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- yes it does change the assessment
- regular alcohol use can affect withdrawal effects
- ask about amount of alcohol he consume
- can effect his medicine tolerate
- escalate pain management
-offer non analgesia options such as icepacks or help him rearrange
- do a pain scale to asses

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1. if the PT is using pain medication at home regularly this may indicate that he has a higher tolerance to pain medication thus needing a modified/increased dose.
2. Ask about potential recreational drug/alcohol use.

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Diazepam

MOA:
- Most MOA of benzodiazepines is facilitated by the action of Gamma Aminobutyric Acid (GABA) - an inhibitory neurotransmitter in the CNS.

Indications for use:
- Muscle spasms

Signs and symptoms:
- drowsiness
- dizziness
- tiredness
- muscle weakness
- nausea
- constipation

Nursing considerations:
- Monitor BP and RR
- Monitor pt during IV administration
-Inform PT to stay in bed/ inform when wanting to get out of bed.

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Enoxaparin

MOA:
- Anticoagulant (blood thinner)
- Prevents clotting in surgery, (DVT)
- Binds to sites to inactive clotting factors

Indications for use:
- Venous Thrombosis, VTE
- Blood clots

Signs and symptoms:
- GI bruising
- Obesity
- Bleeding (nosebleeds, gums, etc)
- Headaches, dizziness,
- Pain at insertion site

Nursing considerations:
- Monitor renal function & excretion
- Notify doctor of any changes
- Monitor fluid intake
- Alternate insertion site to prevent bruising

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1. How do you know it is your patient
- Patient band (name, UR number, DOB, address) matches with the medication chart, correct dates
2. What makes the order legal?
- Signed by a doctor
- Patient consent
- 5 rights of medication filled out
3. Order is legal

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Celecoxib

MOA: The MOA of celecoxib is due to the selective inhibition of cyclooxygenase-2 (COX-2), which is responsible for prostaglandin synthesis, an integral part of the pain and inflammation pathway.  This pharmacologic activity gives celecoxib its analgesic, anti-inflammatory, and antipyretic effects.

Indications: pain
inflammation

Signs and symptoms:
stomach pain, heartburn, gas, diarrhea, constipation, nausea, vomiting
swelling in your hands or feet
dizziness
cold symptoms such as stuffy nose, sneezing, sore throat.

Nursing considerations:
Monitor for fluid retention and edema which is a side effect
Assess range of motion, degree of swelling, and pain
Assess patient for allergy to NSAIDs. Patients with these allergies should not receive celecoxib.
Assess patient for skin rash frequently

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Nursing Consideration
*Monitor obs.
*Monitor GI bleeding.
*Assess patient for increased risk of CV events.
*Establish safety measures if CNS and visual disturbances occur.

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Morphine (opioid)

MOA: Act on opioid receptors in the CNS and GIT producing analgesia, respiratory depression, sedation.

Indications for use: severe pain, common opioid used during anaesthesia.

Signs and symptoms: nausea and vomiting, drowsiness, dizzyness, hypotension, constipation, respiratory depression, confusion, agitation, tachycardia.

Nursing considerations: monitor obs, monitor sedation, consider administering laxatives, vary dose based on pain. Risk when taking diazepam and morphine due to CNS depression - monitor closely/ use lowest dose for shortest amount of time

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1. Match the Name, UR number and DOB to patient in front of you. We also know that all the details are filled out on it (patient identification has been fixed to the document)
2.  Needs to have FOR EACH MEDICATION
date they were prescribed, medicine name, the route, the dose, the frequency, administration times, as well as prescriber signature
3. Medications on first appear to be correct however second page Targin has an unclear dosage, as well as lack of signature on targin and paracetamol and celecoxib

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Targin

MOA: act on receptors in the CNS (mu-opioid receptors) and GIT leading to reducing transmission of the pain impulse, and by modulating the descending inhibitory pathways from the brain

Indications for use: Pain

Signs and symptoms:
- nausea + vomiting
- fatigue
- dizziness
- constipation
- diarrhoea
- sweating
- low blood pressure
- loss of appetite

Nursing considerations:
- do not give until 24 hours after surgery
- check for allergies
- may worsen the drowsiness and his vitals
- explain risks of the medication (risk, route, reason)

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Offer non-pharmacological reliefs:
- repositioning
- offering ICEMAN or heat/cool therapies if available
- getting up to move around ward if stable
- distraction techniques
- offer more fluid and intake of food

Ask about other medications at home, alcohol habits

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1. Maybe, this may mean that if he may have alcohol in his system which may impact the way the medication will affect him, can lead to drowsiness and slow/shallow breathing.
Due to the alcohol it may have impacted his pain tolerance, meaning he may require a different dose of medication

2. When was the last time he had alcohol?
Ask screening questions to determine whether James is an alcoholic?
Are you having alcohol with your medication at home?
What is his pain tolerance?
How much is a nip?

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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?