Pain Management | Nursing Assignment

Nursing
Student’s name:
Institutional:

Question 1
Ted is an 82-year-old male who is day 4 post-operative following a bowel resection and
formation of a temporary colostomy. He is a widower living alone, and his wife died three years
ago due to a bout of pneumonia. He moved into a retirement village a year ago, which is two and
a half hours from the city. Ted has two children, Christopher, who lives oversea with his wife
and son, and the daughter Janice, living with her husband and three children in the city. He has a
partner Gwen 78 living in the same retirement village. Ted was Nil By Mouth for two days
(48hrs) post-operative, and full fluid diet was given on the third day. Ted was also introduced a
light meal the previous evening and today given metformin and breakfast served. He, however,
has vomited twice and has nausea which has been managed by ondansetron 4mg.
The colostomy bag is intact with stoma seen through the bag. The stoma is warm, pink, moist
and slightly above the skin. Since surgery, he has had nil output, and the bowels movements are
sluggish, and no flatus has been passed. Therefore, according to the Roper-Logan-Tierney's
model, Ted meets the activities of living such as communication, breathing, sleeping, safe
environment. However, others such as elimination, eating and drinking, working and playing,
and washing and dressing are yet to meet fully. These factors also comprise of Ted
biopsychosocial, spiritual and cultural impacts.
Question 2
Previously, Ted had a coloscopy and biopsy that confirmed a malignant mass. He has a past
medical history of type II diabetes mellitus, heart failure, obesity and gout. He has a BMI of
37.6, height 175cm and weight 115kgs. At 10 am the vital signs are as follows: BP 135/85
mmHg, T 38.1, HR 98 b/min, RR 26 and SpO2 94% on 3L NP. He also has right-sided
inspiratory coarse crackles and a moist productive cough. He also states that his abdominal pain
is of scale 4-5/10, and on palpation, the pain worsens to a scale of 7/10. Ted abdomen is
distended. The abdominal laparotomy has a clear occlusive dressing, and the minimal ooze is
present. He has a urinary catheter in situ and passing approximately 60-70mls of urine/hr and a
redivac drain with 30 mls of haemoserous fluid. His current medication includes; metformin
500mg Mane, Captopril 12.5mg mane, Frusemide 40mg mane, Allopurinol 100mg Daily and
Paracetamol 1g QID. He also has PCA morphine in situ for effective pain regulation.

Ted is Obese since his BMI is 37.6, which is above the normal range of 18.5 to 24.5 in adults.
His heart rate is a bit higher (average range=75b/min) and also the respiratory rate is a bit higher.
This is most likely due to heart failure. His current medication captopril is being administered to
manage his heart failure. He also has type II diabetes mellitus, and this is the reason for
Metformin administration while allopurinol is used to manage gout. Metformin act by decreasing
the production of hepatic glucose, lowering the intestinal absorption of glucose and improving
the sensitivity of insulin by increasing the peripheral utilization and uptake of glucose (Rena,
Hardie, & Pearson, 2017). Ted's temperature of 38.1 degree Celsius is above the normal range,
and this is a sign of infection. The cardinal signs of infection in the body includes fever, pain,
redness and swelling (Norman, 2016). His wound should, therefore, be cleaned and checked
regularly to prevent infection. Paracetamol is analgesic, and antipyretic hence is administered to
reduce pain and reduce fever.
Ted should be assessed, and all the information and cues collected to be utilized to identify
problems that need to address in regard to his health. Some of the nursing problems identified for
Ted are as follows. Impaired physical mobility (Gordon, 2014) related to pain and
musculoskeletal impairment as evidence by the patient’s reluctance to attempt movement. Ted
has undergone surgery hence impaired musculoskeletal system, also altered nutrition less than
body required requirements (Gordon, 2014) related to the inability to procure adequate amounts
of foods as evidence by patient vomiting. Ted vomited after being introduced to meals which
may lead to altered nutrition. There is also a self-care deficit related to an energy deficit as
patient’s inability toileting task independently. Pain-related to post-operative pain as evidenced
by patient reporting pain is also another problem for Ted. Also, anxiety related to surgical
procedure as evidenced by the patient being restless and Body image disturbance related to the
presence of colostomy bag. Moreover, Ted is at risk of infection due to the broken skin as a
result of surgery and also the presence of indwelling catheters. These problems, therefore, have
to be addressed and considered while making a care plan for Ted. Proper interventions have to be
implemented to ensure that Ted’s needs are met.
Question 3
Goals