NUR 231 Evidence Based Nursing Research


Mr. Edward Hunter, an 89-year old widower, was admitted to your medical ward 5 days ago with end-stage idiopathic pulmonary fibrosis, hypoxaemia (oxygen saturations 82% in the ambulance) and a bacterial chest infection. He has been receiving intensive home support from the ‘acute care in the home’ nursing team for over 6 months, which includes home oxygen therapy. One month ago he suffered a myocardial infarct, which was preceded by frequent episodes of unstable angina. He had a coronary stent in 2007.

Mr. Hunter’s condition continues to deteriorate. He is receiving 15 litres oxygen via the nonrebreather mask. Severe dyspnoea renders him immobile and barely able to eat. He has little appetite and is cachexic. At night, he becomes quite restless and distressed by his pain, breathlessness and cough. The palliative care team reviewed Mr. Hunter 4 days ago because he was experiencing increased pleuritic pain on inspiration. Subsequently, he was prescribed morphine 5mg (5mg/ml) solution nocté for the analgesic, cough suppressant and sedative (narcotic) effects.Yesterday evening, in handover given to the night duty nursing team, it was explained that the palliative care team had reviewed Mr. Hunter again and reduced the dose of morphine to 2-0 – 2.5mg nocté because he was becoming drowsy during the day but was easily roused and orientated once woken and maintaining oxygen saturations 92 -94%.
1.Discuss the common fears and myths that interfere with health-care professionals providing adequate pain management to patients
2.Explain why is it important to recognise an opiate-naïve patient? Discuss how the nurse can mitigate the risk of adverse effects from administration of opiate medications in the opiate-naïve patient experiencing acute pain
3.The central principles of social justice in a health care context are self-determination, equity,access and rights and, participation. How do you interpret the actions of the nurse in withholding the prescribed morphine solution (nocté) from Mr. Hunter in relation to social justice principles Discuss the potential impact on Mr. Hunter if he perceives his treatment for pain to be unfair and unjust.
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