The nurse uses comfort measures to enhance an older adult's pharmacological pain management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adult's pain level?

Choice A reason: Sunken eyes are a sign of dehydration because the fluid loss causes the eyes to lose their shape and appear hollow. This is especially noticeable in older adults who have less fat and muscle around the eyes.

Choice B reason: Lower extremity weakness is a sign of dehydration because the fluid loss affects the blood volume and circulation, leading to reduced oxygen and nutrient delivery to the muscles. This can cause muscle fatigue, cramps, and weakness.

Choice C reason: High fever is not a sign of dehydration, but rather a possible cause of dehydration. Fever increases the body temperature and metabolic rate, which leads to increased sweating and fluid loss. However, fever itself does not indicate dehydration, unless it is accompanied by other signs and symptoms.

Choice D reason: Cough is not a sign of dehydration, but rather a possible cause of dehydration. Coughing can cause fluid loss through the respiratory tract, especially if it is productive or associated with vomiting. However, cough itself does not indicate dehydration, unless it is accompanied by other signs and symptoms.

Choice A reason: This is incorrect because over-the-counter NSAIDs are not generally harmless, especially for older adults. NSAIDs can cause gastrointestinal bleeding, renal impairment, hypertension, and increased risk of cardiovascular events. Older adults are more susceptible to these adverse effects due to age-related changes in pharmacokinetics and pharmacodynamics, as well as the presence of comorbidities and polypharmacy. Therefore, NSAIDs should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice B reason: This is correct because stool softeners and laxatives should be used with opioids. Opioids can cause constipation, which can lead to abdominal pain, nausea, vomiting, fecal impaction, and bowel obstruction. Older adults are more prone to constipation due to decreased intestinal motility, reduced fluid intake, and use of other medications that affect bowel function. Therefore, stool softeners and laxatives should be prescribed along with opioids to prevent and treat constipation in older adults.

Choice C reason: This is incorrect because opioids are not less effective in older clients than in younger clients. Opioids are potent analgesics that can relieve moderate to severe pain in older adults. However, opioids can also cause respiratory depression, sedation, confusion, delirium, falls, and dependence. Older adults are more sensitive to these side effects due to altered pharmacokinetics and pharmacodynamics, as well as the presence of cognitive impairment and frailty. Therefore, opioids should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice D reason: This is incorrect because the dose limit for acetaminophen is not difficult to reach for older adults. Acetaminophen is a safe and effective analgesic for mild to moderate pain in older adults. However, acetaminophen can cause hepatotoxicity, especially at high doses or in combination with other medications that contain acetaminophen. The recommended maximum daily dose of acetaminophen for older adults is 3 grams, which can be easily reached if the patient is not aware of the amount of acetaminophen they are taking. Therefore, acetaminophen should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.