Following surgery, she was placed on morphine patient-controlled analgesia (PCA). She has been using 27 mg of morphine/24 hours with adequate pain control; however, she has developed redness and itching on her neck that is believed to be due to the morphine.

2Part 2After the surgery she was placed on a patient-controlled analgesia (PCA) pump becausethere were most likely concerns of swallowing issues which could lead to aspiration, especiallyin the elderly.“With PCA analgesia, avoid a basal infusion of opioid medication in opioid-naïvepatients. The addition of acetaminophen or NSAIDs is associated with reduced opioidconsumption and better pain control than using opioids alone” (Cadaval Gallardo et al., 2022). Ifthere is a concern with swallowing then she should be administered Lovenox SQ or heparin IV, ifin the hospital, until she is able to swallow. Even though she is having adequate pain control shehas developed an adverse reaction to the morphine, and it should be discontinued but notconsidered a true allergy.Bronchospasm would be an indicator of a severe allergic reaction tothe morphine.I would order Benadryl 50mg PO Q6 PRN to help with the redness and puritus.Based upon her current daily morphine dose of 27mg/day and using a conversion calculator witha 25% reduction yields a 51mg daily dose of hydrocodone.Hydrocodone 10/325mg PO Q6 PRNwould be appropriate.This patient needs to be monitored closely for other adverse reactions andtolerance of switching to hydrocodone.She is already prescribed Miralax but a stool softenersuch as Colace 100mg PO BID should be incorporated into her plan.It would be important toeducate her on increasing her PO fluids and ambulating frequently as tolerated.Earlyambulation after surgery helps reduce the incidence of a post-operative ileus.A dietary plan toinclude sources of fiber would be beneficial without adding another medication to her list.Post-operative patients are at risk for developing pneumonia and they should be educated to performdeep breathing exercises at least every 30 minutes to promote good airflow into the lungs