Question:
- Can I ask very specific questions about the case study on CloudDeakin?
This is really difficult via the Cloud as asking specific questions, or answering questions for
others that can be used in their work, could be considered collusion and thus reportable
academic misconduct. It may be better to ask specific questions of your facilitator in person
or via email of your unit/campus chair.
- Do I need an introduction and/or conclusion?
The case study is not written in an essay format, so there is no need for an introduction or
conclusion. You may use simple headings e.g. Question 1a, then your answer, then Question
1b and so on. However, like all academic pieces of work, all ideas must be acknowledged and
supported by relevant literature, have logical flow and clarity of ideas.
- Are we expected to answer each question on a separate page?
No. Please ensure that your answers are clearly separated from each other, for example with
the use of suitable headings – Question 1a. Headings should be clearly separated from the
text on the page (i.e. make them bold or underline).
- Are we allowed to use abbreviations, for example, NSAIDs?
Write it out in full the first time with the abbreviation in brackets e.g. Non-Steroidal AntiInflammatory
Drugs (NSAID), then you may use the abbreviation thereafter.
- In Question 1a, can we identify and explain any 2 risks?
Two (2) SIGNIFICANT risks in total are required; it could be 2 risks, 2 drug interactions or
2 adverse effects or any combination – it does not matter. The most important part of this
question is to ensure whatever is chosen, they must be SIGNIFICANT.
Some aspects to consider when addressing this question are:
- What is the mechanism of each risk?
- Why is the risk significant?
- Are there any contributing factors/effects? (i.e. other aspects that compound the risk)
- Ensure you relate the risk to the patient
- In Question 1b, do we set out strategies for each risk or do we generally discuss
numerous strategies to cover these types of risks?
Your strategies need to be clearly linked to the individual risks that are identified in Question
1a, so ensure it is clear what risk you are covering.
In answering this question, apply your knowledge of pharmacokinetics and
pharmacodynamics to describe nursing strategies that consider the following aspects:
- Pharmacological nursing strategies (specific to a particular drug)
- Specific nursing assessment
- Specific nursing interventions
- Specific patient education (if applicable)
- Again, ensure you relate the strategies to the patient
HNN215 Quality use of Medicines
Case Study – Frequently Asked Questions
2
- In Questions 1a and 1b, can we use dot points?
The questions ask you to identify and explain (Question 1a) and describe (Question 1b)
respectively, therefore you must ensure you give at least a 3-4 sentence
explanation/description on each point (usually more). We are happy for them to be separated
into dot points, but you must explain/describe each of the points depending on the question.
- In Questions 2a and 2b, can we use dot points?
The questions ask you to explain (Question 2a) and describe (Question 2b) respectively,
therefore you must ensure you give at least a 3-4 sentence explanation/description on each
point (usually more). We are happy for them to be separated into dot points, but you must
explain/describe each of the points depending on the question.
- How many references do I need?
There is no correct answer to this – the number is dependent on how you answer the question
and what you write; thus it is specific to each individual student. All I can say is that I do not
think one number will make a HD and another a Pass – it depends greatly on the quality of
the resources and how they are utilised. I would expect you will look beyond just nursing
journal articles and may need to research medical/pharmacology journals also. You can use
the Australian Medicines Handbook and Therapeutic Guidelines, but avoid websites (NonGovt)
and textbooks (you can use the prescribed texts but not too much). They should all be
current, i.e. from 2009 onwards.
- How do you reference the therapeutic guidelines (eTG), which is available online?
How to cite this depends on whether it is a specific topic cited, or it is a general citation of a
Therapeutic Guidelines book or electronic product. The citations are different for the books,
eTG complete used via the internet or CD ROM installation or miniTG (the hand held
Answer:
1a.
Risks of Acetaminophen
Acetaminophen has been used for more than 50 years. It is safe and doctors mostly recommend it as general treatment. Large amount of acetaminophen are utilized for treating pain. The amount of acetaminophen that is sold recently is below 6,300 tons per year. That is 35 tons for every million of people.
In case of Mr. Banks, he met an accident and his leg got fractured at the right tibia. He had been admitted to the surgical ward for the internal surgery for fixation. During his surgery he has been prescribed with acetaminophen for relieving him from the intense pain of his fracture (DeWall et al., 2014). A drug is safe to a person until the time it has been used in small amount. The acetaminophen utilization is related with expanded rates of death, bleeding of stomach, heart attack and failure of kidney. Acetaminophen is known to cause damage of liver if taken as overdose, and it leads to the liver failure to the people who is taking it as a daily dose for the relief of pain (Lee, 2014).
Risks of Ibuprofen
Ibuprofen is utilized for relieving pain from different conditions, for example, migraine, pain in teeth, menstrual cramp and pain in muscles or bones. It can be also used for reducing fever and relieving slight pain caused from common cold and flu (Henry et al. 2016). Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID), which works by blocking the body’s enzymes which causes inflammation, which helps to reduce swelling and pain. This drug rarely causes any serious problem for liver but may have cause some side effects of liver damage which shows the symptoms including: dark colour in urine; nausea; vomiting; loss of appetite; pain in stomach and yellowing of eyes and skin (McGettigan, & Henry, 2013).
