This case study assignment is based in part on the theory, concepts, nursing principles and resources that were covered in tutorials and lectures.
Collect information: PathophysiologyQ1.
Be specific about the generation and transmission, pain mediators, classification of pain.
Write only about pleuritic conditions.
Process information: Pain managementQ2.
Discuss how the nurse can reduce the possibility of adverse reactions from the administration of opiate drugs to the opiate-naive patients experiencing acute pain.Q4.
What are your thoughts on the actions taken by the nurse to withhold the prescribed medication (nocte) for Mr. Hunter?
Discuss the possible consequences that Mr. Hunter might feel if he feels his pain treatment was unfair or unjust.
As directed by the consultant the registered nurse asks that you immediately test the dose of oxycontin required for Mr. Hunter’s administration.
Although you are required to give Oxycontin 10mg Tablets, the available stock in our drug cupboard only has 20mg tablets.
The registered nurse will break a 20mg tab in half and ask you to give it to Mr. Hunter.
Making rational judgments5.
Is it appropriate for a nurse to give a patient a broken tablet of oxycontin?
Use your knowledge of the absorption of oxycodone controlled-release preparations to support your answer. Comment on the potential outcomes for the patient if this medication is administered after it has been reduced in half.Q6.
Give reasons nurses would administer or withhold concurrent doses (nocte), oxycontin PO 12 hourly, and endone 30mg PR PRN Mr. Hunter.
Planning care in relation to opiate use7.
To explain why opioids cause constipation, we need to relate the mechanism of actions of opioids with the adverse affects on the peripheral nerve system.
How soon should laxatives become prescribed to patients who take opioids?
What does Coloxyl with Senna do to prevent/relieve constipation
Are there non-pharmacological remedies that can be encouraged to help with constipation prevention?8.
What are the advantages of the drug ‘Targin’ compared with controlled-release tablets of oxycontin?Reflection:
What are the top two things you learned from this experience?
What practical steps will you take to implement the lessons you have learned in this situation?
Answer to Question: NUR231 Drug Therapy
Evidence-Based Nursing Research
Part 11: Pathophysiology Of Pain In Relation To Pleuritis
Mr. Edward Hunter had been admitted at the hospital with end stage idiopathic pneumonia fibrosis.
On inspiration, he experienced increased pleuritic discomfort.
The inflammation of both the pleural membrane and the inner wall of the chest can cause pleurisy.
This inflammation leads to innervations in the somatic nerves that cause pain sensation on the parietal.
In the visceral, pleura, there is no such pain receptor.
When inflammation in the periphery or lung parenchyma shifts to the space of the pleural, pain is transmitted.
This causes somatic pain receptors to be activated and the clinical presentation pleuritic pain.
The intercostal nerves also innervate parietal pain.
The pain is mainly localized to the cutaneous nervous system (Yalcin. 2013).
This pathophysiology causes chest pain, difficulty in breath, and pain in the shoulders or back.
This can lead to increased pain in the chest, as well as aggravated symptoms when there is shortness in breath.
(Kass; et.al., 2017) Shoulder pain is caused by the transmission of innervations each hemidiaphragm. 2017).
The following factors can help you to determine if your pleuritic discomfort is due to etiology or symptom onset:
Acute pain, which lasts from minutes to hours, can be caused by trauma, myocardial damage, pulmonary embolism and myocardial infarctions.
Subacute pain (continuing for many hours to days) – This can be due to infection or inflammatory processes.
Chronic pain for several days to weeks can be due to rheumatoid or tuberculosis.Recurrent pain- caused due to Mediterranean fever (Kass et al. 2017).2.
Many myths, fears, and misconceptions can interfere with the responsibility of pain management professionals to ensure that patients are properly managed.
It is possible to believe that acute pain does not exist. But, some people are too focused on it.
The perception of pain involves both the mind as well as the body.
But, complex cases require pain management and should not be ignored due to stressful life events.
Fears and myths that patients experiencing pain may also include the following:
Some people think that persistence pain is an inevitable experience and will not be treated due to aging or disease.
Some people see pain as a way to improve their character.
