Managing Pain in Teenagers With Sickle Cell Disease

Cynthia Fletcher, PhD, RN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2002;2(2) 

In This Article

Case Presentation

Jimmy, a 15-year-old African American male with SCD, is admitted to the pediatric hematology unit with pain "all over his body." Jimmy's mother brought him into the ED at 4 pm the night before and told the triage nurse that Jimmy was in "crisis." Jimmy's mom reported that the pain began early that morning and had "gotten worse." She reported that it was not relieved by his usual doses of ibuprofen or Percocet. Jimmy was medicated with meperidine 75 mg IM 1 hour after he came into the ED and every 3 hours thereafter. Jimmy reported minimal pain relief after receiving the medication. He reported that the slight relief was short-lived, and he continued to complain of unbearable pain through the night. Other clinical pathologies were ruled out and a diagnosis of an acute VOPE was made.

Jimmy was admitted at 8 am the next morning because his pain was not controlled with 75 mg of meperidine given in the ED. The pediatric resident's orders included medication for pain control (meperidine 75-100 mg IM or orally every 3 hours), intravenous (IV) fluids, and hematology and chemistry profiles. The admitting nurse on the pediatric unit recognized Jimmy and welcomed him back to the unit. After completing her admission profile on Jimmy, she went back to the nursing station and announced that their "frequent flyer" was back. A nursing student was assigned to Jimmy. The nursing student instructed Jimmy on the use of the pain scale, which had numbers ranging from 1-10 (1 = minimal discomfort and 10 = the worse pain I have ever had). Later that morning, Jimmy reported to the nursing student that the pain had decreased to a "7" 45 minutes after receiving his medication. However, it was now "10" and he "needed more medication."

Jimmy had received 75 mg of meperidine IM after being admitted to the unit. Although it was 20 minutes before Jimmy was to receive his next scheduled dose of meperidine, the primary nurse gave the nursing student permission to administer the dose at this time. The nursing student prepared meperidine 75 mg IM for Jimmy. On her way into the room, she saw Jimmy completely engaged in a television program and laughing. She returned with the medication to the nursing station and reported to Jimmy's primary nurse what she had observed. The primary nurse remarked to the student that she was not surprised because "Jimmy always wants more medication than he needs." They both concluded that Jimmy was not in enough pain to need the medication at this time. The primary nurse instructed the nursing student to administer the meperidine at the scheduled time and to give it via the oral route.

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