Question

The nurse caring for a 79-year-old man who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurse's management of the patient's pain?

1) The elderly may require lower doses of medication and are easily confused with new medications.
2) The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
3) The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication.
4) The elderly may require a higher initial dose of pain medication followed by a tapered dose.

Answer 1

The nurse should administer lower doses of medication to the elderly patient who has shown agitation with opioid administration in the past, while monitoring for confusion and agitating side effects. Alternatives to opioids, such as acetaminophen or NSAIDs, may also be considered.

Step-by-step explanation:

The principle that should guide the nurse's management of the patient's pain, considering that the 79-year-old man has been agitated in the past following opioid administration, is that the elderly may require lower doses of medication and are easily confused with new medications. It is essential to understand that the elderly can have altered drug absorption and metabolism, which necessitates careful dosing and monitoring. Potentially, lower doses of opioids or alternative pain management strategies might be employed to manage his pain effectively while minimizing the risk of agitation and other side effects. Adverse reactions and confusion may arise, so close monitoring is paramount when administering these medications postoperatively.

Medical professionals should review the key concerns for the recovery and care of the patient, ensuring that alternatives to opioids, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), are considered. These alternatives might be less likely to cause confusion and agitation as compared to opioids. While opioids like oxycodone, codeine, and morphine are effective for severe pain, their administration must be carefully weighed against the risk of side effects, especially in the elderly population.