History of Squamous cell Cancer of the cervix

A 65-year-old Portuguese female, Mrs. M, with a 3-year history of squamous cell cancer of the cervix presents with severe pain in the perineum. The patient lives alone. Her husband died two years ago. She has 6 grown children. She takes care of her 5 grandchildren, ages 3 to 13 while their parents work and she is very close to them. She speaks little English.

1. How might the nurse obtain a thorough pain assessment? What aspects of the pain assessment should be included?

2. The patient describes her pain as an 8 on the 0-10 scale, occurring constantly in the perineum, but is worsened when she voids. She is currently taking hydrocodone/acetaminophen, 2 tablets every 4 hours (12 tablets – 60 mg hydrocodone ≈ 60 mg morphine). She frequently awakens and takes the medications during the night. She states (with help of the translator) that the medicines relieve the pain by approximately 25%. What can be done to ease Mrs. M’s suffering?

3. Examination of the perineum reveals inflamed excoriated tissue from the labia to the rectum. Additionally, stool appears to extrude from the vagina. As Mrs. M’s nurse, what can you do?

4. You are working night shift and observe the following: The excoriation is cleared, and the pain is under control with 10 mg of morphine q 4 hours (or 6 doses/day). She uses approximately 3 additional doses of 10 mg of morphine for breakthrough pain per day. Thus, she is using approximately 9 doses/24 hours. Unfortunately she awakens at night in pain. What might be the best analgesic regimen for this patient? She describes no adverse effects to the medications.

5. The patient is being prepared for discharge to hospice at home when she expresses some concern regarding her son, who has a history of substance abuse. She is afraid he might use her medications. How will you react to this information?