Question

Case Study 2

You are a RN working in community care, visiting Amita, a 76-year-old with a chronic and painful venous ulcer on her lower leg. She takes multiple medications for chronic illness, and a codeine-based medication for pain. Amita lives alone in her own home.

3. How would Amita’s chronic pain impact on her ability to maintain a safe environment?

Consider how chronic pain, particularly a leg ulcer may make it difficult for Amita to maintain a safe

environment. Key points - chronic pain, what is a ‘safe’ environment and the impact on Amita’s ability to maintain safe environment given this scenario. Falls is only one concern, but what impacts this risk? Nurses role – analyse the nurse’s role in facilitating Amita to achieve a safe environment and consider facilitators, barriers and what you can do as a nurse. (250 words)

  

4. Why is Amita, as an older adult, more vulnerable to adverse drug events?

We looked at this in week 7online learning. We also see normal physiological changes that occur as part of ageing to body systems and the impact of socio economic factors, polypharmacy. Consider the immune system, renal system and the digestive system (liver, stomach). Consider how the vulnerability may be related to the issues associated with changes in pharmacokinetics and pharmacodynamics of the older person’s body. Nurse role – analyse with respect to Amita being more vulnerable to adverse drug events. (250 words)

Answer 1

3)Chronic pain

Chronic pain is the occurance of pain more than six months and it is happening due to chronic conditions like cancer, chronic ulcer, back pain etc,chronic pain is the burden for individual, family and community. The chronic pain reduce the quality of life.

Impact of chronic pain

Chronic pain affect all aspect of individuals life such as physical, social, psychological and health care system.

Physical impacts:chronic pain adversely affect physical function and daily living activities. The patient with chronic pain is unable to do their work according to their will because chronic pain may interfere with their function.

The patient with chronic pain is high vulnerable to getting infection.

Psychological:Patient with chronic pain affected by decreased sleep, fear, anxiety, depression and decreased coping skills. The chronic pain also affect the perception and cognition level of an individual and they suffer from emotional instability.

Social effects:the individual have decreased social interaction, decreases leisure time ,less contact with family members. The family members are also affected by anxiety and depression.

Effect on health care system :increse cost of health care.

Chronic pain and safety environment

Chronic pain affect the safety level of an individual. The chronic pain cause altered mental status and reduced perception and cognition level. This will create unsafe environment to the patient. Safe environment is referred to as the environment is free from potential hazards .In the above scenario ,Amita suffering from chronic pain due to leg ulcers and it alter the daily living activities and also she take codeine like drugs and she have psychological problems these all factors are contributed to patient is in unsafe environment.

The ulcer is on her leg so she is unable to walk properly and she can not able to do their daily activities properly and she is fail to organise environment safely without cluttered and she can't clean the environment properly.

She take medication for long time it cause adverse effect and also threatening the safe environment. She staying in her home alone so chance for accident is more.

The risk factors for unsafe environment

:disorganization of home environment

:clutters home environment

:poor cleaning of environment.

:poor physical functioning

:adverse reaction of drugs

:poor sense such as hearing ,vision

:poor cognition and perception.

Unsafe impacts

:freequent falls due to cluttered environment, poor physical functioning ,decreased sensory functioning and decrease cognition and perception.

:occurance of infection :due to chronic pain the patient is unable to keep her environmental clean this may cause infection .

:adverse reaction of drug:chronic pain need long term use of medication, the codeine like medication have greater adverse reaction this cause altered mental status and more prone to fall and accident.

Nurse role to maintain safe environment

As a nurse we have the responsibility to provide safe environment to the individual. The measures to take Maintaining safe environment include

:keep environment safe by good organization of home environment and explain patient to place of each things. Avoid cluttering in home environment. This will help to prevent accidental fall and injury.

:clean home environment :cleanliness of home environment help to prevent infection to the patient.

:assist patients in performing daily living activities and supervise the activities of patient .

:advise the patient to appropriate medication to avoid adverse reaction and educate other measures for pain management such as relaxation techniques and diversional therapy .

:encourage patient to participate in social activities .

4)Lot of changes occur in older person. In that the adverse reaction are common in older adult because of their change during adult hood. The prevalence of adverse reaction is increased with age and there for close monitoring is needed to avoid overburdened.

Age related changes in pharmacokinetics and pharmacodynamics

:The word pharmacokinetics and pharmacodynamics means absorption, distribution ,metabolism and elimination .

The muscles mass is decreased with age and water contents in the body is also decreased it will result in increased volume of distribution and thus increase the toxicity or adverse reaction of drugs.

:The serum albumin decrease with age due to low food intake and underlying disease condition.decrease albumin level cause high amount of free drug fraction this will result in increased adverse reaction.

:the glomerular filtration rate is less in older adult due to reduce renal size and nephrone functioning.this will reduce the elimination of drug and result in increase adverse reaction.

:in older adult the hepatic extraction ratio is high and this is also contributed to increase adverse reaction.

:the pharmacodynamics also increased with age, the older adult experience more sedation and confusion while taking sedative drug. Drug sensitivity is high.

Nurses role to prevent the adverse reaction

As a nurse we have the greater responsibility to prevent occurance of adverse reaction, the measures include

:monitor the therapeutic response to each drug.

:detailed documentation of each drug is needed to prevent such conditions.

:reviewing of each drug, the effect and occurance  of adverse reaction.

:health education regarding adverse effect of all drug.

:identify signs of adverse reaction of drugs and notify to the physician.

:prevent polypharmacy in older adult.