Many patients are reluctant to tell their pain stories to doctors as they fear that it might distract them from other more pressing clinical tasks.
Patients are anxious about side-effects and avoid medication for pain.
People who are afraid of getting addicted to pain relief pills discourage them from using pain relief drugs.
Many people fear taking strong medications such as opioids. They may cause additional complications.
All of these beliefs and fears about pain and opioids highlight the challenges that health care professionals face in providing effective pain management for their patients.3.
Opioid is the best option for patients seeking relief.
While pain management can be done with opioid-naive patients, it is important to distinguish between those who are opioid-tolerant and those who are opioid-naive.
Opioid-naive individuals are more likely to experience the adverse effects associated with opioid.
Clinicians can identify these patients and guide them in the right treatment.
Opioid naive patients will not need to increase their dose as they do for opioid tolerant patients.
Opioid-naive patients don’t receive opioid analgesics as a daily routine (Sun, et al. 2016).
This person has not taken the specified drug for the specified duration of time:
Oral Morphine/Day30 mg/day Oxycidone
60 mg Oral Morphine/Day
30 mg Oxycodone/day
Dosage and administration of any other opioid.
There may be many issues for nurses when prescribing opioid medication to opioid-naive patients.
These patients might be at increased risk of respiratory depression or over-sedation.
This can occur in patients who haven’t used opioids recently or who may require a higher opioid dose.
The nurse can monitor the risk of opioid-naive patient oversedation and mitigate any adverse effects.
The nurse can monitor the patient’s pulse oximetry (blood pressure, respiratory rate) and blood pressure.
However, respiratory rates cannot be used to indicate respiratory distress (Cushman, et al. 2017).
To detect risks and complications following opioid administration, it is important to assess for hypercapnia as soon as possible.
Opioid dependent patients who have taken opioid may also experience nausea.
If this happens, the nurse should offer solid food to patients.
Pain management must include the method of administration.
This is because opioid-naive patients might not respond to transdermal route.
The medication could be less absorbed (Principles Of Opioid Administration 2017).
The second is that there are many opioid drugs on the market. This makes it important to determine which type of opioid to administer.
Fentanly patch might not be appropriate in patients with opioid dependence.
This can limit the clinical effects of the drug (Grissinger 2010).
Patients who are opioid naive should be aware of the dangers associated with dose titration using sufetanil (Principles Of Opioid Management 2017.4.
Social justice principle emphasizes taking actions that eliminate injustice, promote inclusion of diversity, create supportive environments for all people.
This is a value system that values equity, diversity, and a supportive environment to achieve desired health outcomes (Thompson 2016).
The nurse took the action to reduce the dose. This is consistent with the social justice principle.
This was because Mr. Hunter was an elderly patient who was suffering from palliative conditions and excessive doses of morphine were causing him oversedation.
In this scenario, the patient’s condition might worsen.
Because Hunter was at greater risk if Hunter had been left to fend for herself, the nurse acted.
Nursing provided a safe environment for patients while providing care.
In accordance with the values and beneficence of care, the nurse decided to reduce the dose.
Hunter may perceive pain treatment unfairly or unjustly. This could have a psychological effect on the patient.
Hunter might feel that patients are not valued and have been given the wrong treatment.
Hunter may feel unable to trust staff or nurses during his care.
The final result of this is that the patient may not participate in care or may not follow medical advice.
This could result in adverse patient conditions (Fortin et. al. 2016).
Therefore, it is vital to make fair and just decisions for patients throughout the treatment process.
Bobeck and colleagues.
(2017) suggests that nurses be careful when applying oxycontin.
The tablte cannot be taken broken, crushed, or separated.
A broken tablet of oxycontin may prove fatal.
The nurse should not give a patient a ‘broken tablet’ of oxycontin.
More oxycontin can be absorbed into the patient’s body due to the broken tablet.
This can lead to serious health problems and even death.
The medical profession is still trying to figure out the right way to treat pain.
Oxycontin, an opioid, is used.
Oxcontin can be broken into tablets, which causes it to release quickly and is rapidly absorbed into the body.
It is dangerous to take too much oxycontin.
