A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective?

Question

BlackTom AI · Accepted Answer

Around-the-clock (ATC) opioid dosing with additional short-acting doses for breakthrough pain is the recommended approach for severe, constant cancer pain because it maintains a steady analgesic level and prevents pain escalation.

1) Relevant knowledge points and concepts
- Cancer pain control: continuous severe pain in terminal illness is best managed with a baseline long-acting opioid schedule plus rescue doses for breakthrough pain.
- Pharmacologic principles: maintaining steady plasma levels reduces peaks and troughs that cause fluctuating pain and increased suffering.
- Breakthrough pain: short-acting opioids are given as needed in addition to scheduled doses.
- Home care considerations: oral or transdermal routes are preferred; IV therapy is rarely used at home for routine analgesia.
- No fixed “ceiling” for pure opioid agonists; if pain is uncontrolled, options include dose adjustment, opioid rotation, or adjuvant therapies rather than simply switching to nonopioids.

2) Step-by-step reasoning
- Baseline: severe pancreatic cancer causes persistent nociceptive and often neuropathic pain requiring consistent analgesia.
- If opioids are given only PRN when pain is already severe, pain will escalate and be harder to control; this increases suffering and may require higher total doses.
- ATC dosing provides a steady baseline. When a breakthrough episode occurs, an additional immediate-release dose treats the spike.
- Thus, a patient who takes opioids regularly on schedule and uses extra doses for breakthrough pain demonstrates correct understanding and implementation.

3) Calculations
- No numeric calculations are required; logic and pharmacologic principles guide the choice.

4) Why the correct answer is correct
- It reflects evidence-based palliative pain management: scheduled dosing for baseline analgesia with rescue doses for breakthrough episodes.

5) Why the other options are incorrect
- Option 1 (use only when pain >5): Waiting until pain is severe is ineffective and contrary to best practice.
- Option 2 (IV route at home): IV administration is impractical and risky for routine home care; oral or transdermal routes are preferred.
- Option 4 (use nonopioids if opioid max reached): Nonopioids are inadequate alone for severe cancer pain; strategies include opioid dose adjustment, rotation, or adjuvants, not simply substituting nonopioids.

6) Conclusion
The correct choice is: The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. This matches the provided answer.

A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective?单项选择题

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