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Fundamentals of Nursing

Chapter 30

Fundamentals of NursingChapter 30

Chapter 30

Unfolding Case Study

1.
The nurse should recognize that the patient is experiencing severe 7/10 back pain. The rest of the patient’s vitals are currently stable.
2.
To gather subjective information about the patient’s pain, the nurse should perform a “PQRSTU” assessment. During this assessment, the nurse can get more information about what makes the pain worse or better, what the pain feels like, where the pain is felt, how severe the pain is, when the pain started, and what the patient thinks is causing the pain. Objective information would be gathered by checking vital signs and assessing for body language that is indicative of pain such as grimacing or moaning.
3.
The patient has a history of osteoarthritis, so the nurse might hypothesize that it could be contributing to some of the back pain. Additionally, the patient could be experiencing distress from being in the hospital that is manifesting as physical pain.
4.
The rationale for the ketorolac is immediate pain control. Ketorolac is an NSAID that is indicated for the treatment of breakthrough pain and is used to manage moderate to severe pain, such as the pain displayed by the patient in this case study. Physical therapy is ordered to help the patient with exercise and movement that may improve the back pain related to immobility.
5.
One of the main side effects of ketorolac is drowsiness, so the nurse should closely monitor for excessive fatigue. The nurse can monitor for this by frequently assessing the patient’s level of consciousness and monitoring for changes. Another major adverse effect is GI bleeding. The nurse will monitor the patient closely for early warning signs such as tachycardia or a decrease in hemoglobin. Ketorolac can also cause Steven-Johnson syndrome, so the nurse should stay with the patient for a few minutes after administering the medication to watch for the development of a facial rash.
6.
Assessment findings that would indicate effectiveness of the interventions include stable vital signs, lower pain score reported by the patient, and lack of body language cues (e.g., grimacing) that suggest pain.
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