THIS IS THE ASSIGNMENT THAT IS NEEDED:

Think back to meeting Justin Jones from Module 5. He was admitted after a motorcycle accident. He had surgery for fracture reduction on his legs and now has casts on both legs and one arm. For the past three days, he has been receiving narcotic analgesics for severe pain.

Today, he has a new priority problem: constipation. The nurse enters the diagnosis into an electronic care plan. In addition to a list of suggested assessments, the computer database generates the following list of suggested interventions:

• Institute a program to establish a regular pattern of bowel movements
• Administer laxative or stool softener, as prescribed
• Administer enema
• Remove stool manually
• Encourage increased fluid intake, including warm liquids; instruct on and encourage a high-fiber diet
• Encourage a regular program of activity and exercise
• Perform manual reduction of rectal prolapse

Instructions

Write 200250 words using the discussion prompts to guide the content for your initial post. Then, respond to at least two of your peers posts.

Discussion Prompts

• As a nurse, which interventions would you choose and why?
• Identify one resource to support your answer. Be sure to cite your resource using APA (7th ed.) format.

Previous Assignment may be needed to understand: PS THIS IS JUST FOR BACKGROUND KNOWLEDGE, NOT THE ACTUAL ASSIGNMENT. THE INFO BELOW IS JUST FOR BACKGROUND KNOWLEDGE.

Client Information

Meet your client, Justin Jones.

Justin Jones has just been admitted to an orthopedic unit after an automobile accident in which he was driving. He is 80 years old and has been living at home alone. Justin Jones has a history of Type 2 DM and osteoarthritis. He has casts and traction on both legs and a cast on one arm. He is receiving morphine sulfate intravenously via PCA pump. The admitting nurse wrote the following diagnoses and goals on the plan of care.

The nursing diagnosis is acute pain secondary to musculoskeletal trauma (arms, legs, body) and muscle spasmsrisk for Peripheral Neurovascular Dysfunction secondary to casts/traction.

GOALS/EXPECTED OUTCOMES

• Demonstrates correct use of PCA pump
• Rates pain not higher than 4 on a scale of 1 to 10 at all times
• Peripheral pulses palpable
• Fingers and toes warm
• Fingers and toes without pallor or cyanosis
• No edema of fingers and toes
• Capillary refill less than 3 seconds

Critical Thinking Questions

1. What general knowledge will you need to care for this client?
2. What is one thing you could do to ensure Justin Jones safety while managing his acute pain? List two more things you need to know about Mr. Jones to begin his discharge planning.
3. What is another nursing diagnosis you might want to include for Justin Jones?
4. Rewrite the goals/expected outcomes for Acute Pain so that they will have all the required components. Assume that todays date is November 10.
5. What beliefs, values, biases, or emotional responses might interfere with your ability to provide the best care to Justin Jones

The general knowledge that I need to possess to take care of Mr. Jones includes:

• Pain management and use of PCA: the patient is receiving morphine sulfate through the PCA, so I need to know how to manage the device and appropriate dosages (Nemati, 2015).
• Perform neurovascular assessment: the 5 Ps of neurovascular assessment include pain, pallor, pulse, paresthesia, and paralysis (Judge, 2007).
• Orthopedics and immobility: the patient has casts on both of his legs and one arm, and he has muscle spasms.
• Geriatrics and comorbidities: since the patient has been diagnosed with Type 2 DM, it might have an effect on healing or increase the risk of infection. Osteoarthritis will impair the patients mobility.
• Safety standards: fall risk is very high due to mobility issues and age.

Question 2

I need to monitor Mr. Joness respiratory rate, oxygen saturation, consciousness and sedation level while he is using the PCA pump. It is necessary to prevent opioid-induced respiratory depression (Boom et al., 2012).

Two additional things that I need to know before start discharge are related to his normal everyday routine and environment:

• Does he have any support system at home like family, friends, or other caregiver that will assist him after the discharge?
• His home has stairs, is his bathroom accessible, or are there any other barriers that could affect Mr. Joness safety and mobility?

Question 3

Additional diagnosis referred to impaired mobility due to the fractures suffered by the patients that require casts, traction, and pain medication. It is necessary to address immobility risks like pressure ulcers, muscle atrophy, infections, and self-care deficit. There is a risk of constipation due to the use of opioids and immobility (Sizar et al., 2023).

Question 4

Diagnosis: acute pain resulting from musculoskeletal trauma and muscle spasms as documented in the patients report.

Goals and expected outcomes:

• Patient verbalizes correct understanding and demonstrates proper use of the PCA pump.
• Patient must report a pain level 4 on a 0-10 pain scale at all times while using the PCA pump.
• Patient exhibits a relaxed facial expression and his body posture does not indicate pain.
• Stable vital signs and palpable peripheral pulse.
• No signs of edema, pallor or cyanosis on fingers and toes.

Question 5

First of all, there is an age-related bias since Mr. Jones is 80 years old, regarding his ability to accurately report pain or independence issues. There are emotional issues especially if Mr. Jones does not have a caregiver at home that can provide assistance due to the complexities of care and impaired mobility. There is also a bias towards opioid use since it could lead to addiction and even over-sedation. There is also a biased towards cultural beliefs that men should be tough even at old age and they should tolerate pain leading to inaccurate pain reports.

References

Boom, M., Niesters, M., Sarton, E., Aarts, L., W. Smith, T., & Dahan, A. (2012). Non-Analgesic Effects of Opioids: Opioid-induced Respiratory Depression. Current Pharmaceutical Design, 18(37), 59946004.

Judge, N. L. (2007). Neurovascular Assessment. Nursing Standard, 21(45).

Nemati, M. (2015). The evaluation of the benefits of pain control by patients using PCA pump compared to medicine injection to ease the pain by nurses. Journal of Medicine and Life, 8(Spec Iss 4), 144149.

Sizar, O., Gupta, M., & Genova, R. (2023, August 7). Opioid induced constipation. Nih.gov; StatPearls Publishing.

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