Twenty-four hours ago, 38-year-old Mr. Mei Heung received multiple trauma injuries in a motor vehicle crash. He sustained fractures of his left femur and left humerus, both of which required open reduction, and required repair of a liver laceration. In addition, he has rib fractures and a pneumothorax on the left side, resulting in placement of a chest tube on the left. Mr. Heung is intubated and breathing with the assistance of a positive pressure mechanical ventilator. His medical history is noncontributory and his family history is negative for diabetes, cancer, or heart disease. Mr. Heung is drowsy and oriented only to his name. He cannot speak due to the endotracheal tube. A central intravenous line is present in his right subclavian vein. He has a Foley catheter in place as well as a nasogastric tube to intermittent suction.
QuestionsThe module discussed the importance of assessing a patient for potential sources of pain, particularly when the patient is unable to self-report pain. List the potential sources of pain for Mr. Heung based on the facts of the case.
Jim B., a new ICU nurse, is preparing to assess Mr. Heung's pain but is uncertain as to which type of assessment would be the most appropriate to use in his situation. He asks his co-worker, Donna, a more experienced ICU nurse, what would be the best approach for assessing Mr. Heung's pain. Based on what you have learned about pain assessment in the high-acuity patient, what should Donna tell him?
Mr. Heung's wife expresses concern that her husband is receiving intravenous opiates for his pain, telling the nurse that she is afraid that he will become addicted. How should you, the nurse, respond to Mrs. Heung to reduce her fears?
The nurse notes that a new order has been written for meperidine (Demerol®) for Mr. Heung. The nurse is aware that this analgesic agent is no longer recommended. A) Briefly explain the reason meperidine is no longer recommended. B) What is the appropriate action for the nurse to take?
A few days after the accident, Mr. Heung's respiratory status has improved enough to be removed from the ventilator, although the chest tube is still in place. The nurse prepares to give Mr. Heung another dose of morphine intravenously. What potential complication does the nurse need to be aware of and assess for after giving the medication?
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