NURS 6521 - Discussion Week 1

Instructions:

Rea

d

a selection of your colleague

and respond

by suggesting additional patient

factors that might have interfered with the pharmacokinetic and pharmacodynamic

processes of the patients they described. In addition, suggest how the personalized

plan of care might change if the age of the patient were di

fferent and/or if the patient

had a comorbid condition, such as renal failure, heart failure, or liver failure

**minimum of three

(3)

scholarly references are

required for each reply

cited

within the body of the reply & at the end

**

Reply

#

1

Gifty

Manu

I

was

working

in

the

emergency

department

at

Dallas

VA

medical

center

in

Dallas,

Texas,

in

2017

when

I

took

care

of

a

30

years

old

male

that

sustained

injuring

to

the

back

of

his

hand

and

forearm

from

a

piece

of

farm

tool.

The

Emergency

Department

physicia

n

ordered

Dilaudid

2mg

IVP

because

the

patient

was

in

agonizing

pain.

I

administered

pain

medication

and

reassessed

the

pain

level

in

10minutes

later.

The

patient

rated

his

pain

at

a

10/10.

A

second

dose

of

2mg

IVP

Dilaudid

was

ordered,

administered,

and

r

eassessed.

The

patient

still

rated

the

pain

at

a

10/10.

The

physician

ordered

a

third

dose

of

Dilaudid

2mg

IVP.

He

stated,

"due

to

fear

of

respiratory

distress,

the

third

dose

will

be

the

final."

I

gave

the

third

dose

and

reassessed

the

patient's

pain.

He

stated

8/10.

At

this

point,

I

began

to

question

why

the

pain

medication

was

not

resolving

the

patient's

pain

.

Upon

further

questioning

of

the

patient,

I

learned

that

the

patient

was

a

recovering

opioid

abuser.

Based

on

the

information

above,

I

knew

the

p

atient

had

developed

an

increased

tolerance

to

opioids

and

did

not

respond

as

well

to

the

pain

medication.

Tolerance

to

opioids

is

a

phenomenon

that

grows

with

repeated

opioid

use

resulting

in

a

decrease

in

analgesic

effects

or

side

effects

of

opiates,

thu

s

requiring

an

increase

in

opioid

dose

to

achieve

adequate

pain

relief

(Wenzel,

Schwenk,

Baratta,

&

Viscusi,

2016).

The

information

received

was

relayed

to

the

physician,

and

I

received

an

order

of

ketorolac.

I

administered

the

medication

to

the

patient

an

d

reassessed

his

pain

level

20

minutes

later.

He

now

rated

his

pain

as

a

4/10

.

Pain

is

a

complex

phenomenon;

the

use

of

a

combination

of

analgesics

of

different

classes

that

act

on

distant

target

sites

in

the

pathways

may

provide

better

pain

relief

while

reducing

opioid

requirement

and

the

risk

of

adverse

effects

(Chou

et

al.,

2016).

Reflecting

the

nature

of

his

injury

pain

rating

of

4/10

was

acceptable

to

the

patient

and

workforce.

The

plan

of

care

for

the

above

patient

would

include

non

-

pharmacological

m

odalities,

pharmacologic

agent

include

opioids,

Tylenol,

non

-

steroid

anti

-

inflammatory

drugs

(NSAID)

anticonvulsants,

N

-

methyl

D

-

aspartate

receptor

antagonist,

serotonin,

antidepressants

,

alpha2

agonist

and

skeletal

muscle

relaxants,

norepinephrine

reupt

ake

inhibitor,

tricyclic,

multimodal

analgesia

agents,

an

d

perioperative

interventions

(Cooney

&

Broglio,

2017)

.

Reference

:

Chou,

R.,

Gordon,

D.

B.,

de

Leon

-

Casasola,

O.

A.,

Rosenberg,

J.

M.,

Bickler,

S.,

Brennan,

T.,

..

.

&

Wu,

C.

L.

(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

pai

n

,

1

7

(2),

131

-

157.

Retrieved

Instructions:

Read a selection of your colleague and respond by suggesting additional patient

factors that might have interfered with the pharmacokinetic and pharmacodynamic

processes of the patients they described. In addition, suggest how the personalized

plan of care might change if the age of the patient were different and/or if the patient

had a comorbid condition, such as renal failure, heart failure, or liver failure

**minimum of three (3) scholarly references are required for each reply cited

within the body of the reply & at the end**

Reply # 1

Gifty Manu

I was working in the emergency department at Dallas VA medical center in Dallas, Texas, in 2017

when I took care of a 30 years old male that sustained injuring to the back of his hand and forearm

from a piece of farm tool. The Emergency Department physician ordered Dilaudid 2mg IVP because

the patient was in agonizing pain. I administered pain medication and reassessed the pain level in

10minutes later. The patient rated his pain at a 10/10. A second dose of 2mg IVP Dilaudid was

ordered, administered, and reassessed. The patient still rated the pain at a 10/10. The physician

ordered a third dose of Dilaudid 2mg IVP. He stated, "due to fear of respiratory distress, the third

dose will be the final." I gave the third dose and reassessed the patient's pain. He stated 8/10. At this

point, I began to question why the pain medication was not resolving the patient's pain.

Upon further questioning of the patient, I learned that the patient was a recovering opioid abuser.

Based on the information above, I knew the patient had developed an increased tolerance to opioids

and did not respond as well to the pain medication. Tolerance to opioids is a phenomenon that grows

with repeated opioid use resulting in a decrease in analgesic effects or side effects of opiates, thus

requiring an increase in opioid dose to achieve adequate pain relief (Wenzel, Schwenk, Baratta, &

Viscusi, 2016). The information received was relayed to the physician, and I received an order of

ketorolac. I administered the medication to the patient and reassessed his pain level 20 minutes later.

He now rated his pain as a 4/10.

Pain is a complex phenomenon; the use of a combination of analgesics of different classes that act

on distant target sites in the pathways may provide better pain relief while reducing opioid

requirement and the risk of adverse effects (Chou et al., 2016). Reflecting the nature of his injury

pain rating of 4/10 was acceptable to the patient and workforce. The plan of care for the above patient

would include non-pharmacological modalities, pharmacologic agent include opioids, Tylenol, non-

steroid anti-inflammatory drugs (NSAID) anticonvulsants, N- methyl D-aspartate receptor

antagonist, serotonin, antidepressants, alpha2 agonist and skeletal muscle relaxants, norepinephrine

reuptake inhibitor, tricyclic, multimodal analgesia agents, and perioperative interventions (Cooney

& Broglio, 2017).

Reference:

Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., ...

& Wu, C. L. (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. Retrieved