60% to 80% of the dose of oxycontin is absorbed into the central compartment.
The tablet displays a biphasic absorption, which can cause fatal overdoses (Cicero Ellis 2015).
It is important that the nurse be aware of the proper dosage before administering oxycontin.
Oxycontin will be rapidly metabolized by the body and excreted in urine.
Before applying oxycontin the nurse should examine the patient to ensure that he is able to tolerate it.
Side effects can be clearly seen in the patient when the patient is given oxycontin after having been cut in half.
These side effects can lead to serious health problems.
Oxycontin can be slowly absorbed into the body and may take as long as 12 hours to reach your system (Jones Muhuri & Lurie 2017).
It can be used to relieve pain and provide some relief.
However, it can lead to serious complications like severe breathing problems, sedation or coma.
The patient is vulnerable and can endanger their life (Huxtable, et al. 2011).6.
Administration of drugs
Concurrent administration of morphine
Because it is necessary to manage pain, the doctor suggested giving morphine solution of 2 mg to 2.5 mg to the patient.
This situation requires that the nurse be very careful with the route and dosage.
Morphine, a narcotic drug of the same name as heroin, can cause allergies. 2014.).
In order to prevent the risk, the nurse must also keep an eye on the patient.
The overdose can lead to adverse health effects such as increased blood pressure, heart rate, breathing problems, and even death.
The usual time between 4 and 5 hours is for the administration of the doses.
A nurse should check the patient’s condition before administering any dose.
Oxycontin 10 mg PO 12 Hourly
Oxycontin is used for pain management and respiratory problems.
The combination of 10mg of oxcotin along with 2 to 2.5mg morphine decreases oxygen desaturation.
This can improve the patient’s condition (Perrino-et al. 2013).
However, the nurse must note the time frame for giving the dosage as well the route and dosage limit.
PRN Endone 30 mg
Endone (Opioids 2011) is another narcotic drug prescribed to treat severe pain.
Endone is prescribed by a doctor for a dosage of 30mg.
The nurse should be aware of the recommended dosage and route.
This will alleviate muscle weakness, kidney disease (low blood pressure), bowel disorder, and prostrate problem (Jones Muhuri, Lurie 2017,).
Table 1: Justification for using drugs7.
While opioids may be prescribed to relieve pain, there are potential side effects.
The side effects of opioids include itching, nausea, vomiting, nausea, dry mouth, and constipation.
Additionally, opioids may cause the patient to become more dependent on them as they belong to the same drug family.
Opioid can cause constipation in the range of 90-95% (Huxtable et. al. 2011).
This is mostly due to long-term opioid effects on the body (Perrino P.J. Colucci and al. 2013).
The opioids such morphine and other opioids are responsible for both the metabolism and the opioid metabolism (Bobeck, et al. 2017).
Opioids mostly produce pharmacological activities that include analgesia.
The opioids block the release of neurotransmitter.
This is the principal effect on the nervous systems.
It interacts to the u,?
There are two types of opioid receptors: the u and k.
Opioids 2011, which are used to treat pain, warns that opioids may increase constipation.
This can make it uncomfortable for patients and could lead to worsening conditions.
It’s a side effect from opioids like morphine, Oxycontin, or Endone.
This is mostly due to the effects of opioids over long periods.
Long-term opioid abuse can cause obstruction in the process of clearing stool.
If it isn’t treated promptly, it could prove fatal (Bruehl et.al. 2014).
This can cause serious health problems and even death for the patient.
For pain management, it is crucial to ensure that you use the drugs correctly.8.
This case illustrates that overdoses of oxycontin can lead to fetal effects for the patient.
Oxycontin is not available in half tablets.
However, the pain management option of ‘Targin’ is better.
However, as a nurse I have to be more cautious with the use of drugs like oxycontin.
Targin (oxycontin plus naloxone) is something I have to be cautious with.
I have learned about man drugs through the case scenario.
In the case scenario we also saw the side effects.
Before I can sign them for patient care, it is important to remember the side effect of the drug.
I must take the time to care for the patient as well as manage the pain.
