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No. Mr. James seems having some inappropriate behaviour, thinking that a nip of whiskey alleviates his pain and not with the pain relievers anymore. Maybe the effect of medications affected with his whiskey intake.
2. Let Mr. James describe his pain more, facial expressions,

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celecoxib
class-nsaids
MOA- inhibits the production of prostaglandins by blocking COX enzymes 1 & 2 >periphery>decrease pain, inflammation and fever
Indictations- arthritis, post op inflammation
Signs and symptoms- sore throat, SOB, constipation and dizziness , renal impairment and stomach ulcers, increased risk of cardiac events
Nursing considerations- always with food, allergy, swelling, joint pain, GI bleeding, monitor renal function

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Diazepam
Class: Benzodiazepines

MOA: to facilitate GABA ageric transmission in the brain by direct affect of benzodiazepines

Indications for use: anxiety disorders, seizures and alcohol withdrawal, acute agitation

Signs and symptoms: drowsiness, dizziness, headache, nausea

Nursing considerations:  contraindicated in hepatic dysfunction, check any previous history of hypersensitivity to benzodiazepines, lactation, pregnancy, check weight of client, renal impairment.

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1. Check the patient's name, URN, DOB
2.Signed by the GP and date, patient's name, prescriber's name, phone number

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Enoxaparin
Class: anticoagulant

MOA: antithrombin dependent; it acts mainly by accelerating the rate of the neutralisation  of certain activated coagulation

Indications for use: treat DVT; DVT prophylaxis

Signs and symptoms: risk for bleeding, haematomas; anaemia

Nursing considerations: educate patient for any signs of bleeding, sob, bruises; change injection sites

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1. Patient label is accurately printed on the Meds chart with Full name, DOB, gender and URN

2. the date prescribed, name and address of the patient, and name and signature of the prescriber make an order legal

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Celecoxib
Class:

MOA:

Indications:

Signs and symptoms:

Nursing considerations:

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Celecoxib
is in a class of NSAIDs called COX-2 inhibitors.

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Morphine
Class: Narcotic

MOA: Acts on receptors in the CNS and GIT, producing analgesia. The effect varies on the affinity for opioid receptors. Short acting.

Indications for use: High/ severe pain

Signs and symptoms: Causes nausea and vomiting, resp depression (sedation), HoTN, constipation, and bradycardia. It affects the renal system as it is toxic level for longer. Avoid use if hepatic impairment as can cause coma or increased sedation.

Nursing considerations: Monitoring bowels, assessing GCS, monitoring pain, managing nausea/vomiting. Assess pain frequently (PQRST)

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Q1
- Pt label= (URL, address, name, DOB)

Q2
- Doctors signature
- Up to date and in date
- Legible handwriting
- Written by someone authorised
- Date of the order
- Needs to have pt allergies included.
- Drug charts numbered.

Q3
- The PRN Morph order only has 1 signature
- Yes, Dr has signed and filled out the orders correctly; time, 1 of 1 chart, weight and height included.

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Class:
- Opioid analgesic.

MOA:
- Acts on receptors in the CNS and GIT producing analgesia, reducing transmission of the pain impulse and modulating the descending inhibitory pathways from the brain.

Indications for use:
- Moderate to severe pain.

Signs and symptoms:
- Respiratory depression
- CNS depression
- Hypotension

Nursing considerations:
- Administer laxative medication if required.
- Monitor risk of respiratory depression and PAO2.
- Continue to vital signs (BP, RR, PAO2, HR), monitor GCS.

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How do we know this is for our pt?
- Pt name, URN, DOB, gender.
What makes the drug chart legal?
- States the date the medication was prescribed (date of the order).
- Signed by presciber (doctor) and their name printed.
- Pt name, URN, DOB, gender.
- States the medication, class, indication, dosage, route, frequency.
Was the order legal?
No.
- Doctors name hasn't been printed on the 2nd page.
- Paracetamol is listed in medication chart and PRN (QID).

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1.According to our group assessment and management will remain the same as the maximum amount of doses has been given.
2.Apart from the level of pain we can ask about the type of pain, is it radiating or not.

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1. yes
- base level of pain will change
- change the interval of the dosage
2.
-PQRST
-do you use/rely on alcohol to relax?

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Does this change your ax and/or management of his pain? Why/Why not?
Yes.
- Alcohol can speed up or slow down the breakdown of medicine.
- Renal impairment can be caused by opioids, and regular alcohol intake will also impact on this system.
- Alcohol Withdrawal Scale.
What questions would you ask James to better understand his pain?
- How much do you drink?
- How often do you drink?
- What alcohol are you consuming?

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Opioid Receptors: ..."G-protein coupled receptors... linked to nerve membrane potassium channels and membrane bound enzyme adenylate cyclase..." (Broyles et al,2023 p.269)
4 major types:
Mu opioid peptide (MOP)
Kappa Opioid peptide (KOP)
Delta opioid peptide (DOP)
Nociceptin opioid peptide (NOP)
Opioid medications have different affinity to the peptide receptors
Reference
Broyles, B., Reiss, B, Evans, M., Pleunik, S., Page, R., & Badoer, E. (2023).

Pharmacology in nursing: Australia and New Zealand edition (4th Australian and New Zealand Edition ed.). Cengage Learning Australia Pty Limited.

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Considering part 2 of the scenario how would you answer these questions?

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Considering part 2 of the scenario how would you answer these questions?

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Discuss in groups

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What would they be for this medication chart?

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?

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1. How do you know that it is for your patient?
2. What makes the orders legal?
Were the orders legal?

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Compare and contrast the mode of action of the drug classes

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Compare and contrast the mode of action of the drug classes

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Did you find a simpler way to describe them?
Could you say in your own words what they are?
Did you need to go and look them up again? Do you need to rethink your explanation into your own words?