Discuss about the Pain Management Education in Long-Term Care.
The presenting problem, in this case, is the amount of physical and psychological discomfort that the patient exhibits. The case study presents a Mr. Fugerson exhibit heavy breathing, paleness and short of breath. The initial symptom for which a person seeks helps from a doctor, and in this case is the service provider at the emergency room (Groth, 2003). He has a history of 2/24 chest heaviness, and on the attack, he administered himself the pump spray.
Apart from being pale and having short breaths he also appeared diaphoretic. However, we first have to look into his demographic details to know and be sure to issued rugs that would work for him. Being 76 years old makes it easier to see the amount of dosage at that particular age is to be administered (Jones et al., 2006). The presenting problem can also necessarily not be the real problem. The patient might exhibit symptoms that may later disappear or not appear at that particular time and be shown at a later time.
When Mr. Fugerson was being admitted, he had chest heaviness and up entering the emergency department bed, he appeared to be pale, diaphoretic and at the same time had shortness of breath. While presenting, the problem the patient’s history is also a crucial matter to look. , before the diagnosis of the patient, a close analysis should be done to identify the source of pain, as well administer drugs in case of an emergency. There is need actually to check on the demographic information of the patient.
His regular medication indicates specific dosage that he was given upon arrival at the ED he was also administered the drugs. The first symptoms and physical symptoms are the doctor or nurse see and draw a conclusion. The case study of Mr. Fugerson exhibits conditions that are critical and needs medical attention as soon as possible (Linnebur et al., 2005).
Pharmacokinetics is an area of pharmacology concerned with the time course of absorption, distribution, metabolism and the excretion of drugs from the biological system to fully comprehend the effect of an administered drug or the impact of the drug administered to a given individual or subject.
Pharmacokinetics can be defined as the study of absorptions, the overall distribution, modification and transformations and eventually excretion of drugs in the human body National Center for Biotechnology Information (Long, 2013).
For the safe and efficient admission of drugs, clinical pharmacokinetics has to be applied in a therapeutic application with the primary aim being the elimination or minimization of the toxic effects of drugs on patients under therapy. To develop a relationship between the drug concentration and their impact, the clinicians ought to apply the principles of pharmacokinetics which entail distribution quantity, bioavailability and exposure duration (Krantz, Kutinsky, Robertson & Mehler, 2003). The effects of a drug are often directly related to its concentration generally in the human body and on the receptor sites. However, it is not possible to practically measure the level of a drug directly through these sites and therefore the incorporation of blood, plasma or other body fluids samples for analysis. This yields kinetic homogeneity which entails the relationship between the drug concentration on the sample and that of the receptor site where a change in the sample content depicts a change in the receptor site concentration (Guay, 2007).
Most of the drug’s side effects are related to their concentration on the receptor site except for a few other factors such as receptor density regulatory factors and modes of signal transmission. On the contrary, there exists a case of tolerance where the continued use of the drug exhibits a decrease in its effectiveness which is usually as a result of increased metabolism with the intake of a specified dose over time (Linnebur et al., 2005). A case of pharmacodynamics tolerance can also be reported where the same amount of drug concentration at the receptor site produces a lower effect over a continued exposure (Herr, 2002).
Pharmacokinetics, therefore, brings us to the concept of DDI- Drug-Drug Interaction. This is to what extent a given drug when administered works efficiently with other medications to be able to function correctly without an effect or negative impact on the patient. Morphine appears to have negligible interaction with aspirin (McCarthy et al., 2016).
According to (Amsterdam et al. (2014), it appears clinically relevant whether morphine also affects the pharmacokinetics (PK) and pharmacodynamics (PD) of aspirin. According to (Bruce and Bing (1965), majorly in medical terms morphine has been used for pain relief in the clinical management of myocardial infarction. A Morphine Sulphate IV 2.5 mg/4cc PRN to Mr. Fugerson. Morphine has been for a while been administered for chest pains relief to patients with the symptoms. Use of aspirin reduces the mortality rate among patient (Gordon et al., 2004).
With the above data, this brings us to the pharmacokinetics of the medication that he was offered. The pharmacokinetics of these various drugs administered for the medication indications of the patient has to be given in doses that will work efficiently (Clark, 2002).
Often the goal is to attain a therapeutic drug concentration in plasma from which drug enters the tissue. This will, in turn, bring us to enteral routes. For Mr. Fugerson, he uses his pump spray for his chest pains. Intravenous injection was used for him to administer the IV infusion. This injection is usually administered (Chau & Mason, 2005). The intravenous injection is generally administered for rapid asthmatic conditions and other chest cavity problems (Hughes, 1998).
