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Pain Management Case Studies

802 Words4 Pages

Pediatrics. As always, CRNAs need to be meticulous and make sure their pain assessment and subsequent administration of medications to pediatric patients is age appropriate. Often the oral or sublingual route is preferred in children to avoid IV access, which may not be available (Himelstein, 2006).
Pain management techniques
Neuraxial. When opioid therapy fails, palliative care physicians will consult anesthesia for pain management recommendations. Neuraxial techniques and nerve blocks are shown in the literature to be effective adjuncts to pharmacologic pain management in both adult and pediatric palliative care patients. For neuraxial techniques, intrathecal infusions are recommended with straight local anesthetics (LA) or a combination …show more content…

Terminally ill patients may present to the OR for palliative surgery. It is important for CRNAs to have a thorough and extensive discussion with the patient, the patient’s surrogate, and the surgical team regarding anesthetic and surgical goals. This discussion should provide clarification as to whether surgical intervention or medical symptom management is the best option to treat the offending symptoms (Mercadante & Giarratano, 2012).
DNR orders are a controversial topic among anesthesia providers. CRNAs may also face an Allow Natural Death (AND) statement. CRNAs should always discuss DNR orders with the patient or their proxy prior to surgery especially since they were not part of the original discussion about resuscitation.
Some hospitals have a policy to routinely suspend DNR orders prior to surgery, however this becomes a sensitive issue when dealing with hospice or palliative care patients presenting for surgery. Not all hospice patients have DNR orders, and likewise, just because a DNR order exists, should it blindly be followed when presenting to the OR? Scott & Garvin (2012) recommend that healthcare providers treat each DNR order individually versus following a universal hospital

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1065 Words | 5 Pages

In many hospital cases a group of people in charge are always trying to make the best decisions for patients. At times decisions are usually the hardest to comprehend when dealing with life or death circumstances. In the book Five Days of Memorial by Sheri Fink, hurricane Katrina hit, doctors and nurses made a triage decision to place people into three different categories depending on their conditions. In category three, patients remaining were DNR ( Do Not Resuscitate) patients, who aren't to be revived, which were the last patients to leave Memorial Hospital. Dr Ewing Cook, a chief medical officer, states in the book of Five Days At Memorial , that they “only had two choices:quicken their deaths or abandon them.”

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1701 Words | 7 Pages

There was no consideration for the harm the patients received due to this unethical practice. The hospital was only worried about a potential $2 million dollar cost if they were cited for needing improvement (Chen, 2019). The more improvement a hospital is cited to need the less money they receive. There was no worry of the suffering the patient and the family would feel by ignoring a DNR order. Orders like this help a family from distress of not knowing what to do in these situations.

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974 Words | 4 Pages

The career I am going to pursue will be a Certified Nurse Anesthetist. A CRNA provides anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures (BLS 1). Nurse anesthetists are also referred as advanced practice registered nurses (APRNs), before a procedure begins, Nurse anesthetists discusses with a patient of any medications the patient is taking as well as any allergies or illnesses the patient may have, so that anesthesia can be safely administered. Nurse anesthetists then gives a patient the right anesthesia to put the patient to sleep so they feel no pain during surgery or any other procedures. CRNAs remain with the patient throughout a procedure to monitor vital signs and adjust

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846 Words | 4 Pages

When a terminally ill patient undergoes long and grueling unsuccessful treatments, the patient may lose a sense of hope for living and accept their death. Then they may go on to wanting control over their death and leading a patient to pursue PAS. Terminally ill patients are usually weak, tired, and uncomfortable. These are some of the main factors that qualify a patient for PAS because they interfere and prevent the patient from having a good quality of life. In addition, a patient may request PAS to lessen the financial burden of unnecessary medical procedures.

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1083 Words | 5 Pages

There is a correlation between health care members providing information in a timely manner to patients who need to make decisions about their care and treatment and the quality of care patients receive. Lack of care resulted from physicians being reluctant to refer patients to palliative care. Due to a lack of honest open discussions regarding diagnosis, prognosis and treatment options patient’s suffering was prolonged. Since palliative care focuses on improving symptoms, dignity and quality-of-life it is important that sufficient attention is placed on the complex needs of individuals. The delivery of palliative care has become challenging for nurses.

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1800 Words | 8 Pages

Most people would never contemplate whether or not to end their family pet’s suffering, so why can’t people be as sympathetic to their family and friends? In today’s society, the legalization of physician-assisted suicide is one of the most debatable topics. The debates on physician-assisted suicide go back and forth between whether or not patients, specifically terminally ill patients, should have the right to die with the aid of doctors. Opponents believe physician-assisted suicide is morally and ethically wrong for patients to end their lives, and they believe it violates basic medical standards. However, proponents of physician-assisted suicide believe it is a humane and safe way for terminally ill patients to resolve their agony.

