Case Study PATIENT Dilemma, Pain Control or Drug Seeking Behavior, STUDENT Worksheet, Angela Stevens, 28 years old, (Latest 2021) Correct Study Guide, Download to Score A

Is pain always what the patient says it is? Though the patient's rating of pain is always relevant, the nurse must collect and cluster additional clinical data to make correct clinical judgments regarding pain control. In this dilemma, a post-operative patient with a history of narcotic tolerance and chemical dependency continues to require increasing amounts of narcotics for pain control. How to guide clinical decision making without being judgmental is the essence of this patient dilemma. This study source was downloaded by from CourseH on :46:00 GMT -06:00 This study resource was shared via CourseH Clinical Dilemma Case Study Erin McLaughlin Pain Control or Drug Seeking Behavior? I. Scenario History of Present Problem: Angela Stevens is a 28-year-old woman who is post-operative day (POD) #2 after a small bowel resection and lysis of adhesions. She has chronic abdominal pain due to severe Crohn's Disease and has developed narcotic tolerance and dependence as a result. She has been clinically stable post-op, but has been c/o increasing incisional pain despite the Fentanyl/Ropivicaine epidural drip being increased from 8 mL/hr· to 12 mL/hr· earlier today. She has hydromorphone (Dilaudid) 1mg IV push prn every 3 hours for abdominal pain that remains persistently greater than 6/10 on a 0-10 pain scale. Her pain goal is to be 4 or less. Personal/Social History: Angela is a single mother of two children ages three and one. She lives in her own apartment. She has struggled with chemical dependency in the past and denies any current problems. A routine urine drug screen before surgery was positive for benzodiazepines, even though she has no scheduled medications in this pharmacologic classification. She is estranged from her mother and has little support at home. What data from the histories is important and RELEVANT? Why is this significant to the RN? (Each data point must include a corresponding significance.) RELEVANT DATA from Present Problem Clinical significance to the RN -Chronic abdominal pain from severe Crohn’s Disease developing narcotic tolerance and dependence -She has been stable post-op but has been complaining of increased incisional pain -It is important to know that she has developed a tolerance and dependence so that we, as the nurse, can be aware to watch for the s/s of addiction to hydromorphone -Since she has been stable, need to watch her VS to make sure that she stays stable and that when she does state a higher level of pain, that her VS match what she is saying RELEVANT DATA from Social History Clinical Significance to the RN -Single mother with little support at home -She struggled with chemical dependency in the past and denies current problems -Has benzodiazepines in her urine even though -She has no one that is watching her, watching for signs of addiction -A past history increases her chances of relapsing