You find a telephone and dial 222, you state MET call, Surgical Ward Bed 25 and then hang up.\n\nThe doctor soon appears on the ward and you show him Mr Jones chart with the observations that you have documented.\n\nYou state: \n"Mr Jones is very sedated and I am worried about him."\n\nThe doctor prescribes Naloxone 100 mcgs IV, and you give the dose immediately.\n\nThe doctor states that the patient will need to be closely monitored for the next hour.\n\nYou then ask\n"[[Should we continue with the same dose of morphine if he needs it or should we give a reduced dose?]]"\n\nThe doctor states:\n"You can use other analgesia or [[try some other things to help relieve the pain.]]"

This has been a reasonable outcome for Mr Jones. \n\nYou have given Mr Jones both alternate medications for his pain relief and some non medical interventions. Continue to monitor his pain relief, and if possible in the future try some other non medical interventions such as repositioning.

You greet Mr Jones...\n "Hi, Mr Jones, how are you feeling today?"\n\n"I am not feeling very well, my hip is hurting and nobody is giving me anything to help."\n\n"Can you tell me where the pain is?"\n\n"As I told the last nurse, it is in the hip joint and down my leg where the stitches are."\n\n" I can give you some morphine for the pain, but I would like to check with you about the pain level before I do okay, can you give me a number between 1 and 10 so I can try and gauge how severe your pain is?"\n\n"It's very severe, I'd say it's at least an 8."\n\n"What causes the pain to get worse; is it moving around or just sitting in one place?"\n\n"Moving around makes it ache a lot more so I dont want to move around."\n\n"Does it go anywhere else or does it stay in your hip and leg?"\n\n"No, it's only in those areas and it is really painful."\n\n"What type of pain is it, sharp, dull or does it just ache?"\n\n"It's a nasty ache as I said before."\n\n"Is the pain constant or does it come and go?"\n\n"It's constant and nags like a tooth ache, its aggravating because it doesn't go away."\n\nYou decide to [[try some other things to help relieve the pain.]]\n\n[[You give another dose of morphine as prescribed.]]\n\n

You agree with your workmates about Mr Jones. You understand that his operation was a large one and the amount of tissue damage would cause a lot of pain but you also believe that his current analgesia should be enough to control the pain he is experiencing.\n\nMr Jones appears to be very uncomfortable and states that he is not able to move very much because of his painful hip.\n\nYou state "[[You've got a large amount of pain relief onboard, so we will just give it time to work, I'll come back later.]]"\n\nYou state "I don't want to give you any more pain relief, but lets [[try some other things to help relieve the pain.]]"

You have been observing Mr Jones, he is awake now and has been asking for some more pain relief. \n\nYou decide to call the doctor and check with him about the dosage. Mr Jones has been sedated and even though his observations have improved you dont want him to relapse again.\n\nYou state:\n"I am about to give Mr Jones some more morphine but was wondering if the dose should be reduced because of the sedative effect he was exhibiting earlier in the evening?"\n\nThe doctor states:\n"Yes that would be a good idea, reduce his dose by 5 mgs and continue with his observations. You can always use some other analgesia or alternative methods for comfort if you need to."\n\nThis is a good outcome for the patient, he is now at less risk of becoming oversedated and there has been an alternative care plan put in place for future reference.\n\n

This is not a good outcome. The patient should be assessed by a doctor according to MET criteria, by not following procedure the patient has been placed at risk.\n\nPlease select restart from the list on the left of this page.

Mr Jones states he is doing much better and the paracetomol, repositioning and icepack has helped alot. He is even asking for when the physio are coming so he can get moving again. \n\nThis has been a good outcome.

You think for a moment and then you offer Mr Jones a cold pack to place on his suture line.\nYou also check his dressing to ensure that it is not too tight and you help him move to a more comfortable position in the bed.\n\nYou ask:\n"Is the cold pack helping?"\n\n"Yes that feels a bit more comfortable"\n\n"Okay then we will just give it a little more time to work, [[I'll come back later.]]"\n\n[[let me have a look at your medication chart]]\n\n\n\n

This is a reasonable action but you should also consider the use of alternative analgesia, this may help with the pain and reduce the risk of oversedation in the patient.\n\nThis is not the best outcome for the patient.\n\nPlease select restart from the list on the left of this page.

You give a dose of morphine to Mr Jones.\n\nLater in the evening you notice that Mr Jones has become drowsy and has not complained very much about his pain.\nYou take his observations and find that his vital signs have changed. His respiration rate has dropped below 8 and his sedation rate is now 2.\n\nYou discuss Mr Jones condition with another nurse and state\n\n"I think that [[I should call a MET]] for Mr Jones, he is quite sedated and I'm worried about him."\n\nThe other nurse states:\n"[[I would just observe him for a while, it most likely the morphine, it should wear off soon.]]"

Mr Jones has been admitted post an emergency right hip replacement after a traumatic fall from a horse over the weekend.\nHe has been unable to sleep well since the surgery. He states that it is because of the noise at night in the hospital and he is feeling anxious and very tired.\nHe is becoming a little aggressive with the staff and is reluctant to move around a great deal.\n\nYou are the registered nurse on duty for the evening shift of the first day post operatively for Mr Jones.\n\nYou have received handover from the morning staff and you have heard that Mr Jones is not the most pleasant patient to have due to his attitude.\n\nMr Jones is complaining that his pain relief is not working very well and he is hurting quite badly both on movement and at rest.However he does not appear to be in pain when he is sitting in bed and some of the nurses feel that the acute pain that he is complaining about may be psychological pain.\n\nYou should try [[investigating psychological pain.]]\n\n[[You decide to do a physical assessment on your patient.]]\n\n[[You decide to give pain relief]]\n\n

\nThis has not been the best outcome. Although you have applied alternative methods to increase the patient's comfort it has not really eased his pain.\n\nPlease select restart from the list on the left of this page.

You check Mr Jones' drug chart for other analgesia and you notice that he has some paracetamol written up.\n\nYou give Mr Jones one gram of paracetamol and return in half an hour to see if it has taken effect.\n\n"Has that medication helped with the pain?"\n\n"yes I feel better now, it's not hurting as much as before"\n\n[[This has been a reasonable outcome]]

You approach Mr Jones and ask him what level of pain he has.\nHe comments: "My pain level is about 8 at the moment and Im feeling very sore"\n\nYou have a look at his drug chart, note in passing that there are several analgesics available but you opt to give him some more morphine to help lower his pain levels.\n\n[[You take his drug chart]]

Pain Management

Nursing care sometimes requires thinking outside of the box, you should have considered care other than pharmaceutical that you could have given to this patient.\n\n\n\nPlease select restart from the list on the left of this page.

THO-NW