Mr Rogers is 2 days postoperative of a thoracotomy of removal of a malignant mass in his left chest. His pain is being managed via epidural catheter with morphine. As the nurse assumes care of Mr Rogers, he is alert and fully oriented and states that his current pain is 2 on a 1 -to-10 scale. His vital signs are 37.8-92-12, 138/82. What are benefits of epidural versus systemic administration of opioids? The nurse monitors Mr Roger’s respiratory status and vital signs every 2 hours. What is the rationale for this frequent assessments? The nurse monitors Mr Rogers for what other complications of epidural anelgesis?

Question

09-07-2019
Medicine

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Mr Rogers is 2 days postoperative of a thoracotomy of removal of a malignant mass in his left chest. His pain is being managed via epidural catheter with morphine. As the nurse assumes care of Mr Rogers, he is alert and fully oriented and states that his current pain is 2 on a 1 -to-10 scale. His vital signs are 37.8-92-12, 138/82. What are benefits of epidural versus systemic administration of opioids? The nurse monitors Mr Roger’s respiratory status and vital signs every 2 hours. What is the rationale for this frequent assessments? The nurse monitors Mr Rogers for what other complications of epidural anelgesis?

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cnavia19 cnavia19 · Answer 1 · 2019-07-17T18:03:14+02:00

Answer:

Any aggressive surgery, like this one, where there is affectation of various organs of the body, and irritation on the part of the tissues, as well as the risk of severe complications, requires both pain management and constant monitoring. In a thoracotomy, like the one Mr. Rogers underwent, most organs of the thorax, but most particularly the entire respiratory tract, suffers mostly from the intervention. As such, nurses must be aware of the care these patients need.

In answer to question 1, what are the benefits of Mr. Rogers having an epidural catheter, instead of a central line, for pain management with opioids, would be that aside from pain being managed more centrally, and more aggressively, as the opioid is delivered directly to the epidural lining, near the spinal cord, it also has been shown to reduce the risk of other complications, particularly pulmonary complications, like lung failure, or maltreatment of the airways due to intubation, that would be needed for central-line systemic pain management. It has also been shown to reduce heart risks, and a shorter time of stay of patients inside intensive care units. Finally, but not least of all the benefits, patients with this form of pain management show lesser chances of presenting stomach and intestinal bleeding,

In answer to question 2, why the nurse checks Mr. Rogers´ respiratory status and vital signs every 2 hours, that because aside from being protocol, when there is a chest surgery, like this one, where the respiratory tract has been manipulated, there is always the huge chance of respiratory failure and complications. In fact, the mortality and morbidity in cases like this, due to respiratory complications and adverse events, is pretty high, and therefore, requires that the nurse be aware of the vital signs that will show if any of the organs is presenting unusual activity.

In answer to the 3rd question, one severe problem of the epidural line for pain management is always the risk of infection, especially since the line connects directly to the epidural lining of the spinal cord. There should also be monitoring of possible oedema of the lower limbs, numbness in any portion of the lower body, bleeding, or if there is presence of cerebrospinal fluid anywhere where the catheter has been inserted. There also shouldn´t be the presence of drowsiness, or sleepiness in the patient. These are only a few things. It has been proven that epidural pain management presents less risks than the use of central lines for systemic pain relief.