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Old 11-28-2012
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Default Terminal Disease : NBME 2 Concept

A mentally competent 76-year-old man is in the
terminal stage of
multiple myeloma. He is unable to move and requires
24-hour nursing
care. Increasing doses of narcotics are needed to
control severe pain.
As a result, when he is pain-free, respiratory
function is impaired and
consciousness is clouded. The patient says he cannot
live with this
degree of pain and asks to be given a lethal injection
of pain
medication. Which of the following is the most
appropriate step regarding the
pain medication?

A) Reduce the dosage so as not to impair respiration

B) Administer the dosage necessary to control pain
despite
respiratory impairment

C) Administer the dosage necessary to control pain
and add a
centrally acting stimulant

D) Appeal to the family to convince the patient to
tolerate a bit
more pain
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Old 11-29-2012
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Quote:
Originally Posted by usmle2011 View Post
A mentally competent 76-year-old man is in the
terminal stage of
multiple myeloma. He is unable to move and requires
24-hour nursing
care. Increasing doses of narcotics are needed to
control severe pain.
As a result, when he is pain-free, respiratory
function is impaired and
consciousness is clouded. The patient says he cannot
live with this
degree of pain and asks to be given a lethal injection
of pain
medication. Which of the following is the most
appropriate step regarding the
pain medication?

A) Reduce the dosage so as not to impair respiration

B) Administer the dosage necessary to control pain
despite
respiratory impairment

C) Administer the dosage necessary to control pain
and add a
centrally acting stimulant

D) Appeal to the family to convince the patient to
tolerate a bit
more pain
B. Comfort is more important...
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  #3  
Old 11-29-2012
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But wont the comfort provided will actually depress the respiration. So why not give an stimulant along with it
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Old 11-30-2012
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Originally Posted by usmle2011 View Post
But wont the comfort provided will actually depress the respiration. So why not give an stimulant along with it
Because in these cases the pt's comfort is more important, especially in a terminally ill patient. He will most probably die sometime soon. Let him die comfortably.

I was a RN before I went to med school and we did this all the time. It doesn't matter that it causes respiratory depression. The pts. comfort is and should always be your #1 goal.
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Old 11-30-2012
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Originally Posted by usmle2011 View Post
So why not give an stimulant along with it
What will be achieved by saving his life for few more days?
All that you will accomplish is to make him suffer longer.
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