Scenario 4: Jason Brown

Jason Brown is a 21 year old college football player. It is the first post-op day following
surgery of a fracture of his right tibia and fibula. He has sutures over the anterior knee
and the lateral malleolus and a posterior splint on the right leg. He reports considerable
pain. He has an IV of N/S infusing TKVO. O2 is @ 2L./min via nasal prongs.

DR’s Orders:
VS q4h
IV N/S TKVO
C&S swab knee site
Change drsgs. on sutures daily
Morphine 5-10mg IM/IV q4h – prn for pain
Senekot S i-ii tabs OD

Nursing diagnosis:
1) Acute pain related to fractured right tibia and fibula as evidenced by patient’s
complain of considerable pain.
2) Risk for infection related to surgical incision on right anterior knee as evidenced
by doctor’s order of culture and sensitivity swab on the knee site.
3) Risk for constipation related to Morphine as evidenced by Doctor’s order of
Senekot.

Nursing Intervention:
1) Administer pain medication as ordered.
2) Monitor Vital signs. Change dressings as ordered.
3) Encourage patient to drink plenty of fluids and increase fiber on diet. Administer
senekot as ordered.

Morphine Sulfate
Brand name: Duramorph, Statex, epimorph
Generic name: Morphine sulfate
Indications and dosages: Adult PO 10-30 mg q4h prn/ subcu:5- 15 mg prn, IV: 4-10 mg
q4h prn.
Classification: Narcotic
Uses: decreases severe pain
Adverse/Side effects: Anorexia, nausea and vomiting, constipation, drowsiness, dizziness,
sedation, confusion, urinary retention, rash, flushing, bradycardia. Pruritis.
Drug Interaction: Increase effect with alcohol, sedatives-hypnotics, antipsychotic drugs
and muscle relaxant.
Contraindications: Asthma with respiratory depression, increased intra cranial pressure
and shock.
Nursing Consideration/Teaching:
1) Encourage patient not to use alcohol or CNS depressants, respiratory depression
can result.
2) Suggest non-pharmacologic measures to relieve pain as patient recuperates from
surgery.

Senekot
Generic name: Docusate sodium
Pregnancy category: C
Classification: Laxative, Emolient
Action: Acts by lowering the surface tension of the feces and promoting penetration by
water and fat, thus increasing the softness of the fecal mass
Uses: To lessen strain of defecation in persons with hernia or CV disease or other
diseases in which straining at stool should be avoided.
Contraindications: Nausea, vomiting, abdominal pain, and intestinal obstruction.
Drug Interaction: Docusate may increase absorption of mineral oil from the GI tract.
Side effects: Excess activity of the colon resulting in nausea, diarrhea, or vomiting.
Obstruction in the esophagus, stomach, small intestine or rectum.
Client/Family Teaching:
1) May administer PO solutions of docusate with milk or fruit juices to help mask
bitter taste.
2) Drink a glass of water with each PO dose.
3) When used in enemas, add 50- 100 mg to a retention or flushing enema.
4) Because docusate salts are minimally absorbed, it may require 1- 3 days to soften
fecal matter.