Mrs. R: A Case Study

Bone pain: Tiny fractures in the bones, causing bone pain often results due to the accumulation of plasma cells and weakened bone structures. The most common sites of bone pain are back or the ribs, but usually any bone can be affected. Pain is usually worse with movement and at night.

The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety

Pain is one of the most common and feared complications of cancer. It is exacerbated by stress, anxiety, fatigue, and malaise which accompany advanced cancer. Pain is generally absent in the early stages of cancer, but it is a significant factor as the illness progresses to advanced stages. Cancer-associated pain can arise from a variety of direct and indirect mechanisms including direct pressure, obstruction, and invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation (McCance 2010). Pain is generally accepted as whatever the patient says it is, wherever the patient says it is. Treatment of pain and its associated symptoms is a primary responsibility of the healthcare team. Treatment modalities for pain include the use of opioid analgesics, patient-controlled analgesia, psychological interventions, and preventing recurrence of pain. Reinforcing the reporting of pain by the patient is important, as is a respect for the social and cultural differences with respect to pain perception.

The mentality of some patients that are prescribed painkillers is that it will cure whatever illness they may have and permanently take away the pain; however painkillers, are supposed to be used to reduce pain for a short period of time to bring comfort to a patient. Due to this mentality, it is becoming more common to run to pain medications; even when some pain can be treated with other methods. In order to start to cure this epidemic, patients need to be compliant with how they are supposed to properly use these types of medications. (Grounder,

Despite the fact that pain is universally recognized as a part of the healing process, ways to minimize its impact on patients have not been aggressively pursued. The modern perspective of pain merits the use of painkillers for both short term and chronic pain, but studies suggest that the likelihood of drug dependence increases with the intensity of the pain, extent of drug use, and frequency of drug use. (Elander, Duarte, Maratos, & Gilbert, 2013). Patients may prefer not to use painkillers such as opioids due to debilitating side effects and fear of developing dependence, yet there are few alternative methods taught to patients to help manage pain.

Identification of pain has been the most feared and common symptom of cancer (Sloan, et al. 1999). The joint project that includes primary, secondary and tertiary levels of care were successful in breaking down the barriers that crossed traditional boundaries in cancer care. Steering committee member were identified and meetings took place between multi-professional teams and project coordinators to identify their issues and concerns and communication, discharge, pain management and symptom control were identified. Multidisciplinary groups worked were

Pain, which is defined in its widest sense as an emotion which is the opposite of pleasure (White, 2004, p.455), is one of the major symptoms of cancer, affecting a majority of sufferers at some point during their condition (De Conno & Caraceni, 1996, p.8). The World Health Organization (WHO, 2009, online) suggests that relief from pain may be achieved in more than 90 percent of patients;

Only 6 of the informants were on regularly prescribed pain medications. Those on opioids took formulations that included an NSAIDs. Acetaminophen was most commonly used for over the counter pain management. Non-pharmacological interventions used for pain management included prayer, massage,elevation, distraction, visualization, warm compress, position change, nutritional supplements (vitamin B6 ) for neuropathy, etc. Informants frequently described that they wanted their personal experiences to be kept to themselves so not to seem vunerable, and the expression of pain was a sign of weakness in the community. Informants also expressed an aversion to taking pills, especially opioids because of the foggy side

Bone cancer is considered as a rare disease in which cancer cells grow in the bone tissue. It requires to be treated immediately because when bone tumor grows, it presses on healthy bone tissue and can destroy it, which causes pain and swelling where the tumor is located. People has bone cancer will experience burning pain at the early stage and as the tumor develops, the pain become more persistent. Beside that, the bone can easily break due to the cancerous cells can weaken the bone. In some cases, if the tumor grows near a joint, it may make normal movements

Non-pharmacological adjuvants are non-medicinal elements which could include music, relaxation, breathing techniques, imagery, distraction, and massage (Sylvia, Carol, LeeAnn & MSN, 2011). Assessments of pain and side effects refer to the examination of a patient at regular intervals of time. Intervention and reassessment is based on changes related to previous pain and side effect assessments. Patient education is training individuals on how to manage or prevent pain with medication and activity. Goal setting is designed to aid in maintaining and reducing pain by allowing the patient, nurse, and doctor to work together in order to form a plan of pain management. All concepts work together to promote a balance between analgesia and side effects.

If Aisha is alert and cognitive, I will speak to her first to find out her position on taking narcotics to relieve her pain. Then I will encourage Aisha to discuss her feelings with her husband about whatever decision she has made. Then I will assess the situation further and provide teaching to both Aisha and her husband around pain medication, side effects and the therapeutic effect. I will involve the medical doctor (MD) and pharmacist to give further teaching if required. I will also find out from Aisha husband his reason for not wanting Aisha to take narcotics. Aisha husband reason may be guided by Muslim religious principles which place strict conditions on the use of narcotics. Muslim also believe patiently bearing pain is of divine significance (Branden & Broeckcert, 2010). A nurse should take into consideration applicable culture and religious believe of patient and family teaching. A nurse need to advocate for their patient well-being by: listening to, understanding and respecting patient valves opinions, needs and ethno cultural believes (College of Nurses of Ontario, 2009)

For this unit I chose Ewing's sarcoma, a malignant bone tumor, and a primary bone cancer that originates in bone cells. According to Derrer, David a medical reviewer for WebMD, Ewing's sarcoma is a family of tumors that is located in the long bones of the legs and arms, or bones in the chest, pelvis, back, or head (2014). It also develops in the skull or flat bones of the trunks. The most common symptoms of Ewing's sarcoma is pain, however symptoms might vary, depending on the size and location of the cancer. Other symptoms may also include swelling, tenderness, or stiffness in the affected area, fracture, fatigue, fever, weight loss, and anemia. The exact cause of Ewing sarcoma is not fully understood. There seems to be no known risk factors

Metastasis to the bone occurs in 30-70% of cancer patients with metastatic cancer; depending on the primary site of disease.1 Bone metastases can cause severe pain, spinal cord compression, hypercalcemia and pathologic fracture.2 In the subset of cancer patients the goal of treatment is to relieve symptoms caused by the metastasis and/or to control the growth. The primary goal of palliative treatment is to improve patient’s quality of life (QoL) and prevent or treat the symptoms of their disease.

Chronic Pain is an interesting problem in society today. The exact cause of Chronic Pain is not the same in every patient. In fact most patients present with different symptoms and associated pathologies, such as the strong link with depression. Treatment of Chronic Pain is often performed a single practitioner whether that be a Medical Doctor, Chiropractor, Nutritionist, or an alternative health care professional. Chronic Pain is often extremely complex, because of this treatment needs to be multidimensional. Effective care of Chronic Pain requires the collective cooperation of health care professionals

While there are different types of bone cancers, the symptoms for each are generally about the same with the severity varying with the size and location of the tumor (Upstate Medical University, 2014). The most common symptom is pain, which, in the case of cancers such as osteosarcoma, chondrosarcoma, and Ewing’s sarcoma, may occur in the arms, legs, and knees. The pain may start out as being infrequent and only occur at night or when the bone is in use. Over time, as the tumor grows, the pain will increase and become more persistent. The pain is often accompanied by swelling and sometimes even a palpable lump, depending on the location. Fractures can also result due to weakened and fragile bone where malignancy is present (American Cancer Society, 2015). As the cancer progresses, other possible symptoms include fatigue, unexplained weight loss, fever, night sweats, and trouble breathing (Upstate Medical University, 2014).