PSW Joan lets Nurse Joy know that their patient Mary who has breast cancer with bone metastases seemed uncomfortable this morning when providing personal care as Mary had facial grimacing and was making groaning noises. Nurse joy thanks PSW Joan for her observations and goes to screen Mary for pain and Mary indicates her pain level is 6/10 this morning. The result prompts Nurse Joy to complete a pain assessment utilizing the OPQRSTUV that determines the pain this morning is not incident pain from the personal care but instead spontaneous breakthrough pain and that usually opioids help it.

Nurse Joy reviews Mary’s Medication Administration Record and notices her long acting (q12 hour) morphine dose is due in ten minutes at 0800 and that she has PRN orders for 1) Acetaminophen 1 gram q6 hours by mouth PRN for pain 2) morphine 5mg q2 hours by mouth PRN for pain & dyspnea. Nurse Joy determines acetaminophen will not best manage Mary’s moderate pain this morning and decides to focus on the opioid options instead.

It is acceptable for Nurse Joy to administer Mary’s next scheduled long acting morphine dose and a PRN morphine dose at the same time.