September 2018: Case Study A: Post-operative Pain Management Tom Bing is 84 years old with a past medical history of severe osteoarthritis. He has experienced persistent hip and joint pain for the...

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(Mayowa) This assignment is 3000 words and student said that his tutor want more intext reference word by word and follow the example given and scenario should be related to essay examplePlease follow S18: Additional Assignment Guidance: Essay ExamplesS18: Case Study A (Post-operative Pain): Student Essay GuidelinesSeptember 2018: Case Study A: Post-operative Pain Management





September 2018: Case Study A: Post-operative Pain Management Tom Bing is 84 years old with a past medical history of severe osteoarthritis. He has experienced persistent hip and joint pain for the past 7 years and is now only able to walk short distances with the aid of his walking (Zimmer) frame. Tom is otherwise fit and well and has no other relevant past medical history. He lives with his daughter and one teenage grandson in a bungalow. Tom underwent a total hip replacement (THR) for his osteoarthritis 3 days ago and is now back on the orthopaedic ward. His surgery was uneventful and there were no complications during the surgical procedure. Tom is managing small amounts of diet and fluids due to persistent nausea, frequent vomiting, and mild dyspepsia. He has not had his bowels open since the day before the surgery (4 days) and is experiencing mild pruritus to his trunk and back with no visible rash present. He has a small dressing on his wound, which is showing no signs of infection and is wearing anti-embolism stockings (AES). Tom has a morphine patient-controlled analgesia pump (PCA) in progress and is managing to gently mobilise short distances to the toilet and back with the assistance of his walking (Zimmer) frame and one nurse. He is finding his physiotherapy exercises challenging due to persistent nausea, pain, and fatigue. The nurse caring for Tom today had completed a pain assessment using the numerical rating scale tool (NRS). Where 1-3 is calculated as mild pain, 4-6 moderate pain and 7-10 severe pain (Figure 1). Tom has stated he is experiencing moderate pain which he scores as 5-6 when mobilising and mild pain, rated 2-3 when resting in his chair. His current sedation score according to the Alert, Confusion, Verbal, pain, and Unresponsive tool (ACVPU) (NEWS2 2017) is recorded as alert but he is feeling drowsy. All clinical observations are within normal parameters. He continues to experience persistent nausea with no vomiting recorded today and his back and chest remain itchy with no visible rash present. Figure 1: Numerical Rating Scale Tool (NRS) Tom’s current medication regime: Intravenous (IV) morphine PCA 50mg/50ml (concentration 1mg/1ml). No continuous or background infusion. 1mg(1ml) bolus with a lockout period of 5 minutes: total dose 12mg/hr. Paracetamol (acetaminophen): PO 1 gram: 6 hourly: maximum daily dose: 4 grams Enoxaparin Sodium (S/C) 40mg once a day Diclofenac (PO) 50mg, three times a day, when required Ondansetron (PO) 8mg, twice a day Lactulose (PO) 15ml, twice a day S18: Case Study A (Post-operative Pain): Student Essay Guidelines  This information is guidance only, you may not be able to add all of the topic areas presented here.  Critical writing at level 6 involves making decisions regarding the information you decide to present to fully answer the 4 questions in the essay title.  Use the information presented here to carefully structure you assignment. Introduction 5-15%  Provides structure to the essay  Provides the reader with an outline of the essay and what to expect  Present the topics logically and follow this sequence in main body of the essay  Third person only: no ‘I’ or ‘ME’  Outline the topics you are going to present in the essay (logically and sequentially), but succinctly  Make it clear but short and succinct: 1 paragraph max.  Refer to the case study: do not reproduce the case study in full but make it clear this is a case study: introduce the patient name.  Introduce your topic with some relevant background information on the topic: make it short, snappy, and interesting: grab the reader’s attention right at the beginning of your essay.  This assignment will critically examine, explore, discuss, highlight or address…………  Main Body 70-80%  Use the information presented in the case study to illustrate and critically discuss the 4 required areas of the essay: 1. Pharmacological processes 2. Medicines management 3. Nursing care 4. Safe practice and the nurse’s role  Use clearly defined (short) paragraphs  Only present one topic or subject area per paragraph  Logical approach: sequence your paragraphs to aid structure and flow of your topics: helps the reader to understand your essay: do not mix and match topics in a paragraph.  Avoid repetition of topic areas in different sections of the essay.  