I will check the method and dosage of drugs before I use them in the future.
I will be careful when using it.
I will keep you informed about side effects.
I will be more vigilant about the use of drugs like oxycontin.
I will keep the patient safe in mind and work to reduce the rate of mortality and morbidity.
Pain management requires that you use the medication correctly.
I will ensure that the patient is not addicted to opioids.
As a nurse I have to be aware of the proper dosage and route.
Overdoses can result in breathing problems, high blood pressure, and increased heart rate.
I must be attentive to side effects and provide the appropriate care for the patient.
Bobeck E.N. Pena D. Pena D. Gomes I. Fakira A. Devi L. 2017
Blockade in a Novel Neuropeptide Receptor System called BigLEN-GPR171 Reduces the Negative Effects from Prolonged Morphine Administration.
FASEB Journal. 31(1 Supplement), pages.985-8.
Bruehl S. Burns J.W. Gupta R. Buvanendran A. Chont M. Schuster E. France C.R.
Endogenous Opioid inhibition of chronic low back pain influences degree of back pain relief after Morphine administration.
Regional anesthesia & pain medicine, 39(2) p.120.
Cicero T.J. Ellis M.S. 2015.
Abuse-deterrent formulations in the United States and the epidemic of prescription opioid abuse: Lessons learned from OxyContin. JAMA psychiatry, 72(5), pp.424-430.Cushman, P.A., Liebschutz, J.M., Hodgkin, J.G., Shanahan, C.W., White, J.L., Hardesty, I. and Alford, D.P., 2017.
What do providers want information on opioid prescribing?
The qualitative analysis of the providers’ questions.
Fortin M. Cojuharenco I. Patient D. German H.
It’s time to bring justice: How time changes our understanding of justice judgments.
Journal of Organizational Behavior. 37 (S1).Grissinger, M., 2010.
The misuse of fentanyl patches can still pose grave safety issues.
Pharmacy and Therapeutics. 35(12), p.653.
Huxtable C.A. Roberts L.J. Somogyi A.A. & MacIntyre P.E.
A growing challenge for acute pain management in opioid-tolerant patients
Anaesthesia, intensive care, 39(5). p.804.Jones, C.M., Muhuri, P.K.
Trends in Nonmedical OxyContin Use in the United States, 2006-2013.
The Clinical Journal of Pain, 33(5), pp.452-461.
Kass S., Williams P., Reamy B. 2017. Pleurisy. [online] Aafp.org. Available at: https://www.aafp.org/afp/2007/0501/p1357.html#sec-1 [Accessed 23 May 2017].Macintyre, P.E.
A practical guide to acute pain management.
CRC Press.Opioids, A., 2011.
Goodman and Gilman’s The Pharmacological Base of Therapeutics. 12th ed. New York, NY: McGraw-Hill, pp.481-525.
The fears and misconceptions of patients regarding opioids and pain. (2017). Teaching guide [online] Available at: https://trc.wisc.edu/videoguide/Fears_inserts/fear_insert.pdf [Accessed 23 May 2017].
Perrino P.J. Colucci S.V. Apseloff G. Harris S.C.
Intranasal administrations with reformulated OxyContin® tablets can have a different pharmacokinetics, tolerance, and safety than those given to original OxyContin® tablets. This was done in healthy adults.
Clinical drug investigation. 33(6). pp.441-449.Principles Of Opioid Management. 2017. SymptomGuidelines [online] Available at: https://www.fraserhealth.ca/media/16FHSymptomGuidelinesOpioid.pdf [Accessed 23 May 2017].Sun, E.C., Darnall, B.D., Baker, L.C.
Mackey S., 2016.
Incidence and risk factors of chronic opioid misuse among opioid-naive postoperative patients.
JAMA Internal Medicine. 176(9). pp. 1286-1293.Thompson, N., 2016.
Anti-discriminatory practice. Equality, diversity, and social justice.
Palgrave Macmillan.Yalcin, N.G., Choong, C.K. and Eizenberg, N., 2013.
Anatomy, pathophysiology and anatomy of the pleura.
Thoracic Surgery Clinics, 23(1): pp.1-10.