Question

Acute case study

Mr. B is a 73-year-old patient with a history of stroke, coronary artery disease, hypertension, and cerebral vascular disease with dementia. He is able to communicate but is often confused. His speech is scattered due to expressive aphasia. He is post-op day 2 from the right side total knee replacement. His wife, Mrs. B is concerned that he is in pain. He has been receiving oxycodone 5mg for pain every 6 hours around the clock. He is eating poorly in comparison to his normal good appetite but has managed to eat half of a waffle this morning with some orange juice and water. His last bowel movement was a day before surgery per Mrs. B. Mr. B's vital signs are as follows: HR 108, RR 28 with short periods of hyperventilation, BP 132/90, and Temp 36.8 Celsius. He is moaning on occasion but has not been talking much today. You notice that Mr. B has an occasional facial grimace and is fidgeting in the bed. However, he will relax and is reassured when his wife touches his arm or talks softly to him. Upon assessment of his right knee, there is minor swelling and bruising, but the incision is clean, dry and intact with intact sutures present with minimal dried blood present at the incision. Steri-strips are intact. The remainder of his exam is unremarkable.  

1. Which pain assessment tool will you use and why?
2. Do you feel that Mr. B's acute postoperative pain is being well managed? And why or why not?
3. What do you believe should be added or changed about Mr. B's pharmacologic management of his acute pain?
4. Is there anything about his current treatment with oxycodone that may lead to other issues based on what is discussed in his subjective exam and review of symptoms? What can be done to alleviate this problem or problems?
5. What are some non-pharmacologic treatments including integrative medicine techniques for acute post-operative pain that can be utilized along with medications to treat Mr. B's pain?

Answer 1

●COMFORT pain scale is the best tool to assess pain in a post op patient with dementia.This assess the patient alertness,calmness,vitals (respiratory distress,increased respiratory rate ,increased heart rate,increased blood pressure) muscle tone ,physical movements, facial expression and crying

●Mild pain lasts for few weeks post op but can be managed effectively, but Mr.B needs a more management to relieve his discomfort

●A patient who has undergone total knee replacement are to be provided with epidural analgesic at time interval manner but now it is not possible .So for effective pain relief patient can be prescribed a COX2 inhibitor or tramadol or acetaminophen periodically

●The patient is experiencing side effects of Oxycodone

• Constipation :increase fluid intake,fibre intake ,early mobili5
• Anorexia :provide food of choice ,supplements ,stimulants
• Confusion:The dise to be adjusted

●The non pharmacological treatment are

• Physical therapy to start early mobilisation
• Compression boot to prevent any blood clot or DVT
• Elevation of leg to reduce swelling
• Encouraging movement of ankle and foot regularly to improve circulation