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Prioritise The Nursing Responsibilities

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Questions:

1.Prioritise the Nursing Responsibilities and associated Rationales related to the Administration of Morphine to Eleanor.

2.Describe the Structural and Functional Changes that Occur in the Pathogenesis of Ulcerative Colitis that led to Eleanor’s Episodes of Diarrhoea with Blood and Pus.

3.Explain the Characteristics of the Intravenous fluid that was ordered for Eleanor, and the rationale, related to Eleanor’s Specific Fluid Balance status, for the administration of this Intravenous Fluid to Eleanor.

 

Answers:

1.Morphine is one of the opioid pain medicines. Morphine is the member of narcotic drug family. Brokjær et al. (2015) mentioned that nurses mainly provide morphine for giving relief to the patients to severe from moderate pain. During administer of morphine, nurses needs to remind few things as morphine has various side effects. Some particular condition of the service users can alleviate. Therefore, during administration of morphine to Eleanor, the nurse needs to remind the following things:

Responsibilities of Nurses

Rationale

Allergies

Narcotic drugs like morphine may develop side effects such as allergy. It can elevate the health issues of Eleanor.

Monitoring area of pain and measurement of pain

Morphine helps to reduce the pain. Therefore, the nurse needs to measure the severity and apply the dose.  

Check the administration of drug

Morphine can have negative effects on patient’s health (Butler et al. 2013). Moreover, she needs to share this concern with doctors and ask to change it.

Check the necessary parameters of patients such as blood pressure, heart rate and respiratory rate

Morphine can affect the parameters of patient.

Patient consent

Ethical consideration

Proper route

In case of drug administration, nurse should be careful about the route that reduces the chance of overdoes and is the safest way.

Aware about dosage

Eleanor has renal problem (ulcerative colitis). Therefore, overdose can be fetal for her. Nurse needs to be careful.

Other medication of the patient

MAO inhibition may interact with drug that may have side effects on Eleanor.

Site of drug administration

To avoid the inflammation of administration site

Sedative use

The sedative use may interact with drugs, which may have adverse effect

2.Ulcerative colitis is a chronic renal disease. In this case, the inflammation of colon is seen that is the inflammatory bowel disease. Due to the inflammation of colon, the absorption rate of the patient decreases. Ulcerative colitis has various symptoms like bloody stool. The inflammation of colon increases with the progress of the disease. This can influence the bleeding rate. Bloods comes out with mucus with the stool in case of ulcerative colitis. At the time of flare up and the relapse, the blood comes out directly from the rectum. Bressler et al. (2015) mentioned that in case of ulcerative colitis, small laceration of abscesses is made during bowel movement in small intestine. The main reason of the bleeding is abscesses. As the inflammation spread, the area of disease increase and the rate of blood in stool increases. Due to this, the amount of hemoglobin decreases with the raising of erythrocyte sedimentation. In case of Eleanor, the ulcerative colitis has spread to the large intestine. As a result, the rate of blood secretion increases with the inflammation. Inflammation causes the cytokine secretion and the activation of WBC. The increased rate of WBC plays vital role at the site of inflammation and develops the blood secretion.

3.In case of Eleanor, the Hartman’s solution is suggested to maintain the fluid balance. This works as the IV fluid so that the fluid status can be balanced. The compound of Hartman’s solution is the sodium lactate that works for intravenous infusion BP (Yung, Letton and Keeley 2017). The sodium lactate helps provide the sufficient balance of fluid and salts in the body. The concentration of sodium lactate is similar to the fluid of body that is blood. In case of Eleanor, the solution was provided via vein drip. As Eleanor is losing blood, which is a body fluid, therefore this solution can help Eleanor to restore the body fluid. As per the pathology result, doctor suggested to give 1000 mL dose/6hours.

 

References

Bressler, B., Marshall, J.K., Bernstein, C.N., Bitton, A., Jones, J., Leontiadis, G.I., Panaccione, R., Steinhart, A.H., Tse, F., Feagan, B. and Group, T.U.C.C., 2015. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology, 148(5), pp.1035-1058.

Brokjær, A., Kreilgaard, M., Olesen, A.E., Simonsson, U.S., Christrup, L.L., Dahan, A. and Drewes, A.M., 2015. Population pharmacokinetics of morphine and morphine-6-glucuronide following rectal administration–A dose escalation study. European Journal of Pharmaceutical Sciences, 68, pp.78-86.

Butler, S.F., Cassidy, T.A., Chilcoat, H., Black, R.A., Landau, C., Budman, S.H. and Coplan, P.M., 2013. Abuse rates and routes of administration of reformulated extended-release oxycodone: initial findings from a sentinel surveillance sample of individuals assessed for substance abuse treatment. The Journal of Pain, 14(4), pp.351-358.

Yung, M., Letton, G. and Keeley, S., 2017. Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis. Journal of Paediatrics and Child Health, 53(1), pp.12-17.

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