Case Study Pain Management, by Catherine Dowling.
Hi.
My name is Catherine Dowling.
I'm a nurse at Children's Hospital Boston in the cardiac ICU.
This is a case study for you to test your knowledge of pain management.
We will ask you to provide written answers.
You will not receive formal evaluation on your answers, nor will this count towards
your certification status.
Your answers will be used to assist us in improving the teaching tools and lecture materials.
You will be given a summary of the case study at the end of the video to check your answers.
Joey is a three-year-old patient who is now postoperative day one from his fontan procedure.
He was extubated overnight.
Two chest tubes remain in place.
As the nurse approaches, he is guarding and moaning while turning away and reaching for
his mother.
Breath sounds are equal, but diminished bilaterally.
His vital signs are heart rate 160, temperature 37.8 Celsius, blood pressure 120 over 78,
respiratory rate of 25 breaths per minute.
Pupils are equal and reactive to light, 3 to 1 brisk.
Question 1. From your assessment, which factors indicate the child may be in pain?
a, blood pressure of 120 over 78; b, diminished breath sounds; c, guarding and moaning; d,
all of the above.
Note, this will not be used as part of your certification assessment.
The answer is d.
All of the above observations demonstrate that the patient is in pain.
Question 2. Which pain scale or scales would be most applicable for this 3-year-old patient?
a, the FLACC scale; b, the Wong-Baker faces scale; c, all of the above; d, none of the
above.
Note, this will not be used as part of your certification assessment.
The correct answer is c.
Either the FLACC or Wong-Baker scales would be appropriate for this three-year-old child.
The FLACC scale is used in patients who are less than seven years of age.
The faces scale is recommended for a patient who is three years older.
Based on developmental level, the nurse may select either scale.
Question 3. Which therapies would you choose to help alleviate this patient's pain?
a, have the mother leave the room; b, have the mother hold the child; c, administer a
morphine bolus; d, administer diazepam.
Note, this will not be used as part of your certification assessment.
The correct answers are b and c.
The first step in settling the child should be to have the mother hold and sit with the
patient to decrease his stress level.
The next step would be to give a bolus dose of morphine to control pain.
Following the administration of morphine, the child should be reassessed within the
hour with the appropriate pain scale.
Question 4. How would you evaluate the effectiveness of the pain therapy you have chosen?
a, make sure that the patient falls asleep after the chosen intervention; b, reassess,
using the appropriate pain scale; c, reassess within one hour of the intervention; d, nothing.
The intervention should relieve the pain.
Note, this will not be used as part of your certification assessment.
The correct answers are b and c.
The patient's pain should be reassessed using the appropriate pain scale within one hour
of the intervention.
The pain therapy chosen will be effective if the patient pain score is lowered.
Question 5. Ineffective pain management may lead to which of the following complications?
a, depression of the immune system; b, increased myocardial oxygen consumption; c, increased
incidence of metabolic acidosis; d, all of the above.
Note, this will not be used as part of your certification assessment.
The correct answer is d.
All of the complications listed above are complications from improper pain management.
In summary, effective pain management techniques minimize the physical and emotional consequences
of post-operative pain.
Through effective pain assessment and treatment combining both pharmacologic and non-pharmacologic
therapies, nurses can improve patient outcomes and promote well-being.
Thank you.
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