Case Presentation Jenny Alvers is a 38-year-old otherwise healthy female who has been admied directly to the intensive care unit (ICU) after an automobile accident and emergency abdominal surgery. In addition to surgery, she has deep face, neck, and chest lacerations and contusions. Jenny is on a ventilator and somewhat disoriented and restless with elevated blood pressure and heart rate. She is unable to provide a report of pain, but based on her pathologic condition, the nurse assumes that Jenny has pain and consults with the surgeon about orders for a continuous IV opioid infusion. Knowing that Jenny will be subjected to painful procedures such as endotracheal suctioning and wound care during her stay in the ICU, the nurse also requests supplemental IV opioid doses to admin prophylactically. Jenny’s sister reported that Jenny has no allergies but experienced severe nausea when she was given IV morphine following an appendectomy 3 years ago. The surgeon prescribes an IV infusion of hydromorphone at a dosage appropriate for an adult with moderate to severe pain and supplemental IV hydromorphone bolus doses every hour as needed. Scheduled doses of IV acetaminophen and IV ibuprofen are also ordered.
The nurse suspects that Jenny’s restlessness could be related to unrelieved pain and therefore administers an IV hydromorphone loading dose before initiating the infusion. Infusions of IV ibuprofen followed by IV acetaminophen are also administered. An aqua pad circulating cool water is placed over Jenny’s chest to provide additional analgesia. The nurse reduces the external stimuli in the room as much as possible and provides Jenny with calm reassurance and orientation while caring for her. Within 45 minutes of these interventions, Jenny is no longer restless, her vital signs are within normal limits and stable, and she appears to be resting comfortably. Ister
Case Analysis Questions
1. What factors place Jenny at high risk for inadequate pain relief?
2. What methods should be used now, and in the future, to assess Jenny’s pain?
3. What type of pain is Jenny most likely experiencing? How does this information affect treatment decisions?