Refer to the marking rubric in canvas for this task.
Use the information here as a guide to meet the requirements of the rubric:
Criterion 1. Application of pathophysiology and pharmacotherapeutics to inform decision-making and safe medication practice in relation to the case study
Respond to the questions in the case study to explain the pathophysiological processes of the disease to the patient context and the associated medication regimens. Use the estimated word counts as a guide. You will cover aspects of pharmacotherapeutics (that includes pharmacokinetics and pharmacodynamics) to demonstrate your understanding of concepts and principles of medication administration in response to the questions within the case study.
Criterion 2. Application of the ACSQHC Medication Safety Standards and Quality Use of Medicines principles to inform safe medication practice
You will select and integrate principles from the Australian Commission of Safety and Quality in Health Care Medication Safety Standards and Quality Use of Medicines principles to support your discussion and demonstrate safe medication practice. You can choose where you will integrate/synthesise them within your assignment content.
Criterion 3. Use of evidence to inform and support decision-making
Ensure you use peer-reviewed journal articles, textbook(s) and professional websites for your literature.
Criterion 4. Application of nursing professional codes and standards to decision-making and safe medication practice
You will select and integrate relevant nursing codes or standards to support your discussions relating to decision-making and safe medication practice in relation to the case study.
Criterion 5. Apply principles and practices of academic communication, writing and referencing
Use the third person. Avoid diagrams. Avoid bullet points. Use the APA 7th edition referencing guide.
An approximate word count has been provided to guide you – overall count 1500 words+/-10%.
Use the following Clinical Reasoning template (below) to help you structure your assignment. Do not remove the headings. Use valid sources of evidence in support of your work and provide in-text citations and a reference list to achieve maximum points.
NURSING STUDENTS
NUR231 Task Two Assessment Information 1500 words +/- 10%
Refer to the marking rubric in canvas for this task.
Use the information here as a ‘guide’ to meet the requirements of the rubric:
Criterion 1. Application of pathophysiology and pharmacotherapeutics to inform decision-making and safe medication practice in relation to the case study
Respond to the questions in the case study to explain the pathophysiological processes of the disease to the patient context and the associated medication regimens. Use the estimated word counts as a guide. You will cover aspects of pharmacotherapeutics (that includes pharmacokinetics and pharmacodynamics) to demonstrate your understanding of concepts and principles of medication administration in response to the questions within the case study.
Criterion 2. Application of the ACSQHC Medication Safety Standards and Quality Use of Medicines principles to inform safe medication practice
You will select and integrate principles from the Australian Commission of Safety and Quality in Health Care Medication Safety Standards and Quality Use of Medicines principles to support your discussion and demonstrate safe medication practice. You can choose where you will integrate/synthesise them within your assignment content.
Criterion 3. Use of evidence to inform and support decision-making
Ensure you use peer-reviewed journal articles, textbook(s) and professional websites for your literature.
Criterion 4. Application of nursing professional codes and standards to decision-making and safe medication practice
You will select and integrate relevant nursing codes or standards to support your discussions relating to decision-making and safe medication practice in relation to the case study.
Criterion 5. Apply principles and practices of academic communication, writing and referencing
Use the third person. Avoid diagrams. Avoid bullet points. Use the APA 7th edition referencing guide.
An approximate word count has been provided to guide you – overall count 1500 words+/-10%.
Use the following ‘Clinical Reasoning’ template (below) to help you structure your assignment. Do not remove the headings. Use valid sources of evidence in support of your work and provide in-text citations and a reference list to achieve maximum points.
Case Study: COPD (for nursing students)
| Mr James Hodges is 83 years of age, admitted today from an aged care facility. You are working on the medical ward, and he is a patient who is delegated to you to care for. Mr Hodges has recently been discharged following an acute exacerbation of COPD and the residential care staff are concerned that he has been unable to eat because of dyspnoea and that he may not be responding to his medications. Mr Hodges is on continuous oxygen at 2 litres/minute via nasal prongs for at least 15 hours per day.
Subjective data: Feeling anxious; tremor evident; dyspnoeic and fatigued.
