BACHELOR OF NURSING SCIENCE
NUR 231 – Drug Therapy Case Study
SEMESTER 1, 2017
Copyright USC @2010
Course Coordinator – Dr Julie Hanson
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NUR 231 DRUG THERAPY – ASSESSMENT TASK 3 – CASE STUDY
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.
Assessment requirements:
Submission: Submit on or before Friday of week 12 online via safe assign by 11.59pm.
Formatting: Format using 1.5 line spacing and Times New Roman 12.
Word Count: 2,500 words +/- 10% - 45% weighting.
Marking Criteria: All questions must be completed according to the marking criteria in order to achieve a satisfactory grade.
References: In-text references are included in the word count. (The reference list is not included in the word count). Please use academic sources of information such as the texts used in this course and peer reviewed journal articles. Other trustworthy sites include Government-operated websites and NPS MedicineWise.
Completion Guidelines
The case study assignment is an Individual Assessment Item.
You may work collaboratively with others students to understand concepts in this course but your answers must be your individual research, interpretation and application of the materials. All answers must be supported by relevant references to the literature.
Answers that show evidence of deliberate copying from other student's work will be investigated as collusion. Answers that show evidence of deliberate copying from authors will be investigated as plagiarism. Collusion and plagiarism are considered to be academic misconduct and academic penalties apply. For more information see the Bb+ assessment area and course outline re: Student Academic Misconduct.
***Remember to save a copy of your work on an external drive or USB.
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%.
Mr. Hunter’s prescribed therapy includes:
Prednisolone 50mg PO BD
Nicorandil 10mg PO BD
Aspirin 75mg PO daily mane
Ramipril 5mg PO BD
Paracetamol 1 – 2 tablets PO PRN (Maximum 4gm/day)
Simvastatin PO 20mg nocté
Amoxycillin 500mg capsules PO TDS
Clarithromycin 500mg PO BD
Morphine 2.0 – 2.5 mg PO PRN Nocté 4-6 hourly
Docusate 1 tablet BD
Metoclopramide 5mg PO TDS
Oxygen (high flow) to achieve oxygen saturation 92%
You arrive the next morning to find Mr. Hunter crying and distressed. He is refusing his medications and asking to be discharged. His family was called in because of his acute distress and Mr. Hunter’s niece discovers that when he became distressed during the night, he asked a nurse for his dose of morphine and she refused to give it. The nurse claimed that morphine was not written up on the prescription chart and that she felt that he was becoming addicted to it. You observe that Mr. Hunter is still very distressed and extremely dyspnoeic. The respiratory consultant arrives to examine Mr. Hunter after this distressing event and prescribes additional pain relief: Endone suppository 30mg rectally PRN and Oxycontin 10mg orally 12 hourly PRN.
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?
ALTERED SOMATIC FUNCTION AND PAIN MANAGEMENT
Part 2. As you recall, the respiratory consultant reviewed Mr. Hunter and prescribed endone (30mg) rectal suppository PRN and oxycontin 10mg orally 12 hourly PRN. As directed by the consultant, the registered nurse asks you to check a dose of oxycontin for administration to Mr. Hunter immediately. You are required to give oxycontin 10mg tablet but the available stock in the drug cupboard is 20mg tablets. The registered nurse breaks a 20mg tablet in half with a pill cutter and asks you to administer this to Mr. Hunter.
Making reasoned judgments
Question 5. 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
Question 7. 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?
Question 8. 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?
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