Basic Nursing 1st Edition by Judith Wilkinson, Leslie Treas

Exercise 19

Patient Situation
Ivan Benjamin has just been admitted to an orthopedic unit after an automobile accident. He was driving. Mr. Benjamin is 80 years old and has been living at home. He has these preexisting comorbidities: type 2 diabetes and osteoarthritis. He has casts and traction on both legs and a cast on one arm. He is receiving morphine sulfate intravenously via patient-controlled analgesia (PCA) pump. Imagine that you are an orthopedic nurse and must plan care for Mr. Benjamin. The admitting nurse wrote the following diagnoses and goals on the plan of care.
Nursing Diagnoses Goals/Expected Outcomes
1. Acute Pain secondary to musculoskeletal trauma (arms, legs, body) and muscle spasms
2. Risk for Peripheral Neurovascular Dysfunction secondary to casts/traction
• Demonstrates correct use of PCA pump
• Rates pain not higher than 4 on a scale of 1 to 1.0 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 sec
Thinking
Critical Thinking (Considering Alternatives): Older adults are especially sensitive to certain medications, including morphine sulfate. What is one thing you could do to ensure Mr. Benjamin's safety while managing his acute pain (there are several; think of just one)?