| Course | NUR-3480 Nursing Care of Clients with Acute and Chronic Conditions |
|---|---|
| Module | Module 5 |
| Paper type | Nursing paper: chronic pain and opioid safety |
| Length | About 1,024 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3480 Module 5
Sedation Before Breathing: Opioid Safety for a Patient With Chronic Pain After Knee Surgery in Toms River
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3480: Nursing Care of Clients with Acute and Chronic Conditions
Mentor Name
Month Day, Year
Sedation Before Breathing: Opioid Safety for a Patient With Chronic Pain After Knee Surgery in Toms River
The Patient
Mr. Bauer and his Toms River hospital are fictional. Mr. Bauer, 61, a retired electrician, has taken oxycodone for chronic low back pain for six years, currently 30 milligrams a day, about 45 morphine milligram equivalents. He has obstructive sleep apnea and uses a CPAP machine at home. He had a total knee replacement this morning and returned to the orthopedic unit with a patient-controlled analgesia pump of hydromorphone and orders for his usual oxycodone. He calls his pain an 8 and says opioids hardly touch it anymore.
Prescribing Guidance
Dowell et al. (2016) issued the CDC guideline for prescribing opioids for chronic pain. It recommended nonpharmacologic and nonopioid treatment as preferred for chronic pain, setting goals for function, using the lowest effective dose and reassessing benefits and harms regularly. It advised caution at doses of 50 morphine milligram equivalents a day or more and avoiding or carefully justifying doses of 90 or more, avoiding combining opioids with benzodiazepines and offering naloxone to patients at higher risk of overdose, such as those with sleep apnea. The guideline was aimed at primary care, not at acute pain after surgery, but its warnings about risk factors apply in the hospital.
Opioids and Function
Krebs et al. (2018) randomized patients whose chronic pain came from the back or from arthritic hips or knees to a year of either opioid or nonopioid medicines. Pain-related function did not differ between groups. Pain intensity was slightly better in the nonopioid group, and medication-related symptoms were more common with opioids. The trial supports the CDC's preference for nonopioid approaches in chronic pain and helps explain why Mr. Bauer feels his opioids no longer help.
Monitoring Sedation
Jarzyna et al. (2011) wrote the pain management nursing society's guideline on how to watch patients on opioids for oversedation and slowed breathing. They explained that unintended sedation usually precedes respiratory depression, so monitoring sedation with a valid scale is essential, along with respiratory rate and depth and, when appropriate, continuous oximetry or capnography. They identified risk factors, including sleep apnea, obesity, older age, being opioid naive, concurrent sedating drugs and the first twenty-four hours after surgery, and recommended more frequent monitoring for higher-risk patients.
| Source | Key point | Nursing action |
|---|---|---|
| Dowell et al. (2016) | Prefer nonopioids; caution at higher doses; naloxone for higher risk | Use multimodal analgesia; plan naloxone at discharge |
| Krebs et al. (2018) | Opioids did not improve function more than nonopioids | Set function goals; add nonopioid medicines |
| Jarzyna et al. (2011) | Sedation precedes respiratory depression; monitor high-risk patients closely | Sedation scale and capnography; CPAP on |
Nursing Diagnoses
The student identified acute pain related to surgery on top of chronic pain, risk for ineffective breathing pattern related to opioids and sleep apnea and impaired physical mobility.
Implementation
Because Mr. Bauer is opioid tolerant, he needs more opioid than an opioid-naive patient for the same relief, and undertreating his pain would delay his recovery. The student and nurse gave his usual oxycodone, the PCA as ordered, scheduled acetaminophen and the anti-inflammatory and nerve block the surgeon had ordered, and used ice and elevation. Because of his sleep apnea, he was placed on continuous capnography and his CPAP was applied whenever he slept. Each hour for the first day, the student scored his sedation on the Pasero scale, along with respiratory rate and depth.
A Warning Sign
At 0200, the student found Mr. Bauer frequently drowsy and drifting off mid-sentence, a sedation score of 3, though his respiratory rate was 12. Following the guideline, she stopped the PCA, kept him awake, raised the head of the bed, applied his CPAP and called the nurse, who notified the provider. The PCA dose was reduced. By 0300 his sedation score was 2 and his breathing steady.
Watching Other Medicines
The student checked Mr. Bauer's medication list for other drugs that add sedation. He took gabapentin at home for nerve pain, and the surgeon had ordered it after surgery; together with opioids, it increases the risk of sedation. The student made sure the nurse and provider were aware of the combination and that he was not also ordered a sleep aid. She also confirmed that his CPAP machine had been brought from home and that respiratory therapy had checked the settings.
Talking About Tolerance
Mr. Bauer worried that staff would think he was drug seeking because he needed more medicine than other patients. The student explained tolerance to him in plain words and assured him that his pain would be treated. She also documented clearly why his doses were higher, so that every nurse would understand.
Function Goals
On day one, the student and Mr. Bauer set a goal tied to function rather than a pain score: walking to the hallway and doing his knee exercises with physical therapy. He met it with pain at 5 out of 10.
