DRUG THERAPY CASE STUDY ASSESSMENT TASK

This case study assignment is based on the theory, concepts and nursing principles covered in lectures, tutorials and associated resources. It is designed to develop knowledge and problem-solving skills that apply to decision-making and safe drug administration in complex health care settings.

ALTERED SOMATIC FUNCTION AND PAIN MANAGEMENT

Consider the patient Situation

Mr. Edward Hunter, an 89-year old widower, was admitted to your medical ward 5 days ago with end-stage idiopathic pulmonary fibrosis, hypoxaemia (oxygen saturations 82% in the ambulance) and a bacterial chest infection. He has been receiving intensive home support from the 'acute care in the home' nursing team for over 6 months, which includes home oxygen therapy. One month ago he suffered a myocardial infarct, which was preceded by frequent episodes of unstable angina. He had a coronary stent in 2007.

Mr. Hunter's condition continues to deteriorate. He is receiving 15 litres oxygen via the nonrebreather mask. Severe dyspnoea renders him immobile and barely able to eat. He has little appetite and is cachexic. At night, he becomes quite restless and distressed by his pain, breathlessness and cough. The palliative care team reviewed Mr. Hunter 4 days ago because he was experiencing increased pleuritic pain on inspiration. Subsequently, he was prescribed morphine 5mg (5mg/ml) solution nocté for the analgesic, cough suppressant and sedative (narcotic) effects.

Yesterday evening, in handover given to the night duty nursing team, it was explained that the palliative care team had reviewed Mr. Hunter again and reduced the dose of morphine to 2-0 - 2.5mg nocté because he was becoming drowsy during the day but was easily roused and orientated once woken and maintaining oxygen saturations 92 -94%.

Collect information: pathophysiology

Q1. Outline the pathophysiology of pain in relation to pleuritis. Include the generation and transmission of pain, pain mediators and classification of pain. Avoid writing about different conditions and keep your focus on pleuritic pain.

Process information: Pain management

Q2. Discuss the common fears and myths that interfere with health-care professionals providing adequate pain management to patients?

Q3. Explain why is it important to recognise an opiate-naïve patient? Discuss how the nurse can mitigate the risk of adverse effects from administration of opiate medications in the opiate-naïve patient experiencing acute pain?

Q4. The central principles of social justice in a health care context are self-determination, equity, access and rights and, participation. How do you interpret the actions of the nurse in withholding the prescribed morphine solution (nocté) from Mr. Hunter in relation to social justice principles? Discuss the potential impact on Mr. Hunter if he perceives his treatment for pain to be unfair and unjust?

Making reasoned judgments

Q5. Should a nurse administer a 'broken' tablet of oxycontin to a patient? Apply your knowledge of the absorption properties of 'controlled-release' preparations of oxycodone to justify your answer to this question, and comment on what the potential outcome would be for the patient if this medication were administered after being cut in half.

Q6. Give a rationale for why nurses would administer, or withhold concurrent doses of morphine solution (nocté), oxycontin 10mg PO 12 hourly and endone 30mg PR PRN to Mr. Hunter.

Planning care associated with opiate use

Q7. Relate the mechanism of action of opioids to the adverse effects on the peripheral nervous system to explain how opioids cause constipation?

At what point should laxatives be prescribed for patients taking opioids? What action of Coloxyl (docusate) with Senna prevents/relieves constipation?

What non-pharmacological therapies can be encouraged early to help prevent constipation?

Q8. What are the advantages of the drug 'Targin' compared to controlled-release oxycontin tablets?

Reflection:

• What are the two most important things that you have learned from this scenario?
• What actions will you take in your future practice as a result of what you have learned from this scenario?

Attachment:- Assignment Files.rar