| Course | NURS 6912 Symptom Management for the Hospice and Palliative Care Clinician |
|---|---|
| Week | Week 3 |
| Paper type | Pain management plan |
| Length | About 1,040 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6912 Week 3
Relief and Recovery Together: A Pain Management Plan for a 49-Year-Old With Advanced Head and Neck Cancer and Opioid Use Disorder in Sustained Remission
Student Name
College of Nursing, Walden University
NURS 6912: Symptom Management for the Hospice and Palliative Care Clinician
Instructor Name
Month Day, Year
Relief and Recovery Together: A Pain Management Plan for a 49-Year-Old With Advanced Head and Neck Cancer and Opioid Use Disorder in Sustained Remission
Focused Assessment
He cooked on a restaurant line for twenty years, and at 49 this composite patient has squamous cell carcinoma of the base of the tongue that has recurred after surgery and chemoradiation, with no further treatment aimed at cure. He describes two pains. The first is a constant, raw ache in his mouth and throat that becomes severe when he swallows, rated 4 of 10 at rest and 8 of 10 at meals. The second is a burning, shooting pain along the left side of his face and into his ear, present most of the day. On the Brief Pain Inventory, interference is highest for eating and sleep. He has lost weight because meals hurt.
He also has a history of opioid use disorder, in sustained remission for eight years without medication treatment, supported by weekly meetings and a sponsor. He told the team, "I don't want to lose what I built, but I can't eat." This plan treats both facts as clinical information that shapes the plan, not as a reason to withhold relief.
Two further findings shape the plan. He lives with his partner, who works nights, so he is often alone when pain peaks in the evening. And he has a feeding tube placed during chemoradiation that he has not used for months; he would rather eat by mouth, but he is willing to use the tube for medicines on the worst days. That option widens what formulations the team can offer and gives him a way to take medicine when swallowing is at its hardest.
Principles
Cancer pain guidelines recommend matching treatment to the pain mechanism, combining opioid and non-opioid approaches and reassessing regularly (Swarm et al., 2019). The World Health Organization's cancer pain guidance similarly supports individualized treatment by severity and mechanism rather than a rigid step-by-step sequence; the older analgesic ladder is used here only as a reminder that non-opioid and adjuvant medicines belong at every level (World Health Organization, 2018). For a patient with a history of substance use disorder, guidance emphasizes that pain must still be treated, with added structure to protect safety and recovery (Arthur & Bruera, 2019). This plan presents approaches by drug class and gives no doses; dosing belongs to the prescriber and the patient's individual situation.
Management by Mechanism
Mouth and throat pain (nociceptive, tumor and mucosal). Topical anesthetic rinses before meals can reduce pain on swallowing for the length of a meal. Scheduled acetaminophen in liquid form provides a non-opioid base. Because tumor swelling can add to pain, the team will discuss a short trial of a corticosteroid with his oncologist, weighing benefit against effects on mood, sleep and blood sugar. Soft, moist foods and liquid nutrition supplements, with the speech-language pathologist's advice, reduce the work of each swallow.
Facial burning and shooting pain (neuropathic). A neuropathic adjuvant, from either the gabapentinoid or the antidepressant class, is appropriate for this component, chosen with his mood, sleep and kidney function in mind. The team will explain that these medicines take days to weeks to help, so he does not judge them after the first dose. Because gabapentinoids have been misused by some people with opioid use disorder, the choice will be discussed with him openly.
Opioid component. The severity of his pain at meals and the failure of non-opioid measures alone justify an opioid. The plan uses a long-acting formulation for background pain, suitable for his swallowing, with a short-acting liquid formulation timed before meals for the predictable increase. Doses begin low and are adjusted in small steps, with reassessment of pain, function, sedation and bowel function at every change. Buprenorphine, which treats pain and is also used to treat opioid use disorder, will be discussed as an option, since some patients in recovery find it protects both goals (Arthur & Bruera, 2019).