This is usually a change the body exhibits when the drug is taken together with another second drug. It may have an effect of delay, decrease, or even facilitate and enhance the fast drug absorption. It majorly improves and promotes the rate of drug absorption into the plasma of the patient’s body or the individual taking the drug (Lanken et al., 2008)
This drug is known to interact with a total of approximately 507 drugs. Its classification includes platelet aggregation, inhibitors, and salicylates. Its treatment usage ranges from many diseases. Back pain, heart attack, ischemic stroke, rheumatic factors among other infections and diseases.
This drug too has a wide range of interaction with other medications. It is mainly classified as narcotic analgesics. Its usage for treatment ranges on chronic pain and just pain.
This is administered via injection to patients in varying doses when a patient is sick. The doses are given after prescription by medical personnel. It is an opioid analgesic used in high doses when patients require assisted ventilation in case of a respiratory depressant as well as the severe pain of myocardial infarction. Route of administration is usually via injection.
The pharmacodynamics properties of this drug are 50 to 100 times more than that of morphine. This drug action is rapid and short last. It relieves pain, some constipation, ventilator depression among other treatments.
This is anticoagulant administered for angina and usually administered for the acute coronary syndrome.
Drug Interaction Classification; the relevance of a particular drug interaction to a specific patient depends on various factors that the patient. The drugs interaction are classified into
Major; this means the interaction should be highly avoided as the risks exceed the benefits present. This is termed as a highly clinically significant.
Moderate; this drug interaction is to be avoided but under particular circumstance is supposed to be utilized for the drug administration to the patient. This is considered to be clinically significant (Chau, Walker, Pai & Cho, 2008).
Minor; take the alternative drugs that have been assessed and seem to interact together. This means that the risks associated is minimal or no there at all (Gabrail, Dvergsten & Ahdieh, 2004).). If the drug interaction has been chosen, a monitoring plan is invented or placed to ensure the drug works efficiently for the patients at regular intervals as the doctor may assign the nurse or the nurse to tackle it for him or herself (Tedeger et al., 2006).
Mr. Furgerson is administered with a combination of opioid drugs aspirin, morphine and fentanyl alongside a Low Molecular Weight Heparin fusion. Being a senior man of age 76 years, the pain he has m already been determined as a myriad of pharmacological, physiological. This due to his medical history makes it easier for the administration of drugs (Davies, Kingswood & Street, 1996). These drugs tend to have a pharmacokinetic activity that is similar, and their absorption rate varies in ages. The young adults, the aged and the in facts, the metabolic rate to is affected and that in turn affects its pharmacodynamics approach in administration (Furlan, Sandoval, Mailis-Gagnon & Tunks, 2006). The rate of drug absorption is crucial as the administration and absorption of these drugs will reduce. (Linnerbur et al., 2005).
With the above changes comes the change in drug distribution. For example, in older persons, the hepatic flow reduces hence increasing the metabolic rate of drugs in the body system (Ferrell, 2004).
Because of these appearing effects, to the aging, the drug doses should be administered in small doses about 25%- 50%9 Clark, 2001). There are sometimes of opioids to be avoided for the elderly due to their hyperactive activity. Administration of these drugs will have to be limited being that he is aged and his chest cavity (Mason, 2005).
There is a basic drawing that shows the relationship that exists in the drug absorption the pharmacokinetics and the pharmacodynamics of the drug administered and the various variables that affect the victims (Cherny et al., 2001). As seen above; pharmacodynamics is just the drug concentration at the suite faction and the effect it has when multiple factors such as time and other demographic factors are considered before administration of the drug to the patient (Gil et al., 2003).
How would you educate the patient about the interactions of the long terms effects of the medication prescribed in the ED? Describe in details the information you would share with the patient.
Morphine, Aspirin, and Fentanyl are prescribed to treat severe pain; these are the commonly used strong opioids that work on the patients’ nervous system and brain to reduce the amount of pain felt. They can be taken as a liquid by mouth, as quick-acting tablets, or as slow-release tablets and capsules, they are also available as injections (Bueno & Fioramonti, 1988).
Before taking the drugs
Some medicines are not suitable for people with certain conditions, and sometimes medication may only be used if extra care is taken. For these reasons, before taking these drugs, it is essential the doctor know:
Before the start of the treatment, read the manufacturer’s printed information leaflet from inside the pack. The manufacturer’s leaflet will give more information about the specific brand of the drug that has been prescribed to the patient.
Slow-release tablets of morphine should be swallowed whole with a drink of water- do not break or crush the tablets. Slow-release capsules can generally either be swallowed whole or opened, and the contents sprinkled on to soft foods such as yogurt.
Morphine can be taken before or after meals, if the patient forgets to take a dose, they should be made as soon as he or she remembers and continue as before.
Aspirin consists of prescription, and nonprescription, prescription aspirin comes as an extended-release (long-acting) tablet. Nonprescription aspirin comes as a regular tablet, a delayed-release (releases the medication in the intestines to prevent damage to the stomach). Nonprescription aspirin is usually taken every 4 to 6 hours as needed to treat fever or pain. The extended-release are swallowed with a full glass of water (Ballantyne & Mao, 2003).