Objective data: Vital signs: Temperature: 38.6°C, pulse 104 beats per minute (BPM), blood pressure (BP) 140/90 mmHg, respirations 28 breaths per minute, SpO2 (oxygen saturation measured by pulse oximetry) 89% on 2 litres oxygen via the nasal prongs. Administer oxygen to maintain SpO2 at 88 to 92%.
|
Consider the patient situation:
Section 1. Pathophysiology and pharmacology principles and concepts
Collect cues/information
Q1. Outline the pathophysiology of COPD (approx. 200 words)
Q2. Give a written explanation of the pathophysiological basis for the subjective and objective data (approx. 150 words)
Why is Mr Hodges feeling anxious?
What is causing dyspnoea?
Why is his temperature raised?
Why is his heart rate raised?
Why is his BP raised?
Why are his respirations increased?
Why is his oxygen saturation low?
Process information
Q3. Give a detailed explanation of the pharmacokinetics and pharmacodynamics of each of the prescribed medications. Include explanations about drug class, drug action and common adverse effects to demonstrate that you understand how the drugs work and interact with the body.
| salbutamol sulfate (Ventolin) inhaler 100 microgram/metered dose. 2 puffs prn 4 hourly
(approx. 150 words)
|
Drug class:
PD: PK: Common adverse effects: |
| ipratropium bromide (Atrovent) metered dose aerosol
21 microgram inhalation 2-4 puffs 3-4 times daily (approx. 100 words) |
|
| prednisolone (Panafcortalone) 30-50 mg orally once daily for 5 days. (approx. 80 words) |
Identify problems/issues
Q4. Mr Hodges is prescribed 2 litres of oxygen via nasal prongs continuously. What are the important nursing considerations when administering oxygen to patients with COPD? (approx. 100 words)
Evaluate outcomes
Q5. Mr Hodges is preparing for discharge and is prescribed a Salmeterol (serevent) accuhaler 50 microgram/blister to take home. Apply your pharmacotherapeutic knowledge to the patient education you would provide to Mr Hodge’s prior to discharge (approx. 150 words)
Section 2 – Application of the ACSQHC Medication Safety Standards and Quality Use of Medicines principles to inform safe medication practice in this case? (approx. 250 words)
Section 3 – Application of nursing professional codes and standards to decision-making and safe medication practice in this case? (approx. 250 words)
| Mr James Hodges is 83 years of age, admitted today from an aged care facility. You are working on the medical ward, and he is a patient who is delegated to you to care for. Mr Hodges has recently been discharged following an acute exacerbation of COPD and the residential care staff are concerned that he has been unable to eat because of dyspnoea and that he may not be responding to his medications. Mr Hodges is on continuous oxygen at 2 litres/minute via nasal prongs for at least 15 hours per day.
Subjective data: Feeling anxious; tremor evident; dyspnoeic and fatigued.
Objective data: Vital signs: Temperature: 38.6°C, pulse 104 beats per minute (BPM), blood pressure (BP) 140/90 mmHg, respirations 28 breaths per minute, SpO2 (oxygen saturation measured by pulse oximetry) 89% on 2 litres oxygen via the nasal prongs. Administer oxygen to maintain SpO2 at 88 to 92%.
|
Consider the patient situation:
Section 1. Pathophysiology and pharmacology principles and concepts
Collect cues/information
Q1. Outline the pathophysiology of COPD (approx. 200 words)
Chronic obstructive pulmonary disease (COPD) refers to a common respiratory disease resulting in a high personal and societal burden. The pathophysiology of COPD is characterized by a combination of narrowing of the airways and peripheral airway inflammation (Brandsma et al., 2020). The above leads to the limitation of airflow, the destruction and loss of alveoli, terminal bronchioles, and the nearby capillary vessels and tissues resulting in airflow limitation and a reduction in the gas transfer capacity (Gundry, 2019). A decline in the forced expiratory volume in 1s (FEV) in COPD has been associated with the thickening of the walls of the airways as well as the mucus that the airways excrete.
