4.3.2: FRAME 2- Analyze Cues
- Page ID
- 90022
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The hospice nurse visits Rhys, his wife, and his family. Rhys is experiencing severe, intractable abdominal and back pain. Rhys, with his family’s support, has declined disease-directed therapy and is requesting only comfort care measures. Over the past month, Rhys has had a decrease in his physiologic function, as demonstrated by a decrease in the Palliative Performance Scale (PPSv2). Rhys is now bed-bound and requires total assistance with his self-care. He has reduced oral intake and episodic confusion.
QUESTION: Matrix Multiple Choice
Scoring Rule: 0/1
Hospice care includes an interdisciplinary team to provide supportive care services. The nurse recognizes Rhys requires additional comfort interventions.
What interventions can be implemented to assist in reducing Rhys’s current pain? Each row should include a single choice.
| Intervention | Appropriate | Not Appropriate |
|---|---|---|
| Morphine | ||
| Music Therapy | ||
| Lorazepam | ||
| Range of Motion | ||
| Aroma Therapy | ||
| Spiritual Care | ||
| Fentanyl Patch | ||
| Massage |
Putting It All Together
DEBRIEF
The first step in managing pain is to conduct a pain assessment. Pain assessment includes the client ranking their pain on a scale of 1-10. One being little or no pain and 10 being the most severe pain they have ever experienced. In addition to a subjective report from the client, the nurse should observe for non-verbal pain cues such as guarding, jaw tightening, clenching fists, change in breathing pattern, grimacing, or pursed lips.
Comfort care measures include medication by any route, positioning, oxygen, suction, and manual treatment of airway obstruction as needed for comfort, wound care, pain assessment, or other measures to relieve pain and suffering. Interdisciplinary approaches to reducing pain include music therapy, aroma therapy, massage therapy, and spiritual care.
Pharmacological options for pain control may include Morphine and Fentanyl patches. Holistic nonpharmacological options for pain management include music therapy, aromatherapy, massage, and spiritual care. Lorazepam is indicated for anxiety and does not directly reduce pain; however, Lorazepam may influence the experience of pain by decreasing anxiety. Rhys is experiencing severe, intractable abdominal and back pain; therefore, passive range of motion is not an appropriate intervention at this time.
RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)
Managing pain for a client receiving palliative or hospice care can be challenging. Providing quality care requires effective pain assessment and implementing culturally congruent measures to manage the client's pain. When nurses consider the client's cultural pain expression, values, beliefs, and experiences, they improve the quality of care and are also better able to help the family adjust to the dying process (Gilver et al., 2023). The SDOH domain, Health Care Access and Quality, incorporates access to resources, knowledge of existing resources, provider bias and reluctance to refer, understanding/misunderstanding of services, and service eligibility criteria (Gilver et al., 2023).
What Do You Think About?
- What are some additional nonpharmacological measures for managing pain to avoid pain triggers that could be used with Rhys?
- Compare and contrast the benefits and disadvantages of oral morphine and the fentanyl patch for pain management. Consider the pharmacokinetics and pharmacodynamics of each.
- What other services can be part of the collaborative care team?