ASSESSMENT 3 (Peer-Review)
Case study number:
Your name:
Your ID:
Section A (highlight or bold your response)
1. Overall structure (select one):
• Unclear • Vague • Organised • Very well structured
2. Demonstrates good theoretical knowledge on the problem presented (select one):
• Poor • Fair • Good • Very Good • Excellent
3. Contains relevant information showing insight in the problem. The solution offered is based on theoretical background and scientific analysis (select one):
• Poor • Fair • Good • Very Good • Excellent
4. Shows ability to plan and complete all parts of a written report that fit into the requirements of reporting the case (select one):
• Poor • Fair • Good • Very Good • Excellent
5. Meets the standards of technical writing (select one):
• Poor • Fair • Good • Very Good • Excellent
6. Your overall impression:
• Poor • Fair • Good • Very Good • Excellent
7. General aspects of the report (select as many as apply):
• Too hu
iedly written
• Report not set out in formal orde
• Poor spelling
• Poor gramma
• Difficult to follow arguments: muddled, disorganized
Section B
Personal comments/considerations (200 – 250 words)
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NUR231 Assessment 2: Case study
1. What happens to pain threshold and behavioural response to pain in the older people
and discuss
iefly the effectiveness of NSAIDs for pain in the elderly.
Despite multiple studies to determine what happens to pain threshold in aging people, results
are inconclusive (Craft et al., XXXXXXXXXXSome studies have indicated that there is evidence of an
increase in the pain threshold with advancing age, which may also depend on the type of pain
(Alan D. Kaye, 2020).
Older adults are more likely to experience pain, however, a behavioural response to pain is to
accept it as a natural part of aging and not report it ("Treating Pain in the Elderly", XXXXXXXXXXOther
studies have found that more severe pain is associated with aggressive and agitated behaviours
and that there is generally a relationship between pain and disruptive behaviours (Ahn &
Horgas, 2013).
NSAIDs are often used to treat inflammatory type pain in the elderly and can be effective,
however, they pose an increased risk of gastro intestinal toxicity, renal and cardiovascular side
effects and cause adverse interactions with other drugs commonly used by the elderly ("Pain
Management and the Elderly", 2020).
2. Following the MRI report, and the pain being persistent, which analgesics should be
prescribed to Mr Jack? Support your answer with evidence.
Mr Jack’s pain is severe and persistent enough to restrict his usual activities and affect his job
meaning that it is diminishing his quality of life and he has not had relief from NSAIDs.
The World Health Organisation has developed a three step analgesic ladder for pain relief and
these principles should be followed (WHO, XXXXXXXXXXThe general recommendations are to give
drugs by the clock, by mouth and to follow the analgesic ladder (Ali et al., XXXXXXXXXXAccording to
these guidelines, treatment commences with the oral dose of drugs in the following order: non
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opioids such as aspirin and paracetamol, then as necessary mild opioids such as Codeine, then
strong opioids such as morphine, until the patient is pain free (WHO, 2020).
Given that his pain is not responding to NSAIDs, following the principles of the WHO analgesic
ladder, paracetamol should be given regularly in conjunction with a short acting opioid (Ali et
al., XXXXXXXXXXOnce titrated, a slow release opioid can be trialled and adjuvants such as aperients or
additional drugs to calm anxiety may be added (Ali et al., 2018).
Cancer patients very rarely have long term addiction to opioids, but the patient should be made
aware of the side effects of these drugs and reviewed after 48 hours (Mercadante, XXXXXXXXXXLong
term systemic corticosteroids are helpful for patients with metastatic bone pain (Mercadante,
2014) Dexamethasone is recommended for analgesia in cancer patients and reduces oedema
(Alan D. Kaye, 2020).
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References:
Ahn, H., & Horgas, A XXXXXXXXXXThe relationship between pain and disruptive behaviors in nursing
home resident with dementia. BMC Geriatrics, XXXXXXXXXXhttps:
doi.org/10.1186/1471-
XXXXXXXXXX
Alan D. Kaye, J XXXXXXXXXXPain Management in the Elderly Population: A Review. PubMed Central
(PMC). Retrieved from https:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/.
Ali, A., Arif, A., Bhan, C., Kumar, D., Malik, M., & Sayyed, Z. et al XXXXXXXXXXManaging Chronic Pain
in the Elderly: An Overview of the Recent Therapeutic Advancements. Cureus.
https:
doi.org/10.7759/cureus.3293
Craft, J., Gordon, C., Tiziani, A., Huether, S., McCance, K., & Brashers, V XXXXXXXXXXUnderstanding
Pathophysiology - ANZ adaptation (2nd ed., pp XXXXXXXXXXElsevier Health Sciences.
Mercadante, S XXXXXXXXXXManaging Difficult Pain Conditions in the Cancer Patient. Cu
ent Pain
And Headache Reports, XXXXXXXXXXhttps:
doi.org/10.1007/s XXXXXXXXXXy
Pain Management and the Elderly. Practical Pain Management XXXXXXXXXXRetrieved from
https:
www.practicalpainmanagement.com/treatments/pain-management-elderly
Treating Pain in the Elderly. WebMD XXXXXXXXXXRetrieved from https:
www.webmd.com/pain-
management/treating-pain-elderly.
WHO | WHO's cancer pain ladder for adults. Who.int XXXXXXXXXXRetrieved from
https:
www.who.int/cance
palliative/painladde
en/.
https:
doi.org/10.1186/ XXXXXXXXXX
https:
doi.org/10.1186/ XXXXXXXXXX
https:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211
https:
doi.org/10.7759/cureus.3293
https:
doi.org/10.1007/s XXXXXXXXXXy
https:
www.practicalpainmanagement.com/treatments/pain-management-elderly
https:
www.who.int/cance
palliative/painladde
en/