MS contin is a medication, which belongs to the class narcotic analgesics (pain relievers).  Another name for this class of pain relievers is opioid analgesics.  The medication is used in the treatment of severe chronic pain.  It can be used 2-3 times around-the-clock.  MS Contin  is not meant for use in the treatment of short -term pain or  for pain treatment after surgery unless one was already using it before surgery, and those who use it switch from long-acting morphine or short-acting morphine medications.  Children are not approved to use this medication (MS Contin, 2006).

A healthcare provider should do the drug prescription, and MS Contin is not an exception.  Before prescribing MS Contin, the healthcare provider should consider several factors such as the severity of the pain, how the patient responds to the drug, other doze and painkillers taken by the patient, and other medical conditions the patient has (MS Contin, 2006).  The MS Contin tablet is taken around the clock with or without food, and no adjustment on the dosage should be done unless under healthcare provider instructions.  For oral form of morphine, a conversion of mg-per-mg is recommended; this is simply by adding the total mg of morphine taken per day and it is the recommended total MS Contin dose daily, which is taken 2-3 doses per day.  For any other non-morphine painkiller or injected morphine, the healthcare provider converts the current dosage to appropriate MS Contin dosage.  In this case, underestimation of the dose is preferred than overestimation; this is to avoid dangerous side effects.  In the event of more severe pain, the healthcare provider recommends a short-acting painkiller in addition to MS Contin (MS Contin, 2006).

Any medicine, when taken it has side effects and MS Contin is not an exception, however, not all people that take this medication have side effects; most people who take this medication tolerate it quite well.  Incase of side effects, they require no treatment or they are minor, and in most instances, the patient or healthcare provider easily treats them.  Studies shows that the side effects that are common include, drowsiness, sweating, nausea or vomiting, unpleasant or unusual feeling, dizziness or lightheadedness.  Most people with drowsiness and nausea feel better after taking the medication for a week (MS Contin, 2006).  However, in the event of severe nausea, the healthcare provider recommends an anti-nausea medication, which is taken for some days until the patients body becomes accustomed to the medication. However, there are some side effects that potentially serious but occur less frequently.  In case they occur they should be reported immediately to the healthcare provider.  These effects include, severe constipation, confusion, and unsteadiness or falling, urge to take more medication than prescribed, unusual changes in behavior or mood, difficulty in passing urine, slow heart rate, low blood pressure, severe drowsiness, seizures, slow or irregular breathing, signs of allergy reactions (MS Contin, 2006).

For the nursing assessment, the nurse should get to know the patient well before any medication.  The age of the patient should always be stated, the height, weight, and all physical examination possible.  After the physical examination, the medical history of the patient should be assessed concerning the drug that has been taken so far , other medication he/she is taking, any other disease apart from the pain.  The quality, severity and the cause of the pain should be assessed using the pain assessment methods.  This is done to give the right medication to the patient (MS Contin, 2006).

The healthcare provider must assess the nature of pain he or she is prescribing for before giving any medication to the patient.  When assessing the pain there are important aspects o be considered: the site of the pain; the healthcare provider determines the site of the pain of the ailing patient (MS Contin, 2006).  The quality of pain is also assessed; the healthcare provider uses the words used by the patient when describing their pain such as burning, sharp.  It is also important to know if the pain is localized or not; this helps in identifying the cause and type of pain.  The healthcare provider has to know the severity of the pain by measuring the intensity of the pain.  The pain intensity is measured using a visual analogue scale or verbal rating scale.

The categorical verbal rating is such as severe, moderate, and mild while in visual analogue, there is a simple line with words or numbers attached to it (MS Contin, 2006).  The patient moves the slide to match the severity of the pain. The exacerbating factors and relieve factors are used to assess the pain; this is by asking the patient about what worsen or better the pain.  The exact onset  is investigated to determine the fluctuations of the pain throughout the day, and the normal changes in the normal activity patterns causing interference in the daily living.  The effect on the psychological state of the patient is determined especially if there is less socially interactive or completely withdrawn.  It is also important to inquire about the previous and current analgesic therapies (MS Contin, 2006).

Some patients show allergic reaction when taking MS Contin.  These reactions include, hives, itching, an unexplained rash, mouth or throat swelling, wheezing, and difficult in breathing  people who develop itching might not necessarily have an allergy to the medication; this is because morphine stimulates the release of histamine, which results in itching that is unrelated to an allergy.  The development of itching alone without other allergy symptoms is not a likelihood of an allergy to MS Contin.  However, the itching should be reported to the healthcare provider to get medications that relief the itching (MS Contin, 2006).

There are certain medications, which may result in dangerous complications when taken with MS Contin.  The drug interactions can increase the risk of side effects such as confusion, difficulty in breathing and drowsiness.  The medications that might cause negative interactions when taken with MS Contin include, antihistamine, antidepressants, antipsychotic medications, alcohol, alvimopan, benzodiazepines, barbiturates, muscle reluctants, monoamine oxidase inhibitors, sleeping medications, narcotics or opiates.  The complications can be avoided by informing the healthcare provider about all other medications that are taken by the patient (MS Contin, 2006).

