CASE STUDY CHAPTER 11 ANALGESIC GRUG
Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 5th Edition: Stand-Alone Bow-Tie
Case
Study
Topic: Chapter 11: Analgesic Drugs
Focus: Opioid O Altered Presentation O Naloxone
The nurse is caring for a 48-year-old client in the neurology unit.
Nurses’
Notes
1745h: Client was seen in the emergency department 5 days ago to rule out left-sided
subdural hematoma. The client was found at the bottom of the stairs with blood pooling out
of their left ear. The client is ready for discharge when social work is able to obtain longer-
term housing, as client is currently couch-surfing with friends. The client’s past medical
history consists of drug misuse of fentanyl, heroin, and alcohol, but the client states they
have been sober and attending Narcotics and Alcoholic Anonymous meetings for 2 months;
current smoker ½ pack per day; and previous hospital admissions for endocarditis. Vital signs:
T: 37.1 C (98.7 F); BP: 120/68; P: 82; RR: 16 with pulse oximetry of 98% on room air. Client
presents as anxious and agitated but cooperative, alert, and orientated to person, place, and
time. Gait noted to be unsteady at times but improves when client takes their time to walk
slowly when unaided. Client denies any dizziness or headache but complains of numbness
and tingling in lower extremities. Client denies any pain, though states feeling like “pins and
needles” when ambulating and at rest. Bilateral pupils equal in shape, measured at 3 mm,
and briskly react to light. S1 and S2 heart sounds, no S3 or S4, apical heart rate regular and
equals radial pulse. No peripheral edema noted. Bilateral radial pulses regular and palpable,
bilateral dorsalis pedis pulses present and palpable. Skin warm and dry to touch. No
diaphoresis noted. Upon auscultation, reduced air entry noted in bilateral lower lobes with
expiratory wheezing noted throughout all lobes. Abdomen flat, no pain with palpation, bowel
sounds auscultated × 4 quadrants. Client denies nausea or emesis. Client states voiding
independently in the washroom, denies any pain or urgency with urination. Peripheral
venous access device remains in situ but saline locked.
2055h: Client noted to be off unit, observed to be accompanied by friend who was pushing
the client in a wheelchair. Client indicated they were going for a “smoke break.”
2203h: Upon evening rounds, client noted to have returned from being off the unit, sitting
alone in their room. Client presents with disorganized speech, slurring words, gait unsteady,
requiring two-person assist to transfer from wheelchair to the bed. Pupils pinpoint and
sluggish to react to light and remain equal in size. Skin warm to touch, face flushed, with
diaphoresis noted. Client unable to remember why they are in the hospital. Presents as
confused. Only orientated to name. Client somnolent, lethargic, and drifts off to sleep easily,
requiring physical stimulation to respond. Vital signs: T: 36.9 C (98.4 F); BP: 90/56; P: 58; RR:
10; with pulse oximetry of 92% on room air. Bilateral radial pulses palpable, regular, but
slower in rate. Skin cool and dry to touch. No change in auscultation in lung sounds or
gastrointestinal assessment. Difficult to assess renal system. Health care provider notified of
change in client status. No new orders received.
The nurse is reviewing the client’s assessment data to prepare the client’s plan of care.
Complete the diagram by identifying from the choices below to specify what condition the client is most
likely experiencing, two actions the nurses should take to address that condition, and two parameters
the nurse should monitor to assess the client’s progress.
Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 5th Edition: Stand-Alone Bow-Tie
Case
Study
Topic: Chapter 11: Analgesic Drugs
Focus: Opioid O Altered Presentation O Naloxone
The nurse is caring for a 48-year-old client in the neurology unit.
Nurses’
Notes
1745h: Client was seen in the emergency department 5 days ago to rule out left-sided
subdural hematoma. The client was found at the bottom of the stairs with blood pooling out
of their left ear. The client is ready for discharge when social work is able to obtain longer-
term housing, as client is currently couch-surfing with friends. The client’s past medical
history consists of drug misuse of fentanyl, heroin, and alcohol, but the client states they
have been sober and attending Narcotics and Alcoholic Anonymous meetings for 2 months;
current smoker ½ pack per day; and previous hospital admissions for endocarditis. Vital signs:
T: 37.1 C (98.7 F); BP: 120/68; P: 82; RR: 16 with pulse oximetry of 98% on room air. Client
presents as anxious and agitated but cooperative, alert, and orientated to person, place, and
time. Gait noted to be unsteady at times but improves when client takes their time to walk
slowly when unaided. Client denies any dizziness or headache but complains of numbness
and tingling in lower extremities. Client denies any pain, though states feeling like “pins and
needles” when ambulating and at rest. Bilateral pupils equal in shape, measured at 3 mm,
and briskly react to light. S1 and S2 heart sounds, no S3 or S4, apical heart rate regular and
equals radial pulse. No peripheral edema noted. Bilateral radial pulses regular and palpable,
bilateral dorsalis pedis pulses present and palpable. Skin warm and dry to touch. No
diaphoresis noted. Upon auscultation, reduced air entry noted in bilateral lower lobes with
expiratory wheezing noted throughout all lobes. Abdomen flat, no pain with palpation, bowel
sounds auscultated × 4 quadrants. Client denies nausea or emesis. Client states voiding
independently in the washroom, denies any pain or urgency with urination. Peripheral
venous access device remains in situ but saline locked.
2055h: Client noted to be off unit, observed to be accompanied by friend who was pushing
the client in a wheelchair. Client indicated they were going for a “smoke break.”
2203h: Upon evening rounds, client noted to have returned from being off the unit, sitting
alone in their room. Client presents with disorganized speech, slurring words, gait unsteady,
requiring two-person assist to transfer from wheelchair to the bed. Pupils pinpoint and
sluggish to react to light and remain equal in size. Skin warm to touch, face flushed, with
diaphoresis noted. Client unable to remember why they are in the hospital. Presents as
confused. Only orientated to name. Client somnolent, lethargic, and drifts off to sleep easily,
requiring physical stimulation to respond. Vital signs: T: 36.9 C (98.4 F); BP: 90/56; P: 58; RR:
10; with pulse oximetry of 92% on room air. Bilateral radial pulses palpable, regular, but
slower in rate. Skin cool and dry to touch. No change in auscultation in lung sounds or
gastrointestinal assessment. Difficult to assess renal system. Health care provider notified of
change in client status. No new orders received.
The nurse is reviewing the client’s assessment data to prepare the client’s plan of care.
Complete the diagram by identifying from the choices below to specify what condition the client is most
likely experiencing, two actions the nurses should take to address that condition, and two parameters
the nurse should monitor to assess the client’s progress.