Include the case study (patient name) throughout: refer back to the case study and use the 1. Pharmacological processes:  PK: ADME, bioavailability, plasma half-life, peak plasma concentration, synergism, and additive effects in relation to case study information  PD: mechanism of action, side effects, selectivity, affinity, and efficacy in relation to the case study information  Adverse effects/interactions in relation to the case study information 2. Medicines Management:  Nurses role and responsibilities and drug administration: 6Rs (do not list/describe the 6Rs) and the importance of pharmacology knowledge and understanding and nurses  Professional issues: consent, accountability and appropriate knowledge and understanding  Nurses roles and responsibilities in assessment before, during and after drug administration  Nurse roles and responsibilities in the evaluation of effectiveness of the medication and side effects: ADRs  Education, training, and concordance issues: patient and staff  Mode/route of delivery: pharmacological and patient factors in relation to the information in the case study 3. Nursing care: information to illustrate (critically discuss) your points/subjects  Do not provide long explanations of the pharmacology principles/ processes: use them to critically discuss and illustrate the drugs in the case study  Avoid listing and bullet points: this is not critical writing level 6  Avoid long descriptions of the PK/PD of each individual drug in the case study: use the drugs to critically discuss your topic areas in relation to the case study information  Focus on pain management and assessment and the nurses role and responsibilities and the information presented in the case study  Type of pain the patient is experiencing and why?  Pain assessment: critique do not describe pain assessment: relate to the case study information  Pain tools: critique do not describe different pain tools: relate to patient scenario  Complications of poorly controlled pain for this patient with reference to the information in case study: critique do not list all of the potential complications: apply the information to the scenario  Identification and management of side effects: nurses roles and responsibilities 4. Safe practice and the nurses role:  To some extent this may be incorporated in the other areas of the essay  Accountability, consent, knowledge and understanding and the 6Rs  Critical thinking and decision-making skills: would you offer any alternatives or changes to the care and current medication regime?: objectively critically discuss, with relevant supporting literature: relate to professional, legal, and moral/ ethical responsibilities and accountability of the nurse  Professional issues: NMC (2015) The Code and RPS (2018 and 2019) Conclusion 5-15%  Succinctly summarise the key points in your essay: ‘cherry pick’ the important points you have presented  Make it short and snappy: 1 paragraph at the very most  No reflection  Aim to make it clear you have begun your conclusion, I.E. ‘to conclude’ or ‘to summarise’  Reference where appropriate  Do not add any new information  Use the third person only  No reflection on what you have learnt writing this essay: factual only based on your essay contents  Avoid biased subjective opinions in relation to the case study References  Must demonstrate you have read widely and appropriately around your topic areas  Use the Harvard Referencing System accurately and correctly  All references in the main text should be present and accurate in your terminal reference list  Author name and date only in the main text: no journal names or website details  Strictly alphabetical  Do not use numbers or bullet points in your terminal reference list  Do no use non-academic sources to support your points/topics  Contemporary and up-to-date sources should be used Your essay: A Quick Checklist  Have I read the marking grid?  Am I writing at the appropriate level? Introduction  Am I writing in the third person only?  Is my introduction short and succinct?  Have I logically and succinctly set out my topic areas? Main body  Am I using short, clearly defined paragraphs?  Do the paragraphs link well together or are the topics/subjects disjointed throughout  the essay?  Is there logical sequence and flow to my work that makes sense to the reader?  Have I carefully proof-read my essay? Does it make sense?  Is my grammar, punctuation, spelling, and sentence construction correct throughout  my essay? Does it make sense?  Am I presenting and referring to the case study contents throughout my  essay? The name of the patient and details should appear from beginning to the end  of the essay  Am I supporting my points with relevant up-to-date literature linked to the case study information?  Am I comparing /contrasting my topics/points with relevant up-to-date literature and linking this to the case study information?  Am I repeating topics in different sections of the essay: avoid repetition of topic areas in different sections of the essay. Conclusion  Is it clear I have begun to conclude or sum up my essay?  Have I included the key points from my essay related to my topics?  Have I appropriately referenced my conclusion?  Is my conclusion short: one paragraph?  Am I writing in the third person only?  There is no reflection of what I have learnt in my conclusion.  Have I avoided biased and subjective comments regarding the case study and patient in my conclusion Referencing
Answered 40 days AfterApr 02, 2021

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
156 Votes
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 m
edical 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...
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