Answer To: September 2018: Case Study A: Post-operative Pain Management Tom Bing is 84 years old with a past...
Arunavo answered on Apr 09 2021
POST-OP PAIN MANAGEMENT PLAN
A CASE STUDY
Table of Contents
Introduction 3
Pharmacological Process 3
Medicine Management 4
Nursing Care 6
Safe Practice and the Nurse’s Role 8
Conclusion 9
References 11
Introduction
Pain is one of the most subjective and highly complex situations. Pain becomes difficult to explain because of many factors, such as age, gender, any type of previous complications, personal experiences and a number of emotional and psychological elements associated with that person. Pain is an unpleasant sensory and emotional experience of a person which is associated with acute or type of potential tissue damage in the body (Coll et al., 2018). In this case study the patient is an 84 years old male whose name is Tom he has a previous medical history of osteoarthritis, who is undergoing with multiple medications. With an experience of total hip replacement for his osteoarthritis, there is an increased risk of medication interaction along with drug reactions, adherence issues and the frequent pain he is experiencing and also with a problem of frequent vomiting, persistent nausea and mild dyspepsia. Hence, in this report a critical analyse is done on polypharmacy, medicine safety issues, medicine adherence, and pain management. The discussions have also done on the pharmacological processes, which is understanding the different compositions of the medicines, because it is important for the nurse to have the proper knowledge regarding the medicines along with dosages they are giving to the patient (Bauer et al., 2017). The discussion is also done on management of medicines, nursing care and safe nursing practices.
Pharmacological Process
In nursing assessment there are many steps taken in order to properly manage the patients. Among these processes one such process is pharmacology process. Montalban et al. (2018) have discussed that pharmacology in the nursing is an essential aspect because it provides an in-depth understanding of the medications and their safe administration to the patients. Part of this process involves the understanding of pharmacodynamics and the pharmacokinetics of the drugs in order to understand the effectiveness and the safety of the drugs to the patients (Camilleri & Boeckxstaens, 2017). Age related issues brings physiology changes that makes elderly people more vulnerable to disease, and also makes them vulnerable to develop adverse drug reactions. This effects the gastric emptying with the decreased peristalsis, decease in the splanchnic blood flow and the decreased secretion of the digestive enzymes. All the factors mentioned leads to the reduced absorption rate and that also decreases the bioavailability of the oral drugs (Diaconu et al., 2018).
The inability of the patients in self care and administering of medications is taken care by the nurses. May, Schindler & Engeli (2020) have discussed that nurses play an integral role in administering the medications to the patients in proper manner, depending on the environment in which they work. Therefore, the nurses must have a sound knowledge regarding the understanding of pharmacology and the potentially fatal drugs interactions if the drugs are nor administered properly. In this case study, tom is experiencing the problems with nausea, vomiting, pain and fatigue. However, based on the age, the nursing intervention is necessary in order to minimize the pain and also help him in quick recovery. Age related changes in the pharmacodynamics may result because of the alterations in the number of affinities of the receptors, and it also changes the post receptor signalling or the impairment of the homeostatic.
The physical condition of tom, where he has been tested through a pain meter scale. This scale will provide the exact moment when tom is experiencing pain, such as he is experiencing moderate pain while mobilising and mild pain while he is resting in chair. Looking at the condition and the post op recovery process, he is administered with the medications, after which he is in a state of drowsiness. Its is necessary to administer a combination of drugs to tom because of his post op condition. dos Santos et al. (2018) have further discussed that the use of combination of drugs is to cover four elements during the treatment process of pain processing, such as nociception, transmission, modulation and perception. As the individual drugs have different type of mechanism of action. With the growing age there is a decrease in the bone mass and also the lack of calcium content also leads to the danger of increased chances of fractures and osteoarthritis. Therefore, along with the administration of paracetamols, which acts mainly in the brain and spinal cord, the administration of calcium along with glucosamine should also be administered in order to reduce the pain. Similarly, morphine, which binds to the opioid receptors of the neurons in the brain, spinal cord can reduce the amount of pain in the knee.
Medicine Management
Pharmacodynamics as discussed by Lucas, Galettis & Schneider (2018) is the effect of the administered drug over the patient’s body. It has been found that the pharmacodynamics changes take place in the older patients through the increased sensitivity to the several classes of the drugs, which includes cardiovascular and antidepressants. This type of drug administration could lead to an increase in the high mortality rate among the older patients. In this case study the patient does not have any past history of any medical issues, therefore, the drugs that are administered to him are totally related in curing his wounds, subsiding his pain and curing the problems related with vomiting and nausea, because he also did not have any major complications during the surgery.
The patient has been prescribed with Diclofenac, which is mainly prescribed for the musculoskeletal pain, however, it is also used for the acute post-operative pain management. this mechanism is inhibiting the activity of cyclooxygenase enzymes (COX-1 & COX-2). With response to the injury, the nociceptors release chemicals such as substances P and prostaglandins. Cyclooxygenase is necessary in the synthesis for the prostaglandins and thromboxane; thus, the pain and the inflammation are reduced significantly. However, COX-1, found inside the GI tract, kidney and platelets, which is a useful function for the protection of gut mucosa, control of renal sodium and water balance and the platelet aggregation. however, the loss of mucosa protection and the thinning of the blood can also lead to the GI ulceration and the bleeding as well.
Drug is the first step on the World Health Organisation (WHO) pain ladder, a commonly used tool for the guidance of the acute pain management. van der Anker et al. (2018) have discussed that pain ladder uses the multimodal analgesic regime, which the use of multiple analgesic drugs with different modes of action simultaneously. The drugs which are administered many are done using different routes under the same concept. Use of simple analgesics, such as paracetamol and NSAIDs are used the alongside opioids producing opioid sparing effects. These effects constitute in the reduction of the opioid consumption with the regular use of the paracetamol which also reduces the pain scores, along with the improved patient satisfaction. Paracetamol also provides a kind of synergistic effects, when it is combined with other drugs, such as enoxaparin sodium and ondansetron, which has been provided to Tom, which will minimise the side effects of adjunct drugs. Weerink et al. (2017) have discussed that the vulnerability of the older people to the...