Pain and Comfort – Case Study

Ms. P. was a 66-year-old diabetic, and after a stroke had to relocate to a nursing facility. In a short time, her diabetes began to have uncontrollable fluctuations. Her blood sugar ranged from 20 mq/mL to 800 mq/mL. Some of this was caused by erratic eating habits, almost no exercise, frequent urinary tract infections, and considerable stress related to her condition and her future. She bumped her toe while being assisted into her wheelchair after occupational therapy. In a few days, the bruise had sloughed skin, and an open sore was evident. In spite of appropriate treatment, the sore became necrotic and was debrided. Ms. P, who rarely complained, began to moan while she was sleeping and cry a lot during the day. She complained of a continuous burning sensation and said that it felt as if her toe was “on fire.” One day she threw her coffee cup across the room complaining that it was not hot enough. Various pain medications were given by mouth on an inconsistent basis, but the relief she experienced was minimal. She began to beg to die. The nurses thought perhaps she was right—after all, her general condition was poor, and life held little satisfaction for her.

Based on the case study of Ms. P, what could have been the reasons for sporadic pain medication being provided? How would you have provided patient-centered care for Ms. P relatcixed to pain and comfort?