Case Study Of Narcotised Patient
Question:
What actions do you need to take for a narcotised patient such as Matt?
Answer:
Introduction
According to Australian Commission on Safety and Quality in Health Care (2017), the key safety and quality challenge is ensuring that patients who are decorating are receiving appropriate care. The following assignment is based on the interventions recommended for a narcotised patient, (both pre and post-surgery) Matt who is suffering from open right leg injury.
In trigger 1 it is identified that Matt was admitted to paediatric ward and hence this signifies that he is not an adult. In trigger 2, pain assessment is mandate in order to set the dose of Morphine. According to Islam et al. (2015) morphine is an analgesic that is use to manage pain. However, overdose of analgesic like morphine is associated with certain side-effects and thus warrants balance control measures so that side-effects could be minimised without hampering the effective pain management. This balanced control measures can be obtained via pain management and on the basis of pain score, the dose and the route of administration of morphine must be determined. Since Matt is a not an adult as identified in trigger 1, adolescent paediatric tool can be used for multidimensional measurement of pain. According to Jacob et al. (2014), adolescent paediatric tool helps in the evaluation of intensity and quality (including evaluative, affective, sensory, and temporal location) of the pain. In trigger 3, A-E assessment looking at the patient in general to see whether Matt appears unwell. If Matter is awake, then the assessment will start via initiating question like “how are you”. If he appears unwell or shows signs of collapsing he Chouet al. (2016)suggests shaking the patient via asking “are you alright”. If he responds then he has patent airway and is breathing with brain perfusion. If he speaks only small sentences then he may be suffering from breathing problems and failure of Matt too respond signifies critical marker of illness. However, a 30 seconds observation is mandatory to conclude that he is critically ill. Then monitoring of the vital signs should be done (airway, breathing, circulation, disability, exposure). In trigger 2 it would be the duty of the post aesthetic nurse to immediately monitor his level of oxygen situation along with monitoring of his other vital parameters like heart rate and blood pressure. Following this procedure, Matte should be immediately gives external supply of oxygen via nasal cannula. This will help to maintain adequate alveolar oxygen concentration and thereby correcting the effect of hypoventilation(Karcz& Papadakos, 2013). It will also help in correcting the ventilation-to-perfusion (V/Q) mismatch along with diffusion of the aesthetic gases into the alveoli. The head of Matte should be placed in a tilt-up position as this will help to increase the functional residual capacity (FRC) and thereby preventing atelectasis(Karcz& Papadakos, 2013). The external supply of oxygen should only be withdrawn when the vital parameter matches up with the normal range.
Conclusion
Thus from the above discussion it can be concluded that proper monitoring of the vital parameters along with A to E are crucial to control the and regulate the side-effects of analgesic used for pain control and for anaesthesia during surgery.
References
Australian Law Reform Commission: Australian Government (2017)Review of State and Territory Legislation: Informed consent to medical treatment. Access date: 7th April. 2018. Retrieved from: https://www.alrc.gov.au/publications/10-review-state-and-territory-legislation/informed-consent-medical-treatment
Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., …& Griffith, S. (2016). Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. The Journal of Pain, 17(2), 131-157.
Islam, M. M., McRae, I. S., Mazumdar, S., Taplin, S., &McKetin, R. (2016). Prescription opioid analgesics for pain management in Australia: 20 years of dispensing. Internal medicine journal, 46(8), 955-963.
Jacob, E., Mack, A. K., Savedra, M., Van Cleve, L., & Wilkie, D. J. (2014). Adolescent pediatric pain tool for multidimensional measurement of pain in children and adolescents. Pain Management Nursing, 15(3), 694-706.
Karcz, M., & Papadakos, P. J. (2013). Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapierespiratoire: RCTR, 49(4), 21.
Nadeau, D. P., Rich, J. N., &Brietzke, S. E. (2010). Informed consent in pediatric surgery: do parents understand the risks?. Archives of Otolaryngology–Head & Neck Surgery, 136(3), 265-269.
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