Assignment - Developing a Drug Protocol

General Information

You are working on a ward and are a newly registered nurse to this area. You are required to administer medication to one of the patients assigned to you (which represent one of the supplied case studies below). You are unsure of how to give the medication and seek out the unit's medication protocol for help but are unable to find one. You approach the Nurse Unit Manager who suggests you develop a drug protocol for this medication to be utilised on the ward which includes consideration of the patient when discharged i.e education.

Instructions:

1. You are to choose ONE of the following case studies below to write for your assignment.

2. The assignment has two parts. 

Part A: Development of Drug Protocol

Your task for this part of this assignment is to utilise the template supplied (which contains all the headings and additional information [in italics] guiding you as what is required) and develop a drug protocol that is specific medication related to the illness or disease stated in your chosen case study.

This means that if you choose:

Case study 1: You need to develop a drug protocol for the administration of salbutamol for treatment of asthma.

Case study 2: You need to develop a drug protocol for the administration of rivaroxaban for treatment in patients with atrial fibrillation. 

Case study 3: You need to develop a drug protocol for the administration of ibuprofen for treatment of a pain and fever in children (birth to 5 years). 

You are to only choose 1 (ONE) case study from the list below. 

Part B: Justification and Critical discussion

You are required to justify and discuss this medication for treatment of the disease/illness in your chosen case study. Therefore this means if you choose Case Study 1, you need to justify or discuss why salbutamol is drug of choice to be prescribed for treatment of asthma i.e. what is the mechanism of action, what local guidelines exist, what evidence supports the use of this medication etc. that would, or would not, support administering this medication for the treatment of asthma. Suggested word length for this section - 500 to 600 words (max).

You are also required to critically discuss administering this medication to your patient incorporating the drug protocol in Part A. Basically your task here is to individualise the drug protocol to fit your patient. The drug protocol is a generic protocol and contains general information. Each case study has questions to assist in addressing this section of the discussion. You need to consider cultural and teaching aspects e.g: the section of your drug protocol titled 'Patient Advice & Education' may guide your discussion for this section: e.g if your patient education and advice includes a pamphlet, then you need to discuss whether or not this pamphlet would be appropriate taking into account the patient's culture or social background. Is it educationally appropriate for the age of the patient? What additional considerations would you need to consider? In your discussion you may need to consider the laboratory testing and or other medications prescribed that may be supplied in your case study. These are only suggestions to be used as a guide. Suggested word length for this section - 500 to 600 words (max).

NB: This section - Part B, needs to adhere to an Academic essay format which includes an introduction and conclusion - the justification and critical discussion are not individual sections so only requires one introduction and one conclusion for the entire discussion.

Case Studies  -

The following case studies are fiction in both name and any personal information. Any relevance to any person or place is merely co-incidental.

Your requirement for this assignment is to choose ONE case study below.

Case study 1:  

Miss Shana Bell is an 18 year old who has a history of asthma. She has been admitted to the medical ward after presenting to the emergency department via ambulance with a severe flare-up of her asthma. She presented to the emergency department with a 3 (three) day history of increasing shortness of breath requiring increasing use of her salbutamol puffer (which she had run out of that morning) and unable to talk full sentences on arrival.  Miss Bell has a partner and young child who accompany her to the ward. Miss Bell is a heavy smoker and has been smoking since the age of 14. The acute signs and symptoms of her asthma has passed and Miss Bell is being prepared for discharge in the following days from the medical ward. Both her and her partner are unemployed and live in a 1 bedroom apartment so have very little money for medications.

The doctor has charted Miss Bell 2 (two) puffs every 4 (four) hours of salbutamol (Ventolin) metered dose inhaler (MDI) PRN, and 3 days of high dose prednisolone 50 mgs daily. She is for regular 4th hourly observations. Recent observations are within normal ranges. Miss Bell has had bloods attended and results are unremarkable.

All medications are listed below. 

Past medical history is of previous presentations with uncontrolled asthma with no history of admissions to hospital previously.

