Section 1
Part A: Assessment
Cause
Hank’s pain comes from a two-year-old surgery and radiotherapy for his left lung mesothelioma.
Objective Data
Hank is alert, oriented and can respond to questions in an appropriate manner. Hank’s skin appears pale with slight perspiration. The VAS assessment kit shows an intensity score of 2/10. Furthermore, Hank demonstrates distress on movement with visible restrictions on trunk movements. Finally, Hank’s chest is clear though with reduced air entry.
Subjective Data
Hank explains that he has a constant burning pain localized in his left chest area. He states that the pain has been continuous since surgery two years ago. This pain is at a chronic stage and has left him in an incapacitated state. Currently, Hank’s activity level is limited to a level where he cannot walk a distance of more than 100 meters. Finally, Hank reports mood fluctuations based on various pointers such as suicidal, frustration, and anger.
Individual factors
Sensory
Horn et al. (2012) find it necessary to quantify pain as a way determining the appropriate treatment plan. Hawker et al. (2011) view the VAS scale as essential in quantifying Hank’s pain. Consider the question, “How would you score your pain intensity on a scale of zero to ten?” Hank’s response question would show a mild score of 2/10, which Hank states never reduces below that level. He added that on an occasional basis, the pain increases in severity to levels of 8/10.
Emotional Distress
Emotional distress is one of the most common components of pain. Shaw and Linton (2011) note that the typical emotional pain reactions include fear, anxiety, depression, and anger. Consider the question: “How does this pain make you feel?” As a patient with persistent pain, Hank’s emotional components would range in between anger, suicidal tendencies, and frustration.
Beliefs and Attitudes
Individuals possess a series of presumptions concerning pain and what it means to experience various forms of pain. Shaw and Linton (2011) note that the component serves as a guide for stimuli interpretation and response strategies. The nurse could consider the question: “How long have you had this pain?” The answer would be that the pain is post-operative related from surgery two years ago and radiotherapy. In Hank’s case, movement and constant activity intensify his pain, resulting in constant mood swings.
Tools
The nurse would use the visual analog scale (VAS) to help in self-reporting Hank’s pain. The VAS is a reliable tool that rates pain based on a scale of zero to ten on an increasing magnitude. Second, the McGill Pain Questionnaire would serve a great function in assessing the evaluative, affective, and sensory elements of pain in Hank. The tool contains four categories that would evaluate the affective, evaluative, sensory, and miscellaneous components of Hank’s pain. Each of these elements has various pain intensity scales and rating indices associated with various descriptors (Hawker et al., 2011; Herr et al., 2011).
Third, the Brief Pain Inventory (BPI) helps in quantifying pain intensity and related disability to address the patient’s functional status. The BPI will be ideal in assessing Hank’s pain severity and interference. For instance, for severity, the scale uses items such as ‘worst,’ ‘least,’ and ‘average’ as potential descriptions. For interference, the scale measures the pain’s interference with seven activities including general activity, sleep, mood, life enjoyment, work, walking, and relationship with others (Kumar, 2011).
Finally, the Chronic Pain Grade Scale is a multidimensional tool that assesses pain intensity and related disability. The tool is suitable for all chronic pain conditions through the combination of subscale scores to determine the chronic pain grade. The hierarchical categories range from zero for no pain to four for severely limiting pain (Hawker et al., 2011).
Part B: Type of Pain
Hank is suffering from somatic and chronic neuropathic pain. Fallon (2013) asserts that the pain could happen because of a cancer tumor pressing on a group of nerves. Fallon (2013) further defines chronic pain as a kind of pain that lasts for several months beyond the treatment process of a condition. People will often describe such pain as burning or heavy sensation along the affected area. For Hank’s case, the pain comes as a form of burning sensation in the left rib cage area.
One can also determine that Hank is partly experiencing moderate somatic pain. Macaluso and McNamara (2012) describe this pain as localized and skin, muscle and bone related. The author asserts that the pain is the kind that most patients would consider as normal. Based on Hank’s assessment, the pain is localized to the left thorax and occurs as a burning sting. Hank’s pain is also constant and intensifies with movement.
