RRB Nsg. Superintendent-20 July 2019 (Shift-2)
Medical & Surgical Nursing
Medium
Which one of the following is a method for effective control of pain in post-operative patients and those with chronic pain?
Appeared in: RRB Nsg. Superintendent-20 July 2019 (Shift-2)
Explanation
- The intra-spinal route (epidural or intrathecal) delivers analgesics directly to the spinal cord's opioid receptors.
- This method is highly effective for managing severe pain in both acute post-operative settings (e.g., after major abdominal or thoracic surgery) and for intractable chronic pain (e.g., cancer pain).
- By acting directly at the spinal level, it allows for much smaller doses of medication compared to systemic routes.
- The lower dosage significantly reduces the incidence and severity of systemic side effects such as respiratory depression, sedation, and nausea.
- It is considered a superior method for pain control when pain is severe and localized below the clavicles.
Why Other Options Were Wrong
- Option A: The parenteral route (IV/IM) is excellent for acute post-operative pain but is not a practical or preferred method for long-term management of chronic pain in a home setting due to the need for continuous access and higher risk of systemic side effects.
- Option B: The transmucosal route is designed for rapid absorption and short duration of action, making it suitable for managing breakthrough pain, not for providing continuous, baseline analgesia for either post-operative or chronic pain.
- Option D: The transdermal route has a very slow onset of action (often 12-24 hours) and is difficult to titrate, making it unsuitable for acute, fluctuating post-operative pain. It is only effective for stable, chronic pain.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Routes of Analgesic Administration for Post-operative and Chronic Pain as background academic context rather than a clinical decision trigger.
- Nurses managing patients with epidural or intrathecal analgesia must meticulously monitor for complications, including respiratory depression, hypotension, sensory/motor deficits, and signs of infection at the catheter site.
- Patient education is crucial, covering how the pump works (if applicable), the importance of reporting side effects like numbness or weakness, and activity limitations.
- What if? If a patient with an epidural catheter suddenly complains of a severe headache that worsens when sitting up, the nurse should suspect a dural puncture with CSF leak. The immediate nursing action is to have the patient lie flat and notify the anesthesiologist, as a blood patch may be required.
How to Approach the Question
- First, identify the core requirement of the question: a pain control method effective for both post-operative (acute) and chronic pain.
- Analyze each option based on this dual requirement.
- Evaluate the Parenteral route: Good for acute post-op pain, but less practical for long-term chronic pain at home.
- Evaluate the Transmucosal route: Used for breakthrough pain, not continuous control.
- Evaluate the Transdermal route: Good for stable chronic pain, but contraindicated for acute post-op pain due to slow onset.
- Evaluate the Intra-spinal route: Used for major post-op surgery and also for intractable chronic pain, fitting both criteria.
Concept Tested & Keywords
- Concept Tested: Routes of Analgesic Administration for Post-operative and Chronic Pain
- Stem keywords: pain control, post-operative, chronic pain
- Lead-in keywords: effective control
- Negative lead-in flag: false
Question ID
Qz0eDVdTW4ay-kZu7Wvps9
Reference Book
E6 Pharmacology Nursing Lilley 11e Part 1 p. 180-182
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 741-743
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7690-7692
Practise the full RRB Nsg. Superintendent-20 July 2019 (Shift-2)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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