An 85-year-old woman has a medical history of insulin-dependent diabetes and a long-standing problem with osteoporosis. 2 months ago, she was diagnosed with several vertebral compression fractures of her lumbar spine. This is her routine check-up for her blood pressure, blood glucose, and healing decubitus ulcer on her heel. Her husband mentions that she has not been able to lie down and sleep in her bed for days and is managing on a recliner.
She has been able to “cat nap,” but only if exhausted from the lack of sleep. She has not eaten her breakfast and when questioned, she says she is in too much pain to eat or drink. She is unable to give her pain a numeric rating saying “it hurts like always” and “it’s been worse than this before.” Her current medication regimen includes: Morphine sulfate during the day (3-4 tablets) Propoxyphene (100 mg) and acetaminophen (650 mg) Alprazolam at…