From this drug a case of serious allergic reaction is very rare but if a person notice any indications of allergic reactions such as rashes, swelling, itching, extreme laziness and difficulty in breathing.
1b.
Nursing implications for acetaminophen
Assessment
- Assess general wellbeing status and use of alcohol before providing acetaminophen. Patients those are under nourished or suffering from alcohol abuse are at higher danger of creating hepatotoxicity with ceaseless utilization of common dosages of this medication.
- Nurse must evaluate the amount, type of drugs and the frequency in patients. Delayed utilization of acetaminophen builds the danger of unfriendly renal impacts (Van Leeuwen, & Bladh, 2017). For here and now utilize, joined measurements of acetaminophen and salicylates ought not to surpass the prescribed dosage of either medicate given alone. Try not to surpass most extreme every day dosage of acetaminophen while considering all courses of organization and all blend items containing acetaminophen.
- Pain: Assess sort, area, and power before and 30– 60 min following organization.
- Fever: Assess fever; note nearness of related signs (diaphoresis, tachycardia, and discomfort).
- Lab Test Results: To evaluate hematologic, hepatic, and renal capacity intermittently amid drawn out, high-measurement treatment.
- May change consequences of blood glucose checking. It might cause incorrect values when measured with glucose oxidase/peroxidase technique however likely not with hexokinase/G6PD strategy (Kumagai et al. 2017).
- Increase in bilirubin percentage in serum, AST, LDH, ALT, and prothrombin time may detect hepatotoxicity.
- Toxicity and Overdose: If overdose happens, acetylcysteine (Acetadote) is the antitoxin.
Nursing implications for ibuprofen
Assessment
Patients who have asthma, headache medicine actuated sensitivity, and nasal polyps are at expanded hazard for creating excessive touchiness responses. Evaluate for rhinitis, asthma, and urticaria.
- Assess for signs and indications of GI dying (falter stools or hypotension), renal brokenness (lifted BUN and creatinine levels, diminished pee yield), and hepatic disability (raised liver compounds, jaundice). Age-related renal impedance builds danger of hepatic and renal harmfulness (Lynch et al., 2017).
- Assess the skin rash during treatment. End ibuprofen at first indication of rash; might be hazardous. Stevens-Johnson disorder or lethal epidermal necrolysis may create (Godfrey & Pace, 2016).
- Pain: Assess torment (note sort, area, and force) before and 1– 2 hr following organization.
- Arthritis: Assess torment and scope of movement preceding and 1– 2 hr following medication.
- Fever: to monitor temperature; note signs related with fever (diaphoresis, tachycardia, disquietude).
- PDA Closure: To monitor the premature babies for indications of dying, disease and diminished pee yield. Screen IV site for indications of leakage.
- Lab Test Considerations: Creatinine in serum, CBC, and liver capacity tests ought to be assessed occasionally in patients accepting delayed treatment
2a.
Benefits of regular antibiotic
The fundamental advantage managed by suitable, observational, early anti-infection treatment in direct to serious diseases is a superior possibility of survival. On the premise of our own information, we utilized 1.6 for the relationship of unseemly treatment with a deadly result, in a gathering of patients with a casualty rate of around 30%, to compute a relative hazard for a lethal result, and expected that this relative hazard is steady in extreme and less serious contaminations (that is, the total pick up in a serious disease is bigger). An efficient audit and meta-investigation of the 69 forthcoming examinations that inspected a similar inquiry restored a comparative (Isaac et al.2016).
With a specific end goal to make an interpretation of it into an advantage, we need to increase it by years that were picked up, i.e. by the future of the patient. For youthful grown-ups, this will restore an expansive advantage. Little advantage (i.e. no treatment) will be returned for a 92-year-old patient. This is inadmissible, and contrasts immensely from the path in which we hone anti-microbial treatment around the world (Edwards et al., 2012). An inverse approach is dole out to every passing kept a settled advantage. Notwithstanding, we are very persuaded that a few patients, toward the finish of their lives, don’t profit by intercessions. For instance, systematized patients with Alzheimer’s sickness did not profit by anti-infection treatment. No advantage for fitting observational anti-microbial treatment could be appeared for bacteraemia patients with serious dementia who were out of commission and had weight injuries (M. Chowers and M. Paul). We have to accomplish a harmony between the accompanying: the acknowledgment that disease is an intense occasion and, once it is beaten, the patients will come back to their life-way, and that age predisposition ought to be kept away from; and the acknowledgment that anti-toxin treatment is some of the time vain, and will bring about just expenses without benefits.
2b.
