1. you have checked the medication records(MAR) of margaret marks (meet your pat
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Question
1. you have checked the medication records(MAR) of margaret marks (meet your patient , volume1) and prepare her next dose of antibiotics for iv administration. the MAR also indicates that she is receiving morphine for pain and that her last dose was given 1 hour ago. when you enter the room, she was apparently sleeping. you are not able to awake her and verify her identity. what do you suspect to be happening, how should you respond?
•Joshua is a 28-year-old patient in the intensive care unit (ICU). He had a car accident 3 weeks ago and has had several surgeries to repair a fractured femur, ruptured spleen, and intracranial bleeding. He was ventilated mechanically for 10 days and has had numerous invasive procedures. The nurses report that he is very confused and has been hallucinating.
•Richard is a 90-year-old man who has been a resident at a skilled nursing facility for 10 yr. He has no visitors, never leaves his room, has no television or radio in the room, and no longer speaks. He does not respond to verbal or tactile stimulation. He lies in bed in a fetal position. When staff try to move him, he moans and howls.
How would you assess Joshua and Richard (Meet Your Patients) for sensory alterations? You may need to review the Meet Your Patients scenario at the beginning of the chapter in the book to answer this question.
•How would you address your patient’s concerns about the risks associated with her engaging in an exercise program?
•Your patient has experienced a number of injuries as a result of his exercise. Based on your knowledge of physical activity, what questions would you like to ask about his exercise program?
•How would you address your patient’s concerns about the risks associated with her engaging in an exercise program?
Compare and contrast insomnia and hypersomnia.
•How are they different?
•How are they alike?
How does your diet compare to the USDA Choose MyPlate in terms of
a.Servings of bread, cereal, rice, and pasta
b.Servings of vegetables
c.Servings of fruits
d.Servings of milk, yogurt, and cheese
e.Servings of meat, poultry, fish, dry beans, eggs, and nuts
f.Servings of fats, oil, and sweets
Explanation / Answer
Morphine comes under the category of opiate and it is used as pain killer. It is used for acute and chronic pain as well as for palliative care. It can be given orally or in injectable forms through Intravenous, or into the muscle or under the skin or through spinal cord. Maximum effect is around 20 minutes when given intravenously and 60 minutes when given by mouth, while the duration of effect is between 3 hours and 7 hours post administration. Morphine should be given very cautiously as it can present various side effects from minor to major in nature. Continous monitoring of patients are very important, to understand the early warning signs of side effects of Morphine.
Potentially serious side effects include a decreased respiratory effort and low blood pressure and it can affect the older patienrts very easily because of the age related slow down in metabolism as well as patients with kidney disorders. Morphine has a high potential for addiction and abuse. If the dose is reduced after long-term use, withdrawal may occur. Common side effects include drowsiness, vomiting, and constipation.
A large overdose can lead to asphyxia and death by respiratory depression if the person does not receive medical attention immediately. Antidote for Morphine Overdose treatment includes the administration of naloxone. The minimum lethal dose is 200 mg, but in case of hypersensitivity, 60 mg can bring sudden death. In serious drug dependency (high tolerance), 2000–3000 mg per day can be tolerated easily by the client.
As in the scenario Margaret Marks had received Morphine one hour before and she is still very sleepy in nature. The possibility could be some side effect of the medicine.
- As a nurse, it is very important to assess the client's consciousness level with Glasgow coma scale and response to painful stimuli
- Assess the patients Vital Parameters like Pulse, Blood Pressure and Breathing pattern ,to rule out any respiratory depression and slowing pulse rate and blood pressure
- Provide supplemental oxygen if there is shallow breathing and decreasing oxygen saturation
- Check the random blood sugar levels to rule out any hypoglycemic episode
- Call for help in case the patient does not respond to any of the stimulus
- Keeping ready Naloxone which is an antidote can be administered with physicians order
- Keep bedside emergency cart to tackle any emrgency medical situations
- Complete documentation of the event to be noted on the Nursing notes
Sensory Alterations -
Any alteration in the sensory function affects a person's capacity to connect to and function in an environment severely, known as Sensory Alterations. Hospitalized patients or patients with chronic disorders will experience sensory alterations due to different stimuli loads which can result in sensory overload or sensory deprivation. It is very vital to tackle patients very carefully because any further stimulation can disrupt the patients sensory process.
• Prevent further sensory alteration and reduce environmental stimuli like excessive light, noise
• Establish a routine for care when the client is more comfortable than the routine timings
• Speak calmly and slowly with simple explanations and utilize interpreters for communication barriers, to explain things in a better way
• Eliminate personal stimuli and teach self stimulation methods- reading, singing, to promote self realization
• Provide stimulation – visual, auditory, gustatory, tactile and cognitive in nature
Exercise Program -
It is very important to apply different strategies with the patients with mental changes because it is very difficult to predict the mood and behavioral changes. The patient can present with extreme depressive or agitated behaviour so there are risks always associated with these patients. Risks like harm or causing injury to self or the healthcare members or care taker. Certain strategies to be followed which are;
- maintaining self safety by occupying the client along with other groups if possible but definitely not in isolation
- avoid keeping sharp items around the patients andbeds with sharp edges should be avoided
- maintain a safe distance between the client and the care provider
- analyse the patient's change in mood and behavior
Once the doctor gives you recommendation for the exercise program, the tips below can help to avoid injuries on patients :
Delayed muscle soreness that starts 12 to 24 hours after any exercise program and gradually abates is a normal response to taxing your muscles. By contrast, persistent or intense muscle pain shopuld be escalated to the doctor for advice.
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