Discharge
Before discharge, the student taught Mr. Bauer and his wife about his short-term opioid plan, sleeping with CPAP and naloxone, which the provider prescribed because of his higher-risk profile, and how to use it.
Reassessing Function, Not Only Scores
At each reassessment, the student asked Mr. Bauer what he could do as well as how much it hurt: could he bend his knee to the goal angle, walk to the bathroom, sleep for a few hours? On day two, his pain score was still 5, but he walked the length of the hallway and slept four hours with CPAP. The function goals gave both patient and nurse a clearer picture of progress than the number alone.
Limits
The CDC guideline has since been updated and addresses acute pain more directly. Sedation scales depend on careful assessment. A student gives opioids only under supervision.
Conclusion
Mr. Bauer needed effective pain relief and careful protection. The CDC guideline and the SPACE trial supported nonopioid and multimodal approaches and function goals, and the ASPMN guideline showed that sedation monitoring catches danger before breathing slows. Treating his pain fully while watching sedation, using his CPAP and sending him home with naloxone kept him safe.
References
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain: United States, 2016. JAMA, 315(15), 1624-1645. https://doi.org/10.1001/jama.2016.1464
Jarzyna, D., Jungquist, C. R., Pasero, C., Willens, J. S., Nisbet, A., Oakes, L., Dempsey, S. J., Santangelo, D., & Polomano, R. C. (2011). American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Management Nursing, 12(3), 118-145. https://doi.org/10.1016/j.pmn.2011.06.008
Krebs, E. E., Gravely, A., Nugent, S., Jensen, A. C., DeRonne, B., Goldsmith, E. S., Kroenke, K., Bair, M. J., & Noorbaloochi, S. (2018). Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. JAMA, 319(9), 872-882. https://doi.org/10.1001/jama.2018.0899
Reading the NUR 3480 Module 5 assignment instructions
Chronic alterations in health that complicate acute care belong to TESU's catalog description of NUR-3480, and since TESU does not post the syllabus, the fifth module is an opioid safety paper. Write a paper that describes a patient with chronic pain facing an acute pain event, uses prescribing guidance and trial evidence on opioids, applies a sedation monitoring guideline, writes nursing diagnoses, describes multimodal pain care and monitoring and evaluates both relief and safety. Some sections focus on opioid use disorder or on pain in older adults instead. Check which sedation scale your clinical site uses and whether naloxone teaching should be included. Check for other sedating medicines and address the patient's worry about being judged for needing higher doses.
How this NUR 3480 Module 5 example is built
An invented 61-year-old on long-term oxycodone with sleep apnea, after knee replacement in Toms River, opens the paper. The CDC guideline, the SPACE trial and the ASPMN sedation monitoring guideline are explained, each linked to what the nurse does. Multimodal analgesia, capnography, CPAP and hourly sedation scores follow, and at 0200 a sedation score of 3 leads the student to stop the PCA and call for help. Function goals and discharge teaching with naloxone come next, before the limits and conclusion. Annotations note the balance of relief and safety and monitoring that changes care. Sections on other sedating medicines and on talking about tolerance make the plan both safe and respectful.
Reading the NUR 3480 Module 5 grading rubric
Opioid safety papers earn credit for accurate use of prescribing guidance and trial evidence, recognition that tolerant patients need adequate relief, a sedation monitoring plan matched to risk, a clear response to rising sedation and function goals with discharge teaching. Reviewers value a student who explains why sedation is monitored before respiratory rate falls. Using CPAP and capnography for sleep apnea shows attention to risk factors. Offering naloxone shows harm reduction. Guidelines should be cited with full titles and their years noted. Checking for additive sedatives such as gabapentin shows a complete safety review. Explaining tolerance to the patient and documenting it for staff shows respect and clear communication.
NUR 3480 Module 5 help: mistakes that cost marks
Opioid papers often either withhold opioids from tolerant patients or ignore sedation; do both pain relief and monitoring. Another frequent gap is a pain score goal with no function goal. Use multimodal analgesia. Monitor sedation with a valid scale. Know the risk factors. Act on rising sedation before breathing slows. Teach naloxone use. Send your own patient's case for a free first draft. Check every sedating drug on the list. Explain tolerance in plain words. Document why doses are higher. Reassess function as well as pain scores. Teach naloxone use to family too. Confirm CPAP is in use whenever the patient sleeps.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3480 Module 5 questions, answered
Where can I find a free NUR 3480 Module 5 sample paper?
The opioid safety paper about an invented patient with chronic pain after knee surgery in Toms River, from multimodal care to the 0200 warning, appears on this page.
What did the CDC 2016 opioid guideline recommend?
Prefer nonopioid treatment for chronic pain, use the lowest effective dose, use caution at higher doses, avoid benzodiazepines and offer naloxone to higher-risk patients.
Do opioids improve function in chronic pain more than other medicines?
The SPACE trial found no better pain-related function with opioids over twelve months.
Why monitor sedation in patients on opioids?
Unintended sedation usually precedes respiratory depression, giving nurses time to act.
What raises the risk of opioid-induced respiratory depression?
Sleep apnea, obesity, older age, being opioid naive, other sedating drugs and the first day after surgery.