Part 5 The patient was discharged to her home, but 3 months after discharge was admitted to hospice service. She is no longer able to swallow her tablets and requires them to be crushed. The hospice nurse requests your advice on an equivalent regimen using transdermal fentanyl and oxycodone for breakthrough pain. Pain Assessment: 8 out of 10 Current Meds: Metoprolol succinate ER 50 mg daily; rivaroxaban 20 mg daily; levothyroxine 150 mcg daily; polyethylene glycol 3350 17 g daily; lisinopril 2.5 mg daily; amiodarone 200 mg daily; diclofenac transdermal gel 1% to neck and left shoulder four times daily; morphine sulfate ER 30 mg twice daily; mirtazapine 15 mg at bedtime. • What additional recommendations would you have at this time regarding pain management? • Are there any other therapeutic issues that should be addressed?

 My experience with hospice services is that it is considered to be comfort measures. Converting her current dose of morphine ER 30mg BID would yield a Fentanyl 25mcg patch Q3 days. For breakthrough pain Roxicodone oral suspension 20mg/mL can be used. Generally, the oral suspension of Roxicodone is only used for opioid tolerant patients. Given this has been on opioids for longer than 3 months she would be considered opioid tolerant at this time. Her other medications need to be adjusted or discontinued because she is having swallowing difficulties. The metoprolol succinate ER and amiodarone cannot be crushed and if you crush the levothyroxine it may alter its effects. But as I had stated earlier those who are admitted to hospice services are usually only given comfort measures and all other medications are discontinued. References Cadaval Gallardo, C., Martínez, J., Bellía-Munzon, G., Nazar, M., Sanjurjo, D., Toselli, L., & Martínez-Ferro, M. (2022). Postoperative pain control. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica, 33(1), 11–15

Order this paper