Role of the nurse in adhering to quality use of medicines to prevent antimicrobial resistance in the clinical setting
The nurses who are taking care of Mr. Bank must aware of the antimicrobial
Antimicrobial management – As indicated by Edwards et al. (2012), recommending of antimicrobials is generally designated to specialists as they have more skill in prescriptions however the truth all the time is that anti-microbial are being endorsed by junior specialists who are working in various regions and furthermore require help from senior specialists with a specific end goal to relegate a legitimate treatment for a patient.
Senior nurses’ role- According to Ladenheim et al. (2013), senior medical caretakers assume an immense part in clinic’s antimicrobial resistance administration. The creator expresses that senior medical attendants must guarantee that neighborhood antimicrobial stewardship rules are reported and are up to date mode. The fundamental concentrate ought to be on checking on and announcing doctor’s facility’s anti-microbial information, which means monitoring use of antimicrobials like cephalosporins, carbapenems and quinolones.
Nurses and antimicrobial prescribing – Approximately 80 for each penny of all antimicrobials are being recommended by medical attendants inside group settings (Gallagher, 2014). As per Start-Smart-Then-Focus direction, the endorsing of anti-infection agents must be performed following great organization rehearses as it adds to successful treatment.
Reviewing antimicrobial treatment – In nations where medical attendants are not permitted to recommend antimicrobials, they could accept an open door and contribute while doing general ward rounds concentrated on looking into anti-infection treatment. Despite the fact that attendants are not specifically engaged with endorsing of the solutions, they can collaborate with other human services experts when overseeing remedy choices, decreasing recommending blunders and guaranteeing drug consistence.
Communication – First of all the nurses must ask the patients the reasons they are on a medication of certain antibiotics and observe that those the way of giving those antibiotics can be changed from intravenous to oral. As demonstrated by Trossman, it is fundamental that therapeutic chaperons train each other in the midst of staff social events about new infinitesimal life forms and living creatures and prepare to coordinate against its spread. Trossman is prescribing that nursing schools should join more information about hostile to microbial use, antimicrobial resistance and defilement suspicion and control (Trossman, 2014).
Challenges – Nurses may face some challenges while contributing towards antimicrobial resistance because the way they used to work in some specific rules. They may feel like they are not in the correct position and by keeping in mind about the purpose to take an interest in antimicrobial resistance administration. As per Edwards et al it is accepted that wellbeing experts have time, inspiration, learning and every one of the abilities to start a change inside clinical practice yet these convictions are one-sided.
References
DeWall, C. N., MacDonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., … & Eisenberger, N. I. (2014). Acetaminophen reduces social pain: Behavioral and neural evidence. Psychological science, 21(7), 931-937.
Lee, W. M. (2014). Acetaminophen and the US Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology, 40(1), 6-9.
Henry, D., Lim, L. L., Rodriguez, L. A. G., Gutthann, S. P., Carson, J. L., Griffin, M., … & Hill, S. (2016). Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. Bmj, 312(7046), 1563-1566.
McGettigan, P., & Henry, D. (2013). Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS medicine, 8(9), e1001098.
Van Leeuwen, A. M., & Bladh, M. L. (2017). Davis’s comprehensive handbook of laboratory & diagnostic tests with nursing implications. FA Davis.
Kumagai, Y., Song, I. D., Maeda, M., Tanaka, R., Sakamoto, Y., Aso, M., … & Fujita, T. (2017). Effect of High Dose Acetaminophen on Liver Function Tests in Healthy Subjects. Clinical Therapeutics, 39(8), e5-e6.
Lynch, M., Duffell, L., Sandhu, M., Srivatsan, S., Deatsch, K., Kessler, A., … & Rymer, W. Z. (2017). Effect of acute intermittent hypoxia on motor function in individuals with chronic spinal cord injury following ibuprofen pretreatment: a pilot study. The journal of spinal cord medicine, 40(3), 295-303.
Godfrey, J., & Pace, J. L. (2016). Type I Open Fractures Benefit From Immediate Antibiotic Administration But Not Necessarily Immediate Surgery. Journal of Pediatric Orthopaedics, 36, S6-S10.
Isaac, S. M., Woods, A., Danial, I. N., & Mourkus, H. (2016). Antibiotic Prophylaxis in Adults With Open Tibial Fractures: What Is the Evidence for Duration of Administration? A Systematic Review. The Journal of Foot and Ankle Surgery, 55(1), 146-150.
Edwards, R., Drumright, L. N., Kiernan, M., & Holmes, A. (2012). Covering more territory to fight resistance: considering nurses’ role in antimicrobial stewardship. Journal of infection prevention, 12(1), 6-10.
Trossman, S. (2014). The war on superbugs. Addressing the issue of antibiotic resistance. The American nurse, 46(1), 1-8.
Gallagher, R. (2014). Cutting antibiotic use: Nurses need to be fully involved in initiatives to reduce antimicrobial resistance, says Rose Gallagher. Nursing Standard, 29(11), 26-27.
