill her wishes.
5. Make a drug study on the medications given to Jane.
DRUG
INDICATION ACTION ADVERSE NURSING
EFFECT CONSIDERATION

Acetaminophen PO, Rectal: Appears to inhibit Anorexia, nausea, If given for analgesia,
(Tylenol) Temporary relief of prostaglandin diaphoresis, assess onset, type,
mild to moderate synthesis in the fatigue within first location, duration of
pain, headache, CNS and to a 12-24 hrs. pain. Effect of
fever. lesser extent, medication is reduced
block pain if full pain response
impulses through recurs prior to next
peripheral action. dose.
IV (Additional)
Management of
moderate to sever
pain when Acts centrally on Assess for fever.
combined with hypothalamic
opioid analgesia. heat-regulating
center,
vasodilation (heat Assess LFT in pt with
loss, skin chronic usage or
erythema, history of hepatic
diaphoresis) impairment, alcohol
abuse.

Assess for clinical

improvement and
relief of pain and
fever.
Hydrocortisone Management of In pharmacologic CNS: depression, Indicated for many
(Cortef, adrenocortical doses, suppresses euphoria conditions. Assess
Cortenema, insufficiency; inflammation and involved systems
Hycort, solu- chronic use in other the normal prior to and
CORTEF) situation is limited immune response. periodically during
because of Has numerous CV: hypertension therapy.
mineralocorticoid intense metabolic
activity. Used effects.
systematically and Suppresses
locally in a wide adrenal function GI: anorexia, Assess patient for
variety of disorders at chronic doses nausea signs of adrenal
including: of 20mg//day. insufficiency
Inflammatory, Replaces (hypotension, weight
Allergic, endogenous loss, weakness,
Hematologic, cortisol in Derm: acne, nausea, vomiting,
Neoplastic, deficiency states. wound healing, anorexia, lethargy,
Autoimmune Also has potent ecchymoses, confusion,
disorders, septic mineralocorticoid fragility, restlessness) prior to
shock. (sodium-retaining hirsutism, and periodically
activity) petechiae during therapy.

Endo: adrenal Monitor intake and

suppression output ratios and
daily weights.
Observe patient for
peripheral edema,
MS: muscle steady weight gain,
wasting, rales/crackles or
osteoporosis dyspnea. Notify
health care
professional should
these occur.
Misc:
Hypertensives
reactions
including
ANAPHYLAXIS,
cushingoid
appearance (moon
face, buffalo
hump)
Dexamethasone Used systematically In pharmacologic CNS: depression, Asses for signs of
(DexPak, and locally in a doses, suppresses euphoria adrenal insufficiency
Decadron) wide variety of inflammation and (hypotension, weight
chronic diseases the normal loss, weakness,
including: immune response nausea, vomiting,
Inflammatory, has numerous CV: hypertension anorexia, lethargy
Allergic, intense metabolic confusion,
Hematologic, effects. restlessness) before
Allergic, Endocrine, and periodically
Neoplastic, GI: anorexia, during therapy.
Dermatologic, nausea
Autoimmune Suppresses
disorders, adrenal function
Management of at chronic doses Monitor intake and
cerebral edema, of 0.75 mg/day. Derm: acne, output ratios and
Diagnostic agent in Has negligible wound healing, daily weights.
adrenal disorders. mineralocorticoid ecchymoses,
activity. fragility,
hirsutism,
petechiae

Endo: adrenal
suppression

MS: muscle
wasting,
osteoporosis,
avascular necrosis
of joints

Misc: cushingoid
appearance
MORPHINE Severe pain (the 20 Binds to opiate CNS: confusion, Assess type, location
mg/ml oral solution receptors in the sedation and intensity of pain
concentration CNS. Alters the prior to and 1hr
should only be used perception of and following PO,
in opioid tolerant response to Subcutaneous, IM,
patients). painful stimuli CV: hypotension and 20min (peak)
while producing following IV
generalized CNS administration. When
depression titrating opioid doses,
Management of GI: constipation increases of 25%-
moderate to severe 50% should be
chronic pain in administered until
patients requiring there is either a 50%
use of a continuous reduction in the
around-the-clock patient’s pain rating
opioid analgetic for on a numerical or
an extended period visual analogue scale
of time or the patient reports
(extended/sustained satisfactory pain
release). Pulmonary relief. When titrating
edema. Pain doses of short-acting
associated with MI. morphine, a repeat
dose can be safely
administered at the
time of the peak if
previous dose is
ineffective and side
effects are minimal.

Patients on a
continuous infusion
should have
additional bolus doses
provided every 15-
30mins, as needed,
for breakthrough
pain. The bolus dose
is usually set to the
amount of drug
infused each hour by
continuous infusion.

Patients taking
sustained-release
morphine may require
additional short-
acting opioids should
be equivalent to 10-
20% of 24hr total and
6. Make a pain and comforting cycle for your patient using this diagram:

Crying grimacing favoring body part depression decrease function complaints

Symptoms
Bone and lung metastasis
Symptoms
 Pain
 Pain scale of
scale of 8 8
Pain scale of 8 Bone metastasis occurs when
 History  Weight
of breast cancer cells from primary loss
cancer 2 tumor relocate to the bone  Inability
years ago to move
 Numbne
Comforting ss
Comforting strategies intervention  Weakne
ss
-Create a quiet environment Discomfort Discomfort  Fatigue
 Nausea
Speak soothing words Pain may Pain may  Loss
-Play soft music, come and go. come and go.
It usually gets It usually gets
worse at worse at
Comforting night or bed night or bed
intervention rest rest

medications

-Tylenol without relief-her pain rated at an 8 on a 0 10 scale

-Hydrocortisone 7.5/750 mg. 1-2 tabs every 4 hours as needed, which

lowered her pain acuity to a 6

-adjuvant might be considered for bone pain possibly Decadron

-If experiences shortness of breath related to lung metastasis, the

Morphine and Decadron are both helpful in alleviating this symptom