Besides airway inflammation, another phenomenon observed during disease progression is an increase in oxidative stress and protease-antiprotease imbalance. In COPD, oxidative stress is over-activated. The inflammation bronchial, which involves phagocytes like neutrophils and macrophages, results in an overproduction of oxidants. Proteases are produced by various cells in the airways and the production, as well as the release of antiproteases such as secretory leukoprotease inhibitor, a-antitrypsin, and tissue inhibitor of metalloproteinase (TIMPS), regulate their activity (Alfahad et al., 2021). Inflammatory cells like the neutrophils and granulocytes numbers increase in the patients’ sputum, smooth muscles of patients with COPD, and the bronchial glands. An increase in the neutrophils leads to the release of oxidants and proteinases causing imbalances and subsequently favouring lung destruction.
Q2. Give a written explanation of the pathophysiological basis for the subjective and objective data (approx. 150 words)
Why is Mr. Hodges feeling anxious?
Individuals with COPD usually struggle to breathe causing the brain to send distress signals, which trigger anxiety that affects the breathing patterns.
What is causing dyspnoea?
Dyspnoea in the patient is being caused by stimulation of the mechanical pathways associated with an increase in the workload of breathing and a person’s perceptions of their breathlessness.
Why is his temperature raised?
The patient is experiencing exacerbations an indication of severe lung infections, which may cause a high fever in the patient.
Why is his heart rate raised?
The patient’s heart rate is raised because his arteries are narrowed resulting in a rise in pressure, putting stress on the right chamber of the heart and impairing its ability to pump blood.
Why is his BP raised?
COPD causes impaired gaseous exchange in the lungs, limiting oxygen intake and the release of carbon IV oxide, narrowing the arteries hence high blood pressure levels.
Why are his respirations increased?
The patient’s respiration rates are high due to impaired gas exchange in the lungs resulting in rapid breathing to obtain oxygen (Nakagawa et al., 2015).
Why is his oxygen saturation low?
The narrowing of the airways and peripheral airway inflammation damages the alveoli resulting in low oxygen supply into the blood.
Process information
Q3. Give a detailed explanation of the pharmacokinetics and pharmacodynamics of each of the prescribed medications. Include explanations about drug class, drug action, and common adverse effects to demonstrate that you understand how the drugs work and interact with the body.
Salbutamol sulfate (Ventolin) inhaler 100 microgram/metered dose. 2 puffs prn 4 hourly (150 words)
The drug is from the class of bronchodilators. The pharmacodynamics of salbutamol sulfate include an increase in the formation of intracellular cAMP through stimulation of adenylyl resulting in the relaxation of the airway smooth muscle (Kopsaftis et al., 2018). It inhibits the release of the Broncho constricting mediators from the mast cells. The drug provides a short-acting (4 to 6 hours) bronchodilation with a fast onset of around five minutes in reversible airways obstruction. The pharmacokinetics of salbutamol sulfate is that the drug and its metabolites are excreted in the urine and feces. After administration of the medication, 10 to 20 percent of the dose usually reaches the lower airways while the remainder of the medication is deposited in the oropharynx. The swallowed portion of the dose is absorbed in the gastrointestinal tract where it goes through first-pass metabolism. The elimination half-life of the drug is 2.7-5.5 hours after the oral and inhaled administration. The common adverse effects include tremors, headache, mouth and throat irritation, tachycardia, palpations, and muscle cramps (Kopsaftis et al., 2018).
Ipratropium bromide (Atrovent) metered-dose aerosol 21 microgram inhalation 2-4 puffs 3-4 times daily (approx. 100 words)
The drug is anticholinergic. Ipratropium lowers mucus production and causes bronchodilation (Tashkin, 2016). The pharmacodynamics of the drug is that it inhibits the vagally mediated reflexes by antagonizing the action of acetylcholine. They prevent an increase in the intracellular concentration of the cyclic guanosine monophosphate resulting from the interaction of acetylcholine. The pharmacokinetics of the drug is that the drug is not absorbed into the systemic circulation from either the lung or the gastrointestinal tract. Much of the inhaled dose is swallowed. Metabolism is hepatic while elimination takes about 2 hours. The side effects of the drug include dizziness, nervousness, pain, palpitations, dry mouth, blurred vision, rhinitis, cough, back pain, chest pain, nausea, sinusitis, and GI distress among others (Tashkin et al., 2016).