Fentanyl is prescribed for primarily for use in people who have pain from cancer; the patients tend to take higher doses and get the effects as quickly as possible.
The short-term effects of the drugs are:
The long-term effects of the drugs are:
In any event, the effects escalate, then a diagnosis is to run, and an alternative drug is administered to the patient. Mr. Fugerson being an old man has irregular breathing. Opioids side effects can be adverse and if in an event, a patient is exhibiting allergic reactions, severe nausea, and breathing difficulties. Perhaps administering the dosage in different quantity might alter the clinical effects of the drug (Lanken et al., 2008).
References
Ballantyne, J. C., & Mao, J. (2003). Opioid therapy for chronic pain. New England Journal of Medicine, 349(20), 1943-1953.
Bueno, L., & Fioramonti, J. (1988). 7 Action of opiates on gastrointestinal function. Bailliere’s clinical gastroenterology, 2(1), 123-139.
Chau, D. L., & Mason, M. N. (2005). Methadone in end-of-life pain management. Journal of opioid management, 1(5), 244-248.
Chau, D. L., Walker, V., Pai, L., & Cho, L. M. (2008). Opiates and elderly: use and side effects. Clinical interventions in aging, 3(2), 273.
Chau, D. L., Walker, V., Pai, L., & Cho, L. M. (2008). Opiates and elderly: use and side effects. Clinical interventions in aging, 3(2), 273.
Cherny, N., Ripamonti, C., Pereira, J., Davis, C., Fallon, M., McQuay, H., … & Expert Working Group of the European Association of Palliative Care Network. (2001). Strategies to manage the adverse effects of oral morphine: an evidence-based report. Journal of Clinical Oncology, 19(9), 2542-2554.
Clark, J. D. (2002). Chronic pain prevalence and analgesic prescribing in a general medical population. Journal of pain and symptom management, 23(2), 131-137.
Davies, G., Kingswood, C., & Street, M. (1996). Pharmacokinetics of opioids in renal dysfunction. Clinical pharmacokinetics, 31(6), 410-422.
Ferrell, B. A. (2004). AGS MEETING HIGHLIGHT Managing Pain and Discomfort in Older Adults Near the End of Life. ANNALS OF LONG TERM CARE, 12, 49-55.
Furlan, A. D., Sandoval, J. A., Mailis-Gagnon, A., & Tunks, E. (2006). Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. Canadian Medical Association Journal, 174(11), 1589-1594.
Gabrail, N. Y., Dvergsten, C., & Ahdieh, H. (2004). Establishing the dosage equivalency of oxymorphone extended release and oxycodone controlled release in patients with cancer pain: a randomized controlled study. Current medical research and opinion, 20(6), 911-918.
Gil, M., Sala, M., Anguera, I., Chapinal, O., Cervantes, M., Guma, J. R., & Segura, F. (2003). QT prolongation and torsades de pointes in patients infected with human immunodeficiency virus and treated with methadone. American Journal of Cardiology, 92(8), 995-997.
Gordon, D. B., Dahl, J., Phillips, P., Frandsen, J., Cowley, C., Foster, R. L., … & Finley, R. S. (2004). The use of “as-needed” range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society. Pain Management Nursing, 5(2), 53-58.
Guay, D. (2007). Use of oral oxymorphone in the elderly. The Consultant Pharmacist®, 22(5), 417-430.
Herr, K. (2002). Chronic pain: challenges and assessment strategies. Journal of Gerontological Nursing, 28(1), 20-27.
Hughes, S. G. (1998). Prescribing for the elderly patient: why do we need to exercise caution?. British journal of clinical pharmacology, 46(6), 531.
Jones, K. R., Fink, R. M., Clark, L., Hutt, E., Vojir, C. P., & Mellis, B. K. (2006). Nursing home resident barriers to effective pain management: Why nursing home residents may not seek pain medication. Journal of the American Medical Directors Association, 7(3), S21-S28.
Krantz, M. J., Kutinsky, I. B., Robertson, A. D., & Mehler, P. S. (2003). Dose?related effects of methadone on QT prolongation in a series of patients with Torsade de Pointes. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 23(6), 802-805.
Lanken, P. N., Terry, P. B., DeLisser, H. M., Fahy, B. F., Hansen-Flaschen, J., Heffner, J. E., … & Rocker, G. (2008). An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. American journal of respiratory and critical care medicine, 177(8), 912-927.
Linnebur, S. A., O’connell, M. B., Wessell, A. M., McCord, A. D., Kennedy, D. H., DeMaagd, G., … & Jackson, R. C. (2005). Pharmacy Practice, Research, Education, and Advocacy for Older Adults American College of Pharmacy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 25(10), 1396-1430.
Long, C. O. (2013). Pain management education in long-term care: It can make a difference. Pain Management Nursing, 14(4), 220-227.
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