Safety and Recovery Protection
Risk mitigation is built into the plan and explained to him as care, not suspicion. The plan includes the following:
One prescriber and one pharmacy, so that all opioid prescriptions are coordinated and visible.
Limited supplies with regular refills, reducing the amount at home at any time.
Secure storage in a lockbox, since others in the household or visitors could be at risk.
Naloxone in the home, with teaching for him and his partner.
His recovery supports involved with his permission: his sponsor knows he is taking a prescribed opioid for cancer pain, and he plans to tell his meeting.
A plain agreement about what happens if pain increases: he calls the team rather than taking extra doses, and the team responds the same day.
Guidance for survivors and patients with chronic cancer pain supports assessing risk of misuse, using universal precautions and involving the patient in the plan, while not denying opioids to people who need them (Paice et al., 2016).
Monitoring and Reassessment
Pain will be reassessed at every contact using the same numeric ratings for each pain and the Brief Pain Inventory interference items for eating and sleep. The team will track three outcomes that matter to him: how much he eats at a meal, how many hours he sleeps and whether he feels his recovery is secure. Sedation, constipation and nausea will be checked at each change. Constipation will be prevented from the first opioid dose with a scheduled bowel regimen.
The plan names in advance what would prompt review: pain above 6 of 10 at meals despite the before-meal dose, sedation during the day, signs that he is using medication differently from the agreement or his own report of cravings. None of these would end his pain treatment; each would bring a conversation and a change in the plan.
Conclusion
This man deserves effective pain relief and deserves to keep the recovery he has built. The plan treats each pain by its mechanism, uses opioids where they are needed with structure that protects him and involves his own supports. It reflects a principle that applies well beyond this case: a history of substance use disorder calls for more careful pain management, not less pain management.
References
Arthur, J., & Bruera, E. (2019). Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer. Nature Reviews Clinical Oncology, 16(4), 213-226. https://doi.org/10.1038/s41571-018-0143-7
Paice, J. A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., Citron, M., Constine, L. S., Cooper, A., Glare, P., Keefe, F., Koyyalagunta, L., Levy, M., Miaskowski, C., Otis-Green, S., Sloan, P., & Bruera, E. (2016). Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 34(27), 3325-3345. https://doi.org/10.1200/JCO.2016.68.5206
Swarm, R. A., Paice, J. A., Anghelescu, D. L., Are, M., Bruce, J. Y., Buga, S., Chwistek, M., Cleeland, C., Craig, D., Gafford, E., Greenlee, H., Hansen, E., Kamal, A. H., Kamdar, M. M., LeGrand, S., Mackey, S., McDowell, M. R., Moryl, N., Nabell, L. M., ... Gurski, L. A. (2019). Adult cancer pain, version 3.2019, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 17(8), 977-1007. https://doi.org/10.6004/jnccn.2019.0038
World Health Organization. (2018). WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents.
What the NURS 6912 Week 3 instructions ask for
Management prompts in Week 3 usually ask you to develop an evidence-based pain plan for a patient with cancer pain, often with a complicating factor such as substance use history, kidney disease or frailty. Expect three to five pages. Begin with a focused assessment that separates pain mechanisms. Organize treatment by mechanism, naming drug classes and non-drug measures with a reason for each. Describe how an opioid would be started and adjusted without listing doses, unless your prompt requires them. Where there is a complicating factor, explain how it changes the plan rather than whether to treat. Build in monitoring, bowel protection and review triggers, and involve the patient and his supports in the plan.
How this NURS 6912 Week 3 example is built
The assessment describes two pains, interference with eating and sleep and his recovery in his own words, plus a note on his unused feeding tube. A principles section cites Swarm and colleagues on the NCCN adult cancer pain guideline, the WHO cancer pain guidance and Arthur and Bruera on balancing analgesia with nonmedical use risk. Management follows by mechanism, with classes, rationales and a buprenorphine discussion. A safety section lists six measures, from one prescriber to naloxone and his sponsor, and cites Paice and colleagues' ASCO guideline. Monitoring names three outcomes that matter to him and four review triggers. A conclusion states the principle that careful management is not less management. The plan never lists a dose.
