Part 2 After the surgery she was placed on a patient-controlled analgesia (PCA) pump because there were most likely concerns of swallowing issues which could lead to aspiration, especially in the elderly. “With PCA analgesia, avoid a basal infusion of opioid medication in opioid-naïve patients. The addition of acetaminophen or NSAIDs is associated with reduced opioid consumption and better pain control than using opioids alone” (Cadaval Gallardo et al., 2022). If there is a concern with swallowing then she should be administered Lovenox SQ or heparin IV, if in the hospital, until she is able to swallow. Even though she is having adequate pain control she has developed an adverse reaction to the morphine, and it should be discontinued but not considered a true allergy. Bronchospasm would be an indicator of a severe allergic reaction to the morphine. I would order Benadryl 50mg PO Q6 PRN to help with the redness and puritus. Based upon her current daily morphine dose of 27mg/day and using a conversion calculator with a 25% reduction yields a 51mg daily dose of hydrocodone. Hydrocodone 10/325mg PO Q6 PRN would be appropriate. This patient needs to be monitored closely for other adverse reactions and tolerance of switching to hydrocodone. She is already prescribed Miralax but a stool softener such as Colace 100mg PO BID should be incorporated into her plan. It would be important to educate her on increasing her PO fluids and ambulating frequently as tolerated. Early ambulation after surgery helps reduce the incidence of a post-operative ileus. A dietary plan to include sources of fiber would be beneficial without adding another medication to her list. Postoperative patients are at risk for developing pneumonia and they should be educated to perform deep breathing exercises at least every 30 minutes to promote good airflow into the lungs.
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