Prednisolone (Panafcortalone) 30-50 mg orally once daily for 5 days. (approx. 80 words)
Prednisolone is a steroid. The pharmacodynamics of the drug entails a decrease in inflammation. The drug decreases inflammation by suppressing the migration of the polymorphonuclear leukocytes and reversal of capillary permeability (Walters et al., 2018). The drug also suppresses the immune system. The pharmacokinetics of the disease include a peak plasma concentration of between one and two via oral administration. Some of the side effects include fluid retention, easy skin bruising, weight gain, muscle cramps, bloating of the face, and abdominal swelling (Walters et al., 2018).
Identify problems/issues
Oxygen therapy is commonly used among patients who are critically ill or those experiencing dyspnea (Allibone et al., 2018). It is however vital to acknowledge that just like other forms of therapy; it should be used with caution. According to Branson (2018), uncontrolled oxygen administration especially when delivered in high concentrations could result in a worsening case of hypercapnia. The above phenomenon is caused by the inhibition of pulmonary vasoconstriction, further increases in ventilation mismatching due to an increased workload of breathing and absorption atelectasis. The Thoracic Society of Australia and New Zealand and the Global Initiative for Obstructive Lung Disease advise clinicians to maintain a Sp O2 between 88 percent and 92 percent when administering oxygen to patients with COPD (Cousins et al., 2016).
Evaluate outcomes
Q5. Mr. Hodges is preparing for discharge and is prescribed a Salmeterol (Serevent) accuhaler 50 microgram/blister to take home. Apply your pharmacotherapeutic knowledge to the patient education you would provide to Mr. Hodges’ before discharge (approx. 150 words)
The nurse should provide health education to Mr. Hodges to ensure medication safety and improvement of the patient’s health outcomes. Serevent Accuhaler is a selective B2- agonist, which appears as inhalation powder and is prescribed for reversible airways obstruction in patients with either asthma or chronic obstructive pulmonary disease (Adams & Nguyen, 2021). The nurse should caution the patient that the drug is only used for inhalation in a dosage of 50 micrograms twice daily in adults including the elderly. The Accuhaler should be used in a standing position. The patient should note that the drug is not a replacement for other drugs and therefore should be used alongside other oral drugs to improve the patient’s outcomes. Side effects like palpations, headaches, and tremors are usually reduced with regular therapy. However, if the patient experiences paradoxical bronchospasm, he should discontinue the Serevent Accuhaler and seek immediate medical attention. The signs and symptoms of an overdose include dizziness, an increase in the systolic pressure, headache, tachycardia, tremor, and headache. In case of an overdose, the patient should seek supportive care, regular monitoring, and further clinical assessment.
Section 2 – Application of the ACSQHC Medication Safety Standards and Quality Use of Medicines principles to inform safe medication practice in this case? (approx. 250 words)
The Australian Commission on Safety and Quality in Healthcare (2022) Medication Safety Standard recommends that clinicians should be prescribed, dispense and administer appropriate medication. The medication safety standard requires that the clinicians monitor the medication prescribed to patients to ensure that the patients understand their own medicinal needs and risks. This standard is of paramount importance in ensuring that the patient is prescribed safe medication, which is likely to result in an improvement in his health outcomes. It is vital to note that Mr. Hodges is an elderly patient and therefore would need intense patient education on his medical needs, the risks of the drugs he has been put on as well as possible adverse effects that he might experience to improve coping and compliance with the doses to minimize cases of symptom relapse.
Based on the patient’s history of disease and clinical manifestation, he was admitted due to COPD exacerbations and has not been responding well to medication. It is for the above reason that the healthcare team handling the patient should be cautious about the drugs chosen. They should look at the drugs’ pharmacodynamics and pharmacokinetics to prevent adverse events and contraindications. While medicines are widely used in healthcare, if inappropriately used, they could cause medication errors. Medication errors are linked to adverse events, morbidity, and mortality as well as a negative reputation for the clinician and the healthcare organization (Alrabadi et al., 2021). Therefore, healthcare workers should be responsible and accountable for the choices they make concerning patients’ medication.