MS Contin is a narcotin, which is used in pain management for pain relief in patients who need oploid analgesics.  When taken MS Contin interacts with the opioid mu-receptor.  Mu-binding sites are distributed discretely in the human brain, and high densities are found in the hypothalamus,thalamus, posterior amygdata, nucleus caudatus, putamen and in specific cortical areas (MS Contin, 2006).  The terminal axons of the afferents found within laminae I and II of the spinal cord, together with the spinal nucleus of the trigeminal nerve contain high-density mu-binding sites.  Morphine exerts its pharmacological effect on the gastrointestinal tract and the central nervous system, and its primary action brings about sedation and analgesia.  This medication increases the patients' tolerance to pain and decreases discomfort.  Additionally the medication causes euphoria and dysphoria, drowsiness, and alteration in mood.  The opioids, in addition, produce respiratory depression through acting direct on brain stem respiratory centers (MS Contin, 2006).

The indications of MS Contin are relief of chronic and moderate to severe acute pain, relief of severe difficulty in breathing, suppression of cough, treatment of acute pulmonary oedema, and treatment of diarrhea (MS Contin, 2006).

MS Contin is a medication is quite dangerous in case of an overdose.  The effects of the overdose vary depending on whether it was taken with another substance or medication.  The effects of overdose include difficulty in moving limp muscles, breathing or even death, low blood pressure, extreme drowsiness among others. Overdose can be treated by pumping the stomach, administering activated charcoal to prevent drug absorption, or inducing vomiting.  The healthcare provider may administer an antidote to counteract the overdose effects (MS Contin, 2006).

Generic MS Contin tablets are in the following strengths:

  • Morphine sulfate ER 200mg.
  • Morphine sulfate ER 100mg
  •  Morphine sulfate ER 60mg
  • Morphine sulfate ER 30mg
  • Morphine sulfate ER 15mg

Ms contin is not recommended for use during pregnancy; it can cause birth defects such as brain disease, skeletal defects. If taken at the later stages of pregnancy, it may cause narcotic withdrawal; this is after birth, leading to symptoms such as vomiting, tremor, and fast breathing (MS Contin, 2006).  Again, according to research, mothers who are breast-feeding are not recommended to use this medication because it passes through breast milk and can cause problems in a nursing infant; these problems include poor feeding, drowsiness, constipation, or even difficulty in breathing (MS Contin, 2006).

Disease Process

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Breast cancer is a disease caused by mutation of genes that regulate cell growth in the breast tissue. The mutation causes the cells growth to be out of control; these cells grow into masses called tumors (Garcia, 2006).  The abnormal cell growth commonly originates in the milk ducts; however, it can develop in the lobules.  The abnormally grown cells are also altered in their ability to migrate, and they are able to break off the primary tumor, and then move to nearby lymph nodes or tissue.  This enables the cell to move in the body using the blood stream or the lymph nodes.  The cancer cell then settles and creates new blood vessels and the growth of the secondary tumor begins.  The secondary tumor occupies space making it impossible for the other structures because of limited space; this causes organ failure and eventually death (Garcia, 2006).

The medication used in cancer treatment includes Abraxane IV, which is used to treat advanced breast cancer.  Pamidronate is used in the treatment of high blood calcium levels together with bone problems, which occur with some types of cancer.  Arimidex Oral is medication that is used in the treatment of breast cancer in women who are in menopause.  Other medications include Epirubicin IV,  Faslodex IM , Femara Oral, Gemzar IV, Herceptin IV,  Neulasta SubQ , Neupogen Inj, Procrit Inj, Tamoxifen Oral, Taxotere IV, Toremifene Oral, Xeloda Oral, Zoladex SubQ , Zometa IV, Ixempra IV

There are different types of breast cancer treatments.  Surgery in one of them, whereby the patients with breast cancer undergo surgery to remove the cancer cells from the breast.  The surgery include lumpectomy, which is a surgical procedure used in the removal of the tumor and some normal tissue around it (Garcia, 2006).  Another breast conserving surgery is partial mastectomy, which is a surgical procedure done to remove part of the breast containing cancer cells and some tissue around it other types of surgery include total mastectomy where a whole breast containing cancer is removed, modified radical mastectomy where the breast containing the cancer cells is removed together with the lymph nodes below the arm, part of chest wall muscles and the muscle lining over the chest.  The radical mastectomy where surgery is done to remove the breast with cancer, the lymph nodes below the arm and chest wall muscles below the breast.  After sugary, chemotherapy, radiation therapy or hormonal therapy is done to kill any left out cancer cells (Garcia, 2006). 

Radiation therapy is the treatment that utilizes high energy X-ray or any other radiation to kill the cancer cells.  Radiation therapy is categorized into external radiation therapy, which utilizes a machine outside the body to concentrate the radiation to the cancer cells, and internal radiation therapy, which utilizes a radioactive substance that is sealed in needles, wires, seeds or catheters, which are placed into the cancer directly.  The type of radiation therapy employed depends on the stage and type of cancer being treated (Garcia, 2006).

