Final answer:
The nurse should request the physician to order analgesics by an alternative route if a patient with metastatic bone cancer is having difficulty swallowing. This ensures the patient's ongoing comfort and management of pain through suitable palliative care.
Step-by-step explanation:
If a medical nurse observes that a patient with metastatic bone cancer is having difficulty swallowing oral analgesics but the medication has been effectively managing her pain, the appropriate action would be to request the physician to order analgesics by an alternative route. Crushing the medication is not always advisable as some analgesics come in controlled-release forms and crushing them could lead to a rapid dose dump which may be dangerous. Administering medication with food could help if swallowing difficulties are mild, but if the patient cannot swallow, this would not be effective. Administering medication rectally may be an option but requires compatibility of the drug for rectal administration and is not usually the first alternative considered.
A change in the route of administration is necessary when a patient cannot swallow, and this requires a doctor's intervention. Options might include subcutaneous, intravenous, or transdermal routes, often facilitated by a medical device like a central venous catheter or an implanted port, as in the case of the patient Barbara mentioned in the clinical focus. The choice of alternative routes ensures that patients continue to receive the palliative care they need, maintaining dignity and comfort in end-of-life care.