Reading the NURS 6912 Week 3 rubric
Cancer pain plans are generally graded on mechanism-based reasoning, evidence use, safety and individualization. Mechanism credit goes to plans that treat each pain component with a matched approach. Evidence is scored on current guidelines applied accurately. Safety carries weight, including bowel prevention, sedation monitoring and, where relevant, measures that reduce risk without denying treatment. Individualization is credited when the plan reflects the patient's goals and circumstances, such as his wish to protect his recovery. Monitoring with defined outcomes and triggers often earns a separate share. Many courses also score ethical reasoning about stigma. APA references and clear headings complete the rubric for most instructors. Instructors also notice whether monitoring names outcomes the patient cares about, such as eating a meal, rather than scores alone.
Common NURS 6912 Week 3 mistakes, and how to avoid them
Pain plans lose marks when they list opioids and doses without addressing mechanism or non-drug measures. Another loss is treating a history of substance use disorder as a reason to avoid opioids entirely, which graders see as undertreatment. Some plans forget constipation prevention. Others describe monitoring as ongoing assessment with no measures or triggers. Separate mechanisms, match classes to each, describe titration without doses, add safety measures explained as care, name outcomes that matter to the patient and set review points. The desk can prepare a plan for the complicating factor in your own scenario. Leave dosing to the prescriber unless your instructions ask for it.
Get a NURS 6912 Week 3 example written to your instructions
Share the Week 3 case, prompt and rubric, noting any history your scenario includes that complicates treatment, such as substance use, kidney disease or frailty. A plan organized by mechanism, with its titration approach, risk measures and reassessment trigger stated, returns in 24-48 hours. There is no fee for your first.
More NURS 6912 papers and MSN samples
- NURS 6912 Week 1: Discussion post
- NURS 6912 Week 2: Pain assessment writeup
- NURS 6912 Week 4: Dyspnea management plan
- NURS 6912 Week 5: Gastrointestinal symptom plan
- NURS 6912 Week 6: Delirium case analysis
- NURS 6912 Week 7: Case analysis
- NURS 6912 Week 8: Discussion post
- NURS 6912 Week 9: Family teaching plan
- NURS 6912 Week 10: Symptom management plan
- NURS 6912 Week 11: Reflection
- NURS 6910 Week 3: Models of care analysis
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NURS 6912 Week 3 questions, answered
Does the plan include opioid doses?
No. It names the titration approach, the monitoring each adjustment requires and the trigger for reassessment, and it discusses options by drug class. Doses, intervals and conversions belong to the prescriber and the setting, not to an academic sample. If your rubric asks for dosing, the sample points to the references your course assigns instead of stating figures itself.
How does the plan handle his history of opioid use disorder?
As information that changes monitoring rather than a reason to undertreat. The plan coordinates with his addiction medicine clinician, uses a single prescriber, places naloxone in the home and frames the agreement as shared safety. A plan that holds both commitments, relief and recovery, usually scores better than one that sacrifices either to protect the other.
Where does the WHO ladder fit?
It is cited as the familiar starting framework for stepping up analgesia, then qualified: the plan notes that mixed and neuropathic pain, and a patient in recovery, call for more than a stepwise climb. Referencing the ladder shows your reader you know it; naming its limits shows judgment, which is usually the part of the analysis that separates grade bands.
Where can I find a free NURS 6912 Week 3 sample paper?
The full pain plan, by mechanism with safety, monitoring and review triggers, is on this page and can be read free of charge. A plan for the patient your prompt describes can be requested.
How does the NURS 6912 Week 3 plan protect his recovery?
Through one prescriber and pharmacy, limited supplies, a lockbox, naloxone at home, his sponsor's involvement and an agreement to call the team instead of taking extra doses.