Larry Smith was being seen for an outpatient preoperative workup the evening before scheduled urologic surgery. The nurse conducts a workup the evening before scheduled urologic surgery. The nurse conducts a thorough history and examination related to his back pain and current pain management. His anticipated hospital stay is 2 days postoperatively.
Larry Smith is a 68-year-old man. Vital signs are blood pressure, 108/64 mmHg; pulse, 88 beats/min; respirations, 16 breaths/min. He has a well-healed midline scar on his back from lumbar vertebrae surgery, with a shorter scar over his right iliac crest. Larry moves a bit slowly with some limited lumbar range of motion. He also uses a cane for ambulating any distance. He describes his pain as a constant dull ache in the lower back that increases with Larry also reports a feeling of “cold electricity” down both legs, with the left greater than the right, which increases with standing and walking, as well as numbness of the middle toes on his left foot. He has been using mixed opioid and nonopioid analgesics for the past 8 years and previously had used SSRI antidepressants as adjuvant for his pain. Larry’s current healthcare provider weaned him off Vicodin ES about a year ago. He now takes methadone 20 mg twice a day. When the pain is not relieved, he uses Norco for breakthrough pain. His use of Norco is one to two doses per day.
Critical Thinking Questions
1. How should Larry’s postoperative pain be managed both with medications and non-pharmacological methods?
2. What should be included in the care plan for postoperative management of analgesic adverse effects?
3. As part of the patient’s pain management, dexamethasone 5 mg IV is prescribed every 6 hours for 2 days. Explain the use of corticosteroids in pain management. prolonged standing or walking.
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