Section 3 – Application of nursing professional codes and standards to decision-making and safe medication practice in this case? (approx. 250 words)
Standard three of the Nurse Practitioner’s Standards states that ‘Nurse practitioner prescribes and implements therapeutic interventions’ (Nursing and Midwifery Board, 2022). The nurse practitioners should therefore use knowledge when prescribing both pharmacological and non-pharmacological interventions. The nurse practitioners should therefore be in a position to prescribe therapeutic interventions based on an in-depth understanding of the characteristics and the concurrent therapies of the patients. This means that the nurse practitioner should understand the pharmacodynamics and pharmacokinetics of the drug prescribed, the adverse events as well as drug interactions to minimize complications and even deterioration of the patient’s health condition.
The nurse practitioner should provide health education to the patient to achieve evidence-informed management plans. For example, the nurse should educate the patient about his medical needs, the dose that he should take, the importance of compliance with medications as well as cautionary measures in case of emergencies such as an overdose or an adverse event. The above information would result in patient safety concerning medication safety. The nurse practitioner should demonstrate ethics and professional integrity concerning the manufacturers of the therapeutic products and pharmaceutical organization hence being able to provide truthful information upon request by the patient to facilitate informed decision-making and ease of use of the health product.
References
Adams, B. S., & Nguyen, H. (2021). Salmeterol. In StatPearls [Internet]. StatPearls Publishing. Available at https://www.ncbi.nlm.nih.gov/books/NBK557453/
Alfahad, A. J., Alzaydi, M. M., Aldossary, A. M., Alshehri, A. A., Almughem, F. A., Zaidan, N. M., & Tawfik, E. A. (2021). Current views in chronic obstructive pulmonary disease pathogenesis and management. Saudi Pharmaceutical Journal. https://doi.org/10.1016/j.jsps.2021.10.008
Allibone, E., Soares, T., & Wilson, A. (2018). Safe and effective use of supplemental oxygen therapy. Nursing Standard, 33(5). https://doi.org/ 10.7748/ns.2018.e11227
Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., … & Al-Faouri, I. (2021). Medication errors: a focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12(1), 78-86. https://doi.org/10.1093/jphsr/rmaa025
Australian Commission on Safety and Quality in Healthcare. (2022). Retrieved 31 March 2022, from https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard.
Brandsma, C. A., Van den Berge, M., Hackett, T. L., Brusselle, G., & Timens, W. (2020). Recent advances in chronic obstructive pulmonary disease pathogenesis: from disease mechanisms to precision medicine. The Journal of pathology, 250(5), 624–635. https://doi.org/10.1002/path.5364
Branson, R. D. (2018). Oxygen therapy in COPD. Respiratory care, 63(6), 734-748. https://doi.org/10.4187/respcare.06312
Cousins, J. L., Wark, P. A., & McDonald, V. M. (2016). Acute oxygen therapy: a review of prescribing and delivery practices. International journal of chronic obstructive pulmonary disease, 11, 1067–1075. https://doi.org/10.2147/COPD.S103607
Gundry S (2019) COPD 1: pathophysiology, diagnosis and prognosis. Nursing Times [online]; 116: 4, 27-30.
Kopsaftis, Z. A., Sulaiman, N. S., Mountain, O. D., Carson-Chahhoud, K. V., Phillips, P. A., & Smith, B. J. (2018). Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: systematic review. Systematic reviews, 7(1), 1-13. https://doi.org/10.1186/s13643-018-0860-0
Nakagawa, M., Hattori, N., Haruta, Y., Sugiyama, A., Iwamoto, H., Ishikawa, N., … & Kohno, N. (2015). Effect of increasing respiratory rate on airway resistance and reactance in COPD patients. Respirology, 20(1), 87-94. https://doi.org10.1111/resp.12387
Nursing and Midwifery Board. (2022). Nursing and Midwifery Board of Australia – Registered nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 31 March 2022, from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx.
Tashkin D. P. (2016). A review of nebulized drug delivery in COPD. International journal of chronic obstructive pulmonary disease, 11, 2585–2596. https://doi.org/10.2147/COPD.S114034
Walters, J. A., Tan, D. J., White, C. J., & Wood-Baker, R. (2018). Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. The Cochrane database of systematic reviews, 3(3), CD006897. https://doi.org/10.1002/14651858.CD006897.pub4