NUR231 Drug Therapy


Part 1. This case study assignment is based on the theory, concepts and nursing principles covered in lectures, tutorials and associated resources.
Collect information: pathophysiology
Q1. Outline the pathophysiology of pain in relation to pleuritis. Include the generation and transmission of pain, pain mediators and classification of pain. Avoid writing about different conditions and keep your focus on pleuritic pain.
Process information: Pain management
Q2. Discuss the common fears and myths that interfere with health-care professionals providing adequate pain management to patients?

Q3. Explain why is it important to recognise an opiate-naïve patient? Discuss how the nurse can mitigate the risk of adverse effects from administration of opiate medications in the opiate-naïve patient experiencing acute pain?

Q4. The central principles of social justice in a health care context are self-determination, equity, access and rights and, participation. How do you interpret the actions of the nurse in withholding the prescribed morphine solution (nocté) from Mr. Hunter in relation to social justice principles? Discuss the potential impact on Mr. Hunter if he perceives his treatment for pain to be unfair and unjust? 

Part 2. As you recall, the respiratory consultant reviewed Mr. Hunter and prescribed endone (30mg) rectal suppository PRN and oxycontin 10mg orally 12 hourly PRN. As directed by the consultant, the registered nurse asks you to check a dose of oxycontin for administration to Mr. Hunter immediately.

You are required to give oxycontin 10mg tablet but the available stock in the drug cupboard is 20mg tablets. The registered nurse breaks a 20mg tablet in half with a pill cutter and asks you to administer this to Mr. Hunter.
Making reasoned judgments
5. Should a nurse administer a ‘broken’ tablet of oxycontin to a patient? Apply your knowledge of the absorption properties of ‘controlled-release’ preparations of oxycodone to justify your answer to this question, and comment on what the potential outcome would be for the patient if this medication were administered after being cut in half.

Q6. Give a rationale for why nurses would administer, or withhold concurrent doses of morphine solution (nocté), oxycontin 10mg PO 12 hourly and endone 30mg PR PRN to Mr. Hunter.
Planning care associated with opiate use
7. Relate the mechanism of action of opioids to the adverse effects on the peripheral nervous system to explain how opioids cause constipation?

At what point should laxatives be prescribed for patients taking opioids? What action of Coloxyl (docusate) with Senna prevents/relieves constipation?

What non-pharmacological therapies can be encouraged early to help prevent constipation?

8. What are the advantages of the drug ‘Targin’ compared to controlled–release oxycontin tablets?
  • What are the two most important things that you have learned from this scenario?
  • What actions will you take in your future practice as a result of what you have learned fromthis scenario?
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