How many mg of Percocet is prescribed to Mrs. Dettinger? I would question why the acetaminophen and Percocet medications are both prescribed, because the Percocet already contains the ingredients of APAP and has enough; so adding the APAP can increase the patient’s risk of liver damage. Even though, the patient states she is taking Percocet’s but she never mentioned taking the APAP; which is good because taking APAP with Percocet can increase her likelihood of an overdose. I would reassess the patient. I want to understand the characteristic of the pain, because the patient stated “maybe 6.” I would say, “I understand you have pain, can you tell me exactly how you feel?” Knowing that pain can increase stress and reduce healing. I want to …show more content…
reduce the patient’s pain level prior discharge, so I would say, “Sorry that you are hurting let me talk to your doctor to see what we can do for you? Next, I would offer non pharmacologic therapy like a heating pad and making sure patient is comfortable before I leave the room. I would then check with the physician to see if he can prescribe a pain medicine that is non-opioid analgesic like Ibuprofen to decrease the patient pain; because the next dosage of meperidine is not due until another 30 minutes to 1 hour. Her current vital signs are 135/92, P 90, R 20, pulse-ox 96%. There is an order as shown below: Acetaminophen 325 mg 1 to 2 tabs q 4 h prn mild-mod pain Meperidine 100mg IM q3-4h prn mod-sev. Pain Describe your next steps and any concerns you have. Discuss what you give her, how you give it and why. If not why not? I would look up to see if there are any interactions between the Acetaminophen and meperidine. I would inform the patient that once we reduce their pain I will teach you about the medications the doctor prescribe and how to reduce infection and promote healing. I would also question the meperidine 100mg IM q3-4h prn, because the patient should not be discharged with intramuscular prescription. The physician should prescribe an oral medication which can be a more convenient. There is no interaction, so I would administer 1 tablet of Acetaminophen q 4 h prn because the patient is experiencing mild moderate pain with the pain rated at 6. I would then document. The reason I chose one tablet, because she had gall bladder surgery and she has taken 75mg 2 ½ hours ago; I do not want to increase drug toxicity and I would rather administer the lowest amount which 1 tablet is appropriate to help reduce the pain. What do you do next and why? I would wait about 5- 10 minutes and reassess the patient to see how they are feeling after the non-opioid analgesic.
I would ask the patient to rate her pain (0-10). I would check to see if the physician changed the meperidine to a more appropriate form. If the patient’s pain decreased, I would then educated the patient about the acetaminophen and meperidine. I would tell her advise her to take her meperidine q 3-4 hours if pain is severe and if it’s mild pain like what she was previously experienced I would encourage her to take the acetaminophen 1 to 2 tablets every 4 hours. When taking meperidine do not drink or take sedatives for at least 24 hours. This medication may also cause dizziness, drowsiness, and confusion; so avoid getting up without assistance. Be careful making positions changes which can cause dizziness. There are adverse effect that may occur and if the patient experience trouble breathing, seizures, increase heart rate to not hesitate to come back in. It is common to experience minor side effects like dizziness, headaches, nausea, and vomiting when this medication. When taking acetaminophen do not exceed the recommended dosage, because acute poisoning with the liver damage may result nausea, vomiting, abdominal pain. If this occurs notify your prescriber. Also, if you see bruising, bleeding, fever, dark brown urine notify your
prescriber. Are there any suggestions or actions you would like to discuss with the patient, the preceptor or the surgeon? In other words, are there any changes to her care plan that you would pursue? Educate Ms. Dettinger about her medication prescription. Advise her to avoid operating machinery, because the Percocet’s can cause drowsiness and respiratory distress. Advise patient to avoid alcohol. When changing position move slowly to lessen orthostatic hypotension. Discuss with patient to take medication when pain is severe and keep track of time while taking medication because there is a chance for overdose. To preceptor I would show her the proper way a prescription should be written. I would also stress the 7 rights (dose, drug, patient, route, time, reason, documentation) when administering the patients medication. I would inform the preceptor if they find any errors in the prescription, do not be afraid to contact the prescriber by questioning their prescription.
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
Winfield, H., Katsikitis, M., Hart, L. and Rounsefell, B. (1989). Postoperative pain experiences: Relevant patient and staff attitudes. [online] 34(5): pp.543-552. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-45WYV7R-7G&_user=10&_coverDate=12%2F31%2F1990&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=35e6b5e8c8f803b487b35d4ae3b06cef&searchtype=a[ [accessed 8/5/2013]
When it is taken correctly, the side effects are considered to be rare [9]. This type of drug can be a great alternative for pain relief for those who are known to be at a risk of heart disease or even stomach problems [9]. There have also been studies that show improvement for treatment of depression and anxiety [10]. Overall, while acetaminophen is wildly being used, some possible fallbacks should be
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are being consumed. This is also an opportunity for the nurse to question about any adverse reactions the patient may be experiencing resulting from medications. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients continuing to take medications that have been discontinued by the physician. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
Some people alternate the use of other OTC such as Aspirin, which also has other dangerous effects , but hopefully will reduce acetaminophen toxicity.
