Question

Lillian fell when she was returning from the bathroom after the suppository. The nurse found her sitting on the floor complaining of pain on the left side of her rib cage. The nurse called for help and assisted Lillian back to bed. She notified the physician and completed the necessary reports. The physician ordered a follow-up chest X-ray that came back within normal limits. Lillian had a small bruise on her rib cage but no fracture. The physician gave the nurse the following orders over the phone.

acetamynophen( tylenol) 325 mg PO every 4 hours as needed for pain

zolpidem( ambien) 5 mg PO at bedtime for sleep

Alprazolam( Xanax) 0.5 mg PO as needed for anxiety

1-How would the nurse assess Lillian’s pain, and when would the nurse assess for pain when giving the acetaminophen?

2-How does zolpidem work? Be sure to include drug category, mechanism of action, onset and duration of action, and safety considerations?

3-What are the factors that contributed to Miss Lilliane's fall?

Answer 1

1.Answer

Nurse should assess the pain in terms of its intensity, location, duration and description, the impact on activity. Continuous record the pain score before and after administering the every dose of pain medication.

There are three different scare to note the pain:

FLACC: Face, Legs, Activity, Cry and Consolability : - 1, 2 3 rating has been given based on the below complaints

Face: No expression, Disinterested, clenched jaw

Legs: No position, Restless, legs drawn up/kicking

Activity: Lying quietly, tense, jerking or rigid

Cry: No cry, Occasional complaints, screaming

Consolability: relaxed, Reassured by touching or hugging, Difficult to console or comfort.

Wong-Baker faces pain scale: It is used self-report of pain to assess a patient’s experience of pain

Face 0 is very happy because he doesn't hurt at all. Face 2 hurts just a little bit. Face 4 hurts a little more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10hurts as much as you can imagine

Visual analogue scale : To rate their experience of pain using numbers from 0 (being no pain) through to 10 (being the worst pain).

**Continuous record the pain score before administering the every dose of pain medication

2. Answer

Zolpidem is a sedative

The half-life of Zolpidem is only about 1.5 hours. It hits peak levels in the blood after only 30 minutes. That is the reason why it is important to take zolpidem just before going to bed. The sedative effects of zolpidem can be longer for over 8 hours after taking the medication.

Mechanism of action:

1. It activates the neurotransmitter GABA
2. Bind it to the GABA receptors in the same location.
3. GABA activity triggered by the drug
4. Inhibits the neuron activity that is associated with insomnia.
5. Induces sleep

Safety considerations:   

Eating food with zolpidem may make the drug take longer to work. You should take this drug on an empty stomach

As zolpidem decreases oxygen levels in blood, people who have breathing problems should not be taken It is not recommended for Pregnancy and lactating mother as it passes to placenta and breast milk affects the fetus health

Children less than 18years should not be taken.

3. Answer:

Wet floor may be the reason for fall

Dizziness (Few people have a tendency to have dizziness due to tiredness after defecation)