Hank’s physiological changes might include the following. First, Hank would experience shortness of breath as well as increased heart, and blood pressure rates. Second, anxiety and panic are commonplace in individuals with cancer-related illnesses. Hylands-White et al. (2016) state that these symptoms would result in increased respiration, blood pressure, and heart rates. Third, there would be changes in skin color to pale and increased body temperature. Fourth, Hank might start sweating. Fallon (2013) asserts that paleness happens as a result of reduced systematic blood flow. This condition would lead to increased body temperature and eventually sweating.
Section 2
Part A: Management Plan
Pharmacological intervention
Simmons et al. (2012) note that the WHO pain ladder enhances a simple pain management plan that offers relief to all forms of pain. Based on this ladder, the first step would advise the use of a NSAID drug, in this case, Ibuprofen. If the nurse still cannot control Hank’s pain, then it would be appropriate to activate the Step two analgesia. This step involves the use of a weak opioid, in Hank’s case Tramadol, in combination with Ibuprofen. At any step within Hank’s treatment, the nurse can use trials of the two anticonvulsants, Gabapentin, and Carbamazepine, for the neuropathic pain and Capsaicin for the somatic pain (Fallon, 2013).
Dependence
Based on Hylands-White et al. (2016), dependence presents a physiologic adaptation of one’s tissue to a prescription drug. Hank’s dependence on Tramadol will become evidence following prolonged usage. Therefore, withdrawal symptoms may occur if Hank stops using the drug without appropriate adjustments. The nurse can eliminate and reduce the occurrence of these symptoms through slow dose reductions.
Non-pharmacological
These options work best when administered in tandem with an analgesic. First, it would be vital to set Hank on a physical treatment. This process will involve exercises such as walking, aerobics, and stretching. Landier (2010) suggests that such methods are vital as emotional pain relievers through mood enhancement. The intervention, however, requires the presence of a physiotherapist to develop a program that would work specifically for Hank’s condition.
Second, soft music and relaxation have long been acclaimed for their artistic abilities to relieve pain in addition to providing entertainment. Ajorpaz et al. (2014)’s study agrees that it would be helpful in treating Hank’s condition by improving oxygen saturation, heart rate, and respiration rates. Such results support the idea that music and meditational intervention would reduce Hank’s pain and anxiety.
Finally, Hank’s condition also requires adequate physiological treatment. Fallon (2013) suggests that pain would worsen with anxiety, stress, and depression. Hank’s case requires treatment procedures for depression and anxiety. The best non-pharmacological treatment here would include stress management, CBT, and counseling. Such programs would play an important role in assisting Hank as a chronic neuropathic pain patient manage his condition.
Evaluation
Paice and Ferell (2011) state that the evaluations inform the nurse the extent to which patients are responding to the intervention. Therefore, an evaluation will tell them if, indeed, the pharmacological and non-pharmacological interventions reduced Hank’s pain. To ascertain the results of this outcome, it is vital that the nurse gathers information from the client and other caregivers. Positive results are those that effectively address the pain requirements previously noted during the assessment.
Part B: Education
The results from this assessment support the essence of increasing Hank’s knowledge concerning mesothelioma pain management in the homecare environment. All members of this family need to acknowledge Hank’s treatment process as the most difficult yet important in attaining optimal health. Particularly, the adult members of the household need to understand the regimen in question given dosage, side effects, and side effect treatment (Harle, et al., 2015).
Hank’s treatment process relies on a supportive home environment to help facilitate pain management practices. The family is also at risk of burnout given the psychological and physical strain related to Hank’s condition. The nurse in charge has the responsibility of offering occasional home visits to monitor his progress and offer professional support (Smith & Zsohar, 2013).
Part C: Medications
References
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Fallon, T. (2013). Neuropathic pain in cancer. British Journal of Anaesthesia 111 (1), 105–11. doi:doi:10.1093/bja/aet208
Harle, C., Bauer, S., Hoang, H., Cook, R., Hurley, R., & Fillingim, R. (2015). Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study. BMC Family Practice, 16 (48). doi:10.1186/s12875-015-0264-3
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