Medications on admission: 

• salbutamol (Ventolin) inhaler 2 puffs 4hrly PRN
• prednisolone 50 mg daily for 5 days

Miss Bell is to be discharged on an inhaled corticosteroid - fluticasone propionate 250mcg (Flixotide) MDI 2 puffs daily.

Questions (to assist in answering the critical discussion section of Part B):

a) Does this protocol fit, or is it able to be utilised, for Miss Bell?

b) Discuss the importance of this medication in treatment of Miss Bell's asthma. Are there any perceivable issues relevant to Miss Bell's circumstances?

c) What potential problems exist for Miss Bell in adhering to her medication regime to control her asthma? What strategies could be suggested to assist her monitoring/reducing flare-ups of her asthma?

d) What advice and education could be offered to Miss Bell and/or her family to help ensure adherence to her medication regime including the addition of taking the new inhaled medication fluticasone?

Case Study 2: 

Mr Lee is a 78 year old gentleman who has recently emigrated to Australia from China and speaks little to no English. He has been admitted to the medical ward for monitoring and commencement of an anticoagulant after presenting to the emergency department with new onset of atrial fibrillation. Mr Lee weighs 75 kgs and is 158cms tall. Mr Lee is accompanied by his wife, Chen and adult daughter, Xia who are always in attendance. Mr Lee currently resides with his wife at their daughter's residence. His daughter speaks for Mr Lee in all communications with the staff and translates basic information for him including his menu choices. His wife assists with Mr Lee's ADLs. Mr Lee is being prepared for discharge in the next couple of days and his heart rhythm remains in atrial fibrillation. Past medical history is unremarkable other than hypertension and high cholesterol.

The doctor has charted Mr Lee rivaroxaban orally 10mg due 6pm daily on admission to the medical ward. All other medications are listed below.

Additional Medications on admission:

• metoprolol 50mgs daily
• atorvastatin 40 mg nocte
• aspirin 150 mg mane

 Most recent observations and laboratory results:

• Heart rate: 72 - 87 beats/min and irregular on palpation of radial artery
• Blood pressure: 129/65
• Temperature: afebrile
• ECG: shows atrial fibrillation
• CrCl: 50mL/min

Questions (to assist in answering the critical discussion section of Part B):

a) Does this protocol fit, or is it able to be utilised, for Mr Lee?

b) Discuss any potential issues taking rivaroxaban with current medications.

c) Discuss advice and education/strategies that can be offered to Mr Lee and his daughter/wife to help adhere to the medication regime and safely taking rivaroxaban at home? Consider cultural aspects.

Case Study 3: 

You are the nurse at a local health centre. Mrs Broome has brought Makayla, her 2 year old daughter for concerns regarding an ongoing earache. Makayla is from an indigenous background and resides with her extended family in a rural and remote area of Australia. Both she and her mother have travelled some distance to see the doctor. Makayla has a temperature of 38.5 and unsettled with bouts of crying. The doctor diagnoses Makayla with acute otitis media (middle ear infection) and has prescribed some antibiotics. Makayla has had 4 (four) previous episodes of otitis media in the last 12 months otherwise has no other health problems and takes no regular medications. The doctor has advised Mrs Broome to administer ibuprofen for pain and fever associated with this infection and calls you to administer a dose of ibuprofen prior to Makayla and her mother leaving the clinic. Makayla weighs 14kgs. The doctor has prescribed 140mg ibuprofen 6hrly PRN for the pain and fever.

Questions (to assist in answering the critical discussion section of Part B):

a) Does this protocol fit, or is it able to be utilised, for Makayla Broome?

b) Discuss if this medication can be safely administered to Makayla.

c) Discuss education necessary for Makayla's mother to adhere to the safe administration of ibuprofen. Consider cultural aspects.

d) What education and advice could be suggested to Makayla's mother to assist with preventing further episodes of otitis media as a means of employing preventive measures decreasing medication requirements? Consider cultural aspects.

Attachment:- Assignment Files.rar