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1286 Words | 6 Pages

According to Karaim in 2013 “Decisions about sustaining life, allowing it to end or even hastening death are among the most difficult choices terminally ill patients and their families can face”

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1169 Words | 5 Pages

This is a part of the stage where finding recovery and answers challenge doctors and the loved ones that are suffering. In the Institute of Medicine’s critical report Dying in America, there is an idea that emphasizes the importance of making a decision for the patient that is on the stage of death. JoAnn Grif, writer of Dying in America, identifies that decisions for a patient should be made before as a living will from the patient’s own preference and decision. Letting the doctor know so it can improve communication and awareness for the individual that is on treatment, and this consent should ahead of time and planned out. Although, how soon should patients reveal a will to their doctor, some will ask.

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1115 Words | 5 Pages

It is extremely important that every patient has the opportunity to control the care they wish to receive in case of medical emergencies. These wishes may be addressed through legal documentation, known as advanced directives. Through the use of advanced directives patients can appoint a healthcare proxy, express their living will, and make decisions about hospice and palliative care. Advanced directives allow patients to make decisions that may be hard for their families, and their providers to make during this difficult time. “A living will spells out what types of medical treatment a person wants at the end of life if he’s unable to speak for himself ("Power of Attorney, Living Will, and Advance Directive - AARP").”

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815 Words | 4 Pages

References Bipartisan bill encourages Americans to complete ‘advance directives,’ plan for life-sustaining health decisions| News Releases| U.S. Senator Chris Coons of Delaware. (2015, November 18). Retrieved from http://www.coons.senate.gov/newsroom/releases/release/bipartisan-bill-encourages-americans-to-complete-advance-directives-plan-for-life-sustaining-health-decisions Nursing Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions. (2012, March 12). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Nursing-Care-and-Do-Not-Resuscitate-DNR-and-Allow-Natural-Death-Decisions.pdf Olin, J. (2012, February 24).

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602 Words | 3 Pages

Morals and common sense also have a play in whether to use palliative sedation. I think the fear of legal action from the family stops many medical doctors from using sedation. My personal back story of when my Aunt had a disease where she couldn’t fend for herself anymore; she couldn’t wash herself, she couldn’t feed herself nor do anything that a normal person could do. She eventually was hospitalized for months and was always in pain. I killed me and my family to know that there wasn’t anything for us to do about how she was feeling.

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1097 Words | 5 Pages

A durable power of attorney is enacted by a legal document which names a person of 18 years of age or older as a surrogate decision maker allowing them to make all health care decisions if a person become unable to do so (Goldberg & Bennington Jr., 2013). This individual may also make bank transactions, sign social security checks, apply for disability, or simply write checks to pay the utility bill while an individual is medically incapacitated (Nabili & Shiel Jr., 2015). A Do-Not-Resuscitate Order is A do-not-resuscitate order also known as a DNR order, is a written document in which it expresses the wish that if breathing and

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954 Words | 4 Pages

Ms. Long has been admitted to a skilled nursing home after four months in the hospital, and has been assigned a public guardian since she is no longer able to make life decisions on her own. The guardian is faced with the problem of deciding whether maintaining/sustaining life-giving care or palliative/hospice care is appropriate for their charge. With the medical team, and a personal assessment, the apparent choice would be palliative or hospice care. Comfort care at this stage becomes the basic concern. The palliative care plan should be the consideration for the do-not-resuscitate (DNR) provision.

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395 Words | 2 Pages

In addition to supporting palliative patients in the OR, anesthesia providers need to be prepared to care for them outside the OR as well – whether in the ICU or PCU. CRNAs may be called upon to administer anesthesia for patients undergoing tracheostomies outside of the OR. Increasing numbers of ALS patients in PCUs are having beside tracheostomies (Chan & Devaiah, 2009). Interventional Radiology. CRNAs may also encounter palliative patients in IR.

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1034 Words | 5 Pages

When a patient is terminally ill, they should have every right as human beings to make their own informed decision on whether to end their life or carry on and die naturally. Financially, the patient could potentially make their choice much easier if they are are already at a certain stage of their being. If financial problems line up with soon-to-be death, then why not take the easy way out? With the way hospitals are in today’s society, constantly crowded and such in most countries, the patient may very well see the perfect opportunity to take the high road in their respective situation. It is not an easy decision to make for everyone by any means, but at the end of the day each and every patient has control over their own body and should be able to make their own

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