Chemotherapy in another type of treatment, which uses drugs to stop the cancer growth by either stopping the cells from dividing or killing the cells.  The drug is taken by mouth or through injection into the vein.  When the drug enters the blood stream, it is able to kill the cancer cells throughout the body (Garcia, 2006).  This type of chemotherapy is known as systematic chemotherapy.  There is a chemotherapy, which is placed into the spinal column, a body cavity or an organ; the drugs placed in these areas are meant to affect cancer cell in the regions; this is regional chemotherapy.  The type of therapy administered depends on the stage and type of cancer being treated (Garcia, 2006).

Breast cancer is diagnosed because of symptoms being experienced and the precautionary testing.  Precautionary testing are in form of mammograms, self-exams and clinical breast exams.  Mammogram should be performed annually, particularly on older women and women at the age of 40.  Clinical breast exams are mostly performed on women that are in their 20's and 30's.  They are physical exams done at least every three years by a professional.  Individuals on themselves do the self-exam; this entails feeling the breast area for lumps.  Incase of any abnormality, visit the doctor (Garcia, 2006).

The second diagnosis is because of cancer symptoms.  The most common symptom is presence of lumps within the breast.  Others include inverted nipple, underarm lumps, nipple discharge, and swelling of the breast among others.  The health professional performs tests, which include, biopsy, diagnostic mammogram, breast ultrasound, ductogram and MRI.  If the tests reveal the breast cancer existence, then the doctor determines the widespread of the cancer cells and how serious it is.  The doctor then goes ahead to prescribe the appropriate treatment (Garcia, 2006).

There are other symptoms, which show a great danger; these symptoms include flaking or peeling of the nipple skin, change in shape and size of the breast, pitting or redness of the skin over the breast, like orange skin (Garcia, 2006).

A great proportion of breast cancer cases experienced can be explained by factors that influence exposure to oestrogen, which include hormonal factors, obesity, reproductive factors, alcohol and physical activity.

When considering age, the older women have higher risk of developing breast cancer when compared to young women.  The women reproductive history is also a risk factor, with women with fewer children having a great risk compare to women with many children (Garcia, 2006).  The reproductive factor which influence breast cancer risk include the age at menarche, age at first birth, parity, breast feeding, age of menopause, endogenous hormones, exogenous hormones, hormone replacement therapy, breast density, previous breast disease and family history.  The non-reproductive lifestyle factors are bodyweight, physical activity, alcohol consumption, diet, shift work, in-utero exposure, height, medical radiation exposure, medication and medical conditions (Garcia, 2006).

Diseases that are related to the diet for instance the heart diseases have increased chances of cancer development.  This includes vascular diseases, which are because of high fat consumption (Garcia, 2006).

Nursing Process

Mrs. B,  is a 67 year old lady, who has been on breast cancer treatment. She was treated by radiation/chemotherapy.  She has been prescribed with MS Cotin to relieve the pain she is experiencing after the breast cancer treatment.  Despite taking the pains relieve medication prescribed to her, she still is in great pain.  Apart from the pain, she is also experiencing oral thrush and difficulty swallowing.

The nurse diagnosis shows that Miss B is suffering from acute pain that is related to the breast cancer treatment.  This is evident because of the elevated pulse rate, restlessness and perspiration as recorded on her medical history (Wisconsin cancer pain initiative case studies n.d.).  The nurse also receives complains of oral thrush and difficulty in swallowing from Miss B every time she takes her medication.  

In this case, the nurse plans to find out the root cause of the pain, the non-response to medication and the cause of the oral thrush pain and difficulty in swallowing.  The nurse should find out how much pain medication is the patient taking.  The frequency at which Mrs. B is taking the medication should also be determined.  If she is taking less medication than the one prescribed to her, the nurse should find out why Mrs. B is doing that for example, is she fearing the side effects, addiction or does she lack knowledge on how to take the medicine (Wisconsin cancer pain initiative case studies n.d.).

The implementation of the plan is first to advice Miss B to take the medication as scheduled or prescribed.  The nurse should also monitor Mrs. B's behavior and the effectiveness of the medication she is taking.  Meanwhile the nurse should try to eliminate or reduce the pain experienced by Mrs. B.  This is by, for instance, reducing the fear, fatigue by massage, distraction, relaxation and other therapeutic activities (Wisconsin cancer pain initiative case studies n.d.).

The pain could also be reduced using the break through drug. If the evaluation shows that the patient is taking the medication as prescribed by the doctor and no desired outcome is realized then it is wise to consult the doctor for further treatment (Wisconsin cancer pain initiative case studies, nd).

The doctor will then have to evaluate Mrs. B once more to assess the severity, the cause, the quality, and the location of the pain.  The evaluation would be done using the pain assessment method (Wisconsin cancer pain initiative case studies, nd).  The doctor would also check if there was the case of under dose or incorrect medication using the results of the evaluation and the drugs, which Mrs. B was taking (Wisconsin cancer pain initiative case studies n.d.).

Incase of incorrect medication the doctor will have to prescribe new medication according to the pain assessment results.  On the other hand, if the medication were correct according to the assessment results, then the doctor would prescribe another pain reliever.  The doctor would also prescribe for the effects experienced by Mrs. B; the oral thrush and difficulty in swallowing.

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