To provide the best care for their elderly patients, nurses must incorporate pain assessment into their daily care of patients. Pain assessment is a key aspect of the nurse’s role. There are many factors to consider when assessing patients’ pain such as if they are verbal or non-verbal, what language they speak, their age and their cultural background. There are many tools that a nurse can use to assess a patient’s pain but one of the most common tools is the 0-10 scale. This tool can be asked verbally by asking what their pain level is on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain they have ever had. You may also use this tool in a visual manner with faces that correlate to the numbers. 0 being a happy face and 10 being a very sad face. Elderly patients from diverse cultural backgrounds are increasing in long term care facilities so it is important to have a 0 – 10 pain scale written in their native language. Some patients are stoic and do not express their pain as much as other people so it is important to understand that a 0 – 10 pain scale might not always be sufficient and could be combined with observing any physical signs that the patient might be in pain such as facial expressions and guarding. Nurses must have a good base of knowledge and attitude towards pain and always take what the patient reports their pain scale to be as truth. If the patient does report pain it would be important to treat the pain or if it is a new occurrence to follow this assessment up with another val...
...amount of pain) is a great teaching tool for the patient who is able to self-report (Nevius & D’Arcy, 2008). This will put the patient and nurse on the same level of understanding regarding the patient’s pain. The patient should also be aware of the added information included with the pain scale: quality, duration, and location of the pain. During patient teaching, it should be noted that obtaining a zero out of ten on the pain scale is not always attainable after a painful procedure. A realistic pain management goal can be set by the patient for his pain level each day.
In the medical profession, personnel are asked to make judgments or draw conclusions based on measureable results. Physical assessments, vitals, CT scan, MRI, biopsy are all activities engaged in to prove abnormalities and make decisions as to the way forward. So having hunches are not considered reliable and rightly so. To decide to give a particular medication because of a mere hunch can lead to serious errors. However, pain which is now considered a part of the vital signs is based on the patients’ philosophy or view point and we (nurses) are told not to ignore but respond. This is highly subjective. It’s viewed how the patient sees it and not as tangible or measurable as the other ways of proving when something is abnormal. The situation to be presented will disclose a patient’s ordeal due to a nurse’s approach to or understanding of pain management. It will also assess whether the nurse responded in accordance to protocol.
Nurse Molly, who is continuing the care in the Medical Surgical Unit noted that Toby-Finn and his brother, Toto are anxious. She initiated a therapeutic communication, and encouraged both of the patient and the brother to verbalize their feelings and concerns. Toby-Finn then stated that he is worried that the pain will never go away. Nurse Molly is aware that pain is an unpleasant sensory and emotional sensation associated with actual and potential tissue damage (Porth, 2011). To her best knowledge, Nurse Molly explained about acute and chronic pain.
Nurse practitioner should be able to recognize these descriptors and take them as potential indicators of pain and clarify with further questioning.
Conclusions. An adequate and clear understanding of the concept of pain and implementing interventions of pain treatment and management is essential in the clinical settings. Understanding the concept of pain is necessary for its relationships with other concepts that are related and similar to the pain experience for theory building. The in the end, understanding the concept of pain will ultimately benefit the patient and lead to better and approp...
Pain is universal and personal to those who are experiencing it. It is subjectively measured on a scale of 0-10 with zero being no pain and 10 being the worst pain ever. This can be problematic for patients and doctors because this score can be understated or overstated. Doctors will make quick decisions based on this score. Patients might feel not believed because only they can feel the pain. However, untreated pain symptoms may be associated with impaired activities of daily life and decreased quality of life. Pain is defined in our textbook, “as an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Ignatavicius & Workman, 2016, p 25). Actual pain is understood by most because there is an
In a pain assessment, the pain is always subjective, in a verbal patient; pain is what the patient says that it is. Nurses must be able to recognize non verbal signs of pain such as elevated pulse, elevated blood pressure, grimacing, rocking, guarding, all of which are signs of pain (Jensen, 2011). A patient’s ethnicity may have a major influence on their meaning of pain and how it is evaluated and responded to behaviorally as well as emotionally (Campbell, & Edwards 2012). A patient may not feel that their pain is acceptable and they do not want to show that they are in pain. For some people, showing pain indicates that they are weak. Other patients will hide their pain as they do not want to be seen as a bother or be seen as a difficult patient.
Pharmacology is a vital component in the perioperative practice. Medication use is monitored closely during the perioperative period. Preoperatively, there are certain drugs that must be discontinued prior to a surgery as they increase surgical risk, including anticoagulants, tranquillisers, corticosteroids and diuretics (Laws, 2010b). In fact, these drugs can increase the risk of respiratory depression, infection, fluid and electrolyte imbalance and increased risk of bleeding (Hamlin, 2010). Open communication is important in obtaining a medication history, and in identifying the drugs taken prior to the surgery. If any of these medications has be...
Next break both the paracetamol tables in half (this speeds up the process of them breaking down) and add to a conical flask with the propanone and leave in a warm water bath (set to 40 degrees Celsius) until the tablets have broken down.