Case Study: John Jones
John Jones, age 84, has been in a long-term care facility for four years after the death of his wife who was his primary caregiver. Mr. Jones has a history of hypertension (HTN), type 2 diabetes (controlled by diet) with the long-term or chronic complication of peripheral neuropathy, osteoarthritis (OA), and gastroesophageal reflux disease (GERD). His medications include acetylsalicytic acid (aspirin)81mg every morning, furosemide (Lasix) 20mg BID, acetaminophen (Tylenol) 650mg Q 4 hours PRN pain, and omeprazole (Prilosec) 20mg BID.
Mr. Jones becomes agitated when he is assisted out of bed in the morning and winces with pain. He often complains of his hands, knees, and lower legs hurting. The pain he describes in his hands and knees can be considered pain from arthritis. He takes Tylenol for arthritis pain when offered but states there is little relief. He rates the pain in his hands and knees as a â€œ6â€ on a scale of â€œ0â€ being no pain and â€œ10â€ being the worst pain possible), and it decreases to a â€œ4â€ after the Tylenol is given. He rates the pain in his lower legs as a â€œ10,â€ and this pain decreases to a â€œ7â€ after taking Tylenol. When reviewing his medication records, you notice that he takes the Tylenol twice a day, usually in the morning with breakfast and at bedtime. The nurse caring for Mr. Jones notes that he will take medication when asked whether he is in pain, but otherwise he does not complain of pain. Mr. Jones states, â€œI can deal with the pain in my hands and knees, but my legs hurt all the time.â€ As a nurse, you are aware that pain is a significant problem in the older adult population as at least 50% of community-dwelling older adults, and as many as 85% of nursing home residents, suffer from pain and that pain is often undertreated in this population (Horgas, Yoon, & Grall, 2012)
It is clear that the pain Mr. Jones is experiencing is not being managed in a way that will provide him comfort. Pain is often undertreated in the older adult population related to factors found in health care providers as well as patients themselves.
As a nurse, you understand that the Joint Commission requires nursing assessment of pain as a requirement to be in compliance with regulatory guidelines for pain management.
In addition to the pharmacological pain relief measures, Mr. Jones could benefit from non-pharmacological measures to decrease both his arthritis pain as well as the neuropathic pain in his lower extremities.
- Identify one myth or misconception about pain and the management of pain in the older adult population that may have an effect on the undertreatment of Mr. Jonesâ€™ pain and discuss why these myths occur.
- Discuss the factors that add to the problem of undertreatment of pain in the older adult population.
- What are some of the major problems for the older adult who suffers from untreated pain?
- Mr. Jones has been offered morphine as well as other adjuvant medications for the pain in his legs, but he refuses as he states, â€œI donâ€™t want to get addicted to that stuff.â€ How would you describe the use of morphine for pain and the potential for addiction?
- Describe how you would assess Mr. Jonesâ€™ pain and a tool that can be used to assess pain in the older adult.
- Describe the World Health Organizationâ€™s (WHO) Three-Step Analgesic Ladder for pain management, considering the pain that Mr. Jones is experiencing. He is having a moderate level of pain, â€œ6,â€ on a scale of 1-10 related to the arthritis in his hands and knees. He is also experiencing a severe level of pain in his lower extremities related to diabetic neuropathy (he rates his pain as a â€œ10â€ [on a scale of 1-10]).
- Discuss several nonpharmacological techniques for pain management.
Horgas, A. L., Yoon, S. L., & Grall, M. (2012). Nursing standard of practice protocol: Pain management in
Thielke, S., Sale, J., & Reid, C. M. (2012). AGING: Are these 4 pain myths complicating care?The Journal
of Family Practice, 61(11), 666-670. Retrieved from http://www.chronicpainperspectives.com/articles/feature-article/article/aging-are-these-4-pain-myths-complicating-care/0bf757elf76f31745e78b94866999973.html