Pain Medication Allotted-Molly Juniper

Molly Juniper, a 32-year-old, was cooking at home one evening when she accidentally spilled a pot of boiling water. The water spilled over her left hand causing second degree, partial thickness, scalding burns to her fingers, hand, and an area surrounding the left, anterior forearm, approximating 3% total body surface area (TBSA). The scald burns scattered throughout the hand and fingers and there is a small circumferential burn on the forearm. She is healthy and has no medical history, taking daily vitamins with breakfast. She lives in an apartment with her two children, ages six and nine years and is the primary provider for her family.

Several hours have passed, and Molly has required maximum pain medication allotted. Molly remains alert and oriented, her neurovascular assessments remain within normal parameters, with pulses strong and equal, and capillary refill < 3 seconds. Molly verbalizes feeling severely anxious regarding her pain and her concern for how long the neighbor can watch her children. The nurse prepares to call the on-call health care provider (HCP) to discuss Molly’s situation.
1.     Explain each of the prescriptions and its purpose, specific to Molly’s care. In other words, why is it being prescribed?

1.     PCA: hydromorphone 1 mg/mL.-
a.     Loading dose 2 mg IV.
b.    Basal rate 0.5 mg hourly.
c.     Demand dose 1 mg.
d.    Lockout interval: 20 minutes.
2.     Assessment of respiratory rate, sedation score, and pain control every 2 hours.
3.     Alprazolam 0.25 mg orally twice daily as needed for anxiety.
4.     Naloxone 0.4 mg IV as needed, may repeat every 20 minutes; notify HCP if administered.
5.     Docusate sodium 100 mg orally.
6.     Social services consultation.
7.     Acetaminophen 500 mg PO every 4 hours as needed, and 30 minutes before dressing changes, not to exceed 3,000 mg in 24 hours.

Complete Answer:

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