Best Medication & Multidisciplinary Care For Abdominal Pain, Diarrhea - Essay.

It is 1400pm and you have come on for a pm shift and you are caring for a gentleman called Bob Jackson. Bob arrived on the ward last evening at 9pm following an admission from the emergency department with increasing abdominal pain and diarrhoea for the past week. (See NSG2HPB for full examination). Bob presses his call bell and asks for pain relief. He describes his pain using COLDSPA as:

According to Bob’s medication chart the options you have for pain relief are: 

• Paracetamol 1gm PO QID (Bob last had 1gm dose at 0800am) 
• Endone 5-10mg PO PRN (3-4 hourly) (Bob last had 5mg dose at 1100am) 
• Celebrex 200mg PO PRN (BD) (Bob last had one 200mg dose before he came to hospital he has not had a dose since his hospital admission) 

1.Which medication(s) would you administer to Bob now based on the above information you have been given? And Why? Provide a detailed rationale for your answer (use an array of literature to support your choice) 

2.Working as a nurse requires a multidisciplinary team approach. Select one member of the multidisciplinary team (NOT a medical practitioner) that you would engage in Bob’s care throughout his hospital admission. Provide a detailed rationale for your answer (use an array of literature to support your choice) 

Best Medication for Abdominal Pain Relief

Constant abdominal pain and diarrhea may be an indication of a serious underlying medical problem (Smith & Shimp, 2014). The pain experienced by a patient suffering from abdominal pain and diarrhea can be as a result of numerous factors that range from indigestion to intestinal infections. Therefore, it is important to identify the possible causes of all the symptoms so as to aid in medications and possible tips of prevention and treatment.  Abdominal pain can be in different forms, for example, sharp, dull and cramp-like. The pain that originates from between the pelvis and the chest is at times accompanied by loose, bloody or fatty stool.

1.This paper seeks to identify the best medication for a male patient who has been experiencing a dull abdominal pain for the last two weeks coupled with occasional diarrhea which leaves the patient feeling a little better. Based on the information given, I would administer Paracetamol because six hours have elapsed since the last time the patient had the last dose.  Bennett, Brown & Sharma (2012) explain that sticking to the prescription will help in managing the pain safely. Care should be taken to ensure that the paracetamol administered conforms to the requirement for the correct dosage of 1gm every six hours or 4gm within 24 hours in six hour intervals. It is important to adhere to the dosage instructions to avoid cases under dosage or over dosage which has side effects, for example, permanent liver damage.

Endone is also administered to Bob to help relieve the pain because the dosage requirements stipulate that there is need to administer it after every 3-4 hours. The prescription by the doctor is based on the assessment of the patient’s condition characterized by a dull ache on the abdomen. This medicine relieves pain by affecting how the patient’s body reacts to pain. It activates opioid receptors in the body systems thereby interfering with the pain transmission process through the nervous system (Kapural, 2014). This results into reduced pain sensation through reduced transmission of pain signals. Based on the severity of the pain experienced by Bob, it was effective to adjust the dosage and administer Endone even before the end of the 4 hour interval. This is because the medicine relieves pain for 3-6 hours depending on the severity. Based on the mechanism through which it suppresses pain, it is the best medication for Bob in attempting to relieve the abdominal pain.

Multidisciplinary Team Approach to Patient Care

Celebrex can only be administered if the other forms of medication fail to relieve the pain that Bob is feeling. Besides, the administration needs to be done in very controlled quantities because of the side effects, for example, stomach and intestinal bleeding which could lead to death of a patient (Sackheim, 2015). Therefore, at this point in time, it is better not to be administered to Bob to give time to see how endone and paracetamol will help relieve the pain in his abdomen. The need to continue with the dosage after every 12 hours will only be motivated by the inefficiency of paracetamol and endone in relieving Bob from abdominal pain.

2.In a hospital set up, patient care is a team affair with the main objectives being maximization of patient satisfaction and safety and increasing quality of outcomes. Besides, it optimizes the performance of the different members of the multidisciplinary team, reduces hospital costs and increases job satisfaction.  Kalisch & Schoville (2012) assert that the use of multidisciplinary teams in taking care of an admitted patient improves patient outcomes, adds to patient level of satisfaction and limits adverse events.

The existence of such teams comprising of caregivers from different levels of the treatment and care pyramid leads to enhanced communication thereby reducing cases of mortality and morbidity and in the end improving level of satisfaction of both the worker and the patient, in this case, Bob. Cohesive teamwork improves communication between different levels of medical and non medical practitioners (Henwood, 2014). Also, it reduces cases of adverse events, leads to improved outcomes, reduces the length of patient stay in wards and yields greater patient satisfaction.

Taylor(2015) explains that emergency care services are considering the use of new models in delivering care as a way of dealing with the changing demography of patients and increased dynamic of the health care industry. Non-medical practitioners are considered to be very important in implementing new models of care. As a nurse, I would engage Bob’s guardian throughout his hospital admission. As a nurse, I will also be able to assess Bob’s condition and in a situation that Bob has a difficulty in remembering to take medication, the guardian will help him remember when to receive his prescription.

By developing a good relationship with both the patient and the nurse, confidence is strengthened in working alongside each other to ensure good care of the patient. However, the use of a guardian in aiding in Bob’s care might be costly in terms of expenses for training thereby leading to inconsistencies in his or her use as a non medical practitioner. Also, it is important to encourage the non medical practitioners to only perform tasks that they have experience in or those that they have been trained to undertake in regard to patient care (Aluise, 2012). This will help avoid cases of under dosage, over dosage or administration of wrong medication to the patient. In taking good care of a patient, there is need for adherence to standard of practice and accountability for the scope of their assigned roles. Nurses and doctors need to be equally involved in planning and management of new posts and the patients need to be notified about the involvement of new caregivers. Besides, codes of practice need to be harmonized with any changes in clinical roles of both medical and non medical practitioners.

Conclusion

The paper is about the possible causes of abdominal pain and diarrhea and the most appropriate medication in treating a dull ache in the abdomen. Also, it explains the appropriateness, efficiency, frequency and prescription of paracetamol, endone and celebrex in making a patient (Bob) feel better. Further, the paper explains the roles of non medical practitioners in patient care and how their relationship with the nurses and doctors affect the overall quality of patient care. The good working relationship between medical and non medical practitioners enhances proper training, enhances communication and reduces rates of mortality. In this regard, it also strengthens the working relationship between the caregivers.

References

Aluise, J. J. (2012). The Physician as Manager. Berlin: Springer Science & Business Media.

Henwood, S. (2014). Practical Leadership in Nursing and Health Care: A Multi-Professional

Approach. Boca Raton: CRC Press.

Kapural, L. (2014). Chronic Abdominal Pain: An Evidence-Based, Comprehensive Guide to

Clinical Management. Berlin: Springer.

Mindy Ann Smith, L. A. (2014). Family Medicine, 6E. Pennsylvania: McGraw Hill Professional.

Morris J. Brown, P. S. (2012). Clinical Pharmacology. Edinburgh: Elsevier Health Sciences.

Sackheim, K. A. (2015). Pain Management and Palliative Care: A Comprehensive Guide. 

Berlin: Springer.

Schoville, B. K. (2012). It Takes a Team. The American Journal of Nursing , 50-54.

Taylor, R. (2015). Patient Power. RSA Journal , 42-45.