Case Studies Flashcards
Mr J has been admitted to your ward via the emergency department following a motor vehicle accident where he sustained a fractured tibia and fibula. He is currently prescribed pethidine for pain.
- What aspects do you consider in assessing Mr J’s pain?
history of present pain onset and duration location quality and character of pain intensity aggravating/relieving factors associated physical effects
Mr J has been admitted to your ward via the emergency department following a motor vehicle accident where he sustained a fractured tibia and fibula. He is currently prescribed pethidine for pain.
- What are the actions of opioid analgesics?
Opioid drugs produce their pharmacological actions, including analgesia, by acting on receptors located on neuronal cell membranes. The presynaptic action of opioids to inhibit neurotransmitter release is considered to be their major effect in the nervous system.
Mr J has been admitted to your ward via the emergency department following a motor vehicle accident where he sustained a fractured tibia and fibula. He is currently prescribed pethidine for pain.
- What are the commonly reported adverse effects of pethidine?
nausea and vomiting, sedation, dizziness, diaphoresis, urinary retention constipation
Mr J has been admitted to your ward via the emergency department following a motor vehicle accident where he sustained a fractured tibia and fibula. He is currently prescribed pethidine for pain.
- Following administration of pethidine, what observations will you make specific to the drug and its effects?
bladder scans TPR O2 stats BP Bowel movements Pain assessments
Mr J has been admitted to your ward via the emergency department following a motor vehicle accident where he sustained a fractured tibia and fibula. He is currently prescribed pethidine for pain.
- What is the antidote for opioid analgesia?
Naloxone - short acting opioid antagonist - displaces opioid drug from receptors.
Mr N is a busy executive who has been admitted to your ward following an episode of haematemesis. A gastroscopy reveals the presence of a gastric ulcer and the presence of Helicobacter pylori is later confirmed. He is commenced on triple therapy consisting of lansoprazole, clarithromycin and amoxicillin.
- Outline the actions of each of Mr N’s medications.
Lansoprazole =
is a proton-pump inhibitor (PPI) which acts by irreversibly blocking the H+/K+ ATPase enzyme system of the gastric parietal cells
Clarithromycin
is an antibiotic useful for the treatment of a number of bacterial infections. Especially Helicobacter pylori.
It prevents bacteria from growing by interfering with their protein synthesis.
Amoxicillin
is an antibiotic useful for the treatment of a number of bacterial infections.This drug acts by inhibiting the synthesis of bacterial cell walls.
Mr N is a busy executive who has been admitted to your ward following an episode of haematemesis. A gastroscopy reveals the presence of a gastric ulcer and the presence of Helicobacter pylori is later confirmed. He is commenced on triple therapy consisting of lansoprazole, clarithromycin and amoxicillin.
- What specific nursing observations will you undertake?
Check all NG aspirate, emisis and stools for blood
Monitor O2
Assess for abdominal pain
Mr N is a busy executive who has been admitted to your ward following an episode of haematemesis. A gastroscopy reveals the presence of a gastric ulcer and the presence of Helicobacter pylori is later confirmed. He is commenced on triple therapy consisting of lansoprazole, clarithromycin and amoxicillin.
- Discuss the education that you would provide Mr N with regard to his medications and lifestyle issues.
Educate signs and symptoms of GI complications and the importance of reporting them
Educate about the intake of caffine, aspirine, alcohol and NSAID use as these increase stomach acidity
Encourage patient to avoid foods that cause pain or increase acid production
Mr G is a 75-year-old man who has returned to the ward from the operating theatre following prostatectomy. On return, he has an epidural infusion for analgesia.
- Where is epidural analgesia inserted?
It is inserted into the space between the dura matter and the ligamentum flavum, at the spinal levels C7-T10
Mr G is a 75-year-old man who has returned to the ward from the operating theatre following prostatectomy. On return, he has an epidural infusion for analgesia.
- What drugs are commonly used for epidural analgesia? (3 marks)
Lignocaine Prilocaine Mepivacaine Bupivacaine fentanyl
Mr G is a 75-year-old man who has returned to the ward from the operating theatre following prostatectomy. On return, he has an epidural infusion for analgesia.
- What are common adverse effects of epidural analgesia?
Local complications at the site of injection- inflammation, haematoma, nerve injury, abscess formation, necrosis
Epidural – headache, hypotension, infections, nueropathies, paraesthesias and autonomic dysfunction
Allergies – rash, bronchospasm, anaphylaxis
Systemic effects – numbness of tongue, CNS stimulation
Mr G is a 75-year-old man who has returned to the ward from the operating theatre following prostatectomy. On return, he has an epidural infusion for analgesia.
- What specific observations would you undertake while the epidural analgesia is in progress? (3 marks)
The epidural can affect sensory, motor and autonomic nerves, and observations should therefore include: date and time of observation; respiratory rate; oxygen saturations; pulse; urine output; itching; pain; sedation and nausea score; sensory level; motor block; blood pressure.
The epidural site should be checked daily for signs of infection, leakage or tenderness.
- Given the loss of sensation resulting from epidural analgesia, pressure area care must be rigorous, and micturation should be encouraged.
Ms J is a 29-year-old woman who presented to the emergency department with calf pain in her left leg on walking. On inspection, a red, swollen area was identified. This was later diagnosed as a deep vein thrombosis. Ms J had recently been prescribed an oral contraceptive pill. She was commenced on an intravenous infusion of heparin and transferred to your ward.
- What are the intended actions of the heparin infusion?
Heparin will not dissolve blood clots that have already formed, but it may prevent the clots from becoming larger and causing more serious problems.
Once active thrombosis has developed, larger amounts of heparin can inhibit further coagulation by inactivating thrombin and preventing the conversion of fibrinogen to fibrin.
Ms J is a 29-year-old woman who presented to the emergency department with calf pain in her left leg on walking. On inspection, a red, swollen area was identified. This was later diagnosed as a deep vein thrombosis. Ms J had recently been prescribed an oral contraceptive pill. She was commenced on an intravenous infusion of heparin and transferred to your ward.
- What specific observations would you undertake on Ms J with regard to the heparin?
4th hourly observations – pulse, respirations, temperature and blood pressure (more frequent if condition warrants it).
• Hourly infusion observations.
• Hourly intravenous injection site checks as per Intravenous Cannulation Procedure.
• Daily urinalysis.
• Neurological observations (as per precautions section) as required for specific patients.
• Report to Medical Officer any evidence of bleeding from any site.
Ms J is a 29-year-old woman who presented to the emergency department with calf pain in her left leg on walking. On inspection, a red, swollen area was identified. This was later diagnosed as a deep vein thrombosis. Ms J had recently been prescribed an oral contraceptive pill. She was commenced on an intravenous infusion of heparin and transferred to your ward.
- What early signs might indicate that she is receiving too much heparin?
?Bleeding is the chief sign of heparin overdosage. Nosebleeds, blood in urine or tarry stools may be noted as the first sign of bleeding. Easy bruising or petechial formations may precede frank bleeding.
