Pain Case Study

Answer the following questions based on this case study

RJ is a 79 year old man who fell when he got out of bed to go to the bathroom at home. He arrived to
the unit with Buck’s traction to his R lower leg, and had surgery for a Right hip fracture two days ago. He
lives alone since his wife died, and his children say he is active, but becoming a bit forgetful. They also
say he is very proud and does not like to look weak or ask for help. He does admit that his R hip is a bit
uncomfortable, but he’d like to wait for pain medication. The nurse comes to assess him and notes that
he is restless in the bed and grimacing as he tries to adjust his position in bed. His vital signs are T 98.8,
HR is 99, RR is 26, and BP Is 168/100, which is an increase compared to his baseline vital signs. He is not
hungry and picked at his lunch and refused to order dinner. His physician prescribed morphine IV every 4
hours as needed for severe pain, hydrocodone and acetaminophen every 4 hours as needed for
moderate pain, and acetaminophen every 6 hours as needed for mild pain. RJ insists that the
acetaminophen is all he needs and the nurse gives him the acetaminophen for pain that he reports as
“just a little pain.” Upon reassessment, the vital signs and observations are unchanged and RJ is resistant
to the nurse’s offer to help him get repositioned and refuses to get out of bed with physical therapy.

 What are the priority assessments with this patient?

Monitor vitals, monitor for signs of DVT (edema, pulmonary embolus, tenderness on palpation), and
investigate reasons for refusing pain medication regimen.

 What is the significance of the patient’s behavior and change in vital signs?

Patient refusing to report pain honestly leads to mis-matched intervention. Increase in pain is
associated with increased HR, BP, and RR.

 What should the nurse teach this patient about the pain medication ordered and why he should
or should not use it?

Managing pain is more effective when planned ahead with a structured schedule. It takes time for
medications to work. It is recommended to continue and take pain medications before intense pain
is felt, so that pain is managed at a comfortable level.

 Identify at least 3 different non-pharmacologic measures the nurse could use to reduce the
patient’s pain in addition to the use of pain medication.
(1) Physical therapy
(2) Guided imagery
(3) Ice pack