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question 1
-Both substances work to slowly suppress the central nervous system, lowering heart rate to dangerous levels and straining the respiratory system, which can make it difficult to breathe
question 2
-last alcohol intake

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Report to the Doctor
ask for further dosage

assess the level of pain
how often do you consume alcohol
have you taken anything else to reduce the pain
how much alcohol drink daily
increased resistance to the pain

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1. Would change assessment/management as alcohol shouldn't be taken alongside analgesics and benzo's as can cause adverse effects
- Also shows that he may experience pain at home often, so is 9/10 extreme pain, or a baseline for him?
2. Ask how often he is in pain at home and which number he would normally rate it
- Ask how often he drinks to determine alcohol dependency, and how much is a 'nip'

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1. Taking pain relief medications with alcohol can intensify it's impact and cause dangerous side effects. Some of these include organ damage, loss of consciousness and death.

2.

Can you describe the type of pain you are experiencing? (e.g., sharp, dull, throbbing, burning)
Does the pain radiate or spread to any other areas of your body?
Can you describe what makes the pain worse or better? (e.g., certain movements, rest, applying heat or cold)
Have you noticed any factors or activities that seem to be associated with the pain? (e.g., eating, physical exertion, stress)
How would you describe the intensity and frequency of the pain? Is it constant or does it come and go?
Are there any other symptoms accompanying the pain? (e.g., numbness, tingling, weakness)

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Clexane  Enoxaparin

MOA: Inactivate clotting factors

Indications for use:
Prevention of venous thromboembolism, a term refferring to blood clots in the vein
Treatment of venous thrombosis

Prevention of extracorporeal thrombosis during haemodialysis
Treatment of acute STEMI, non-STEMI and unstable angina

Signs and symptoms: Risk of bleeding, Renal impairment, allergic reactions, bruising, pain at injection site, increased risk for severe thrombocytopenia.

Nursing considerations:

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Diazepam (Benzodiazepine)

MOA: Increases the inhibitory effects of GABA (an inhibitory neurotransmitter) on the CNS, resulting in muscle relaxant, sedative, anxiolytic (calming) effects

Indications for use:
- Anxiety short term management
- Muscle spasms
- Alcohol withdrawal
- Epilepsy

Signs and symptoms:
- Respiratory depression
- Oversedation
- Ataxia
- Confusion
- Blurred vision

Nursing considerations:
- When taken with opioids, increases risk of respiratory depression
- Dependence on benzos
- Assess sedation levels
- Could be falls risk if heavily sedated and ataxic
- Advising not to drive or operate machinery when taking benzodiazepines
- Closely monitor and dosage as sedates and can cause respiratory depression

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1. Patient ID: full name, DOB, URN and gender
2.

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Paracetamol

MOA: Provide an analgesic effect by inhibiting prostaglandin synthesis in the CNS and activating descending pathways.

Indications for use: To relief from Mild and moderate pain, reduces fever.

Signs and symptoms: lower body temperature, relief pain, relaxation of muscles, reduce HR & RR,

Nursing considerations: sodium reduction, high risk of liver damage in case of chronic liver disease.

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1.
Medication chart:
- Patient identification,
- including full name,
- DOB,
- unique record number,
- gender.
- A completed allergies and adverse drug reactions alert section

2.
Medicine order on the chart:

-       the date the medicine is prescribed

-       medicine name

-       Slow release check box

-       Route of admission

-       Dose to be administered

-       Frequency of administration

-       Time of administration

-       Prescriber signature

3. The "Print your name" section is not filled out by the prescriber on any of the patient's regular medications, however the prescribers signature is printed at least once on the chart.

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Celecoxib

MOA:
Inhibit production of prostaglandins by blocking COX =>decreased pain, inflammation, fever

Indications:
- pain due to inflammation and tissue injury,
eg/
- post operative or serious injury
- rheumatoid arthritis
- osteoarthritis

Signs and symptoms:
- constipation
- dizziness
- headache
- skin rash
- hypertension
- fluid retention

Nursing considerations:
Pt ed: S&S of GI bleeding Several brands (OTC) total dosage
Take with meal/milk Enteric coated

IM inject slowly & apply pressure
IV over 15seconds
LFTs

Use lowest effective dose
Use paracetamol to reduce dose

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1. Name, date of birth, UR number
2. prescribers signature contact and name, medication name, route, dose, fr or sr, hourly freq, max prn dose, indication
3.no name was printed on second order and date where dose of targin should be

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Morphine

MOA:
Morphine exerts its agonist activity primarily at the mi opioid receptors.  Morphine is an opioid analgesic, which binds with stereospific receptors at many sites within the central nervous system (CNS) to alter processes affecting both the perceptions of pain and the emotional responses to pain.

Indications for use:
Short term management of severe pain

Signs and symptoms:
Cough suppression
Respiratory depression
Nausea and emesis
constipation
respiratory depression
circulatory depression

Nursing considerations:

Monitor blood pressure prior to administration.  Hold if systolic BP < 100 mm Hg or 30 mm Hg below baseline.

Monitor patient's respiratory rate prior to administration.

Reassess pain after administration of morphine.

Monitor for respiratory depression and hypotension frequently up to 24 hours after administration of morphine.

Place call light signal close to patient.  Accompany patient if need to get out of bed to minimize risk of falls.

Concomitant use of benzodiazepam and other central nervous system (CNS) depressants. may result in profound sedation, respiratory depression, coma, and death, limit dosage and duration to the minimum requirement and monitor patient for signs and symptoms of respiratory depression and sedation.

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Question 1
- Name, date or birth, UR number (Check the patient identification label) and list of allergies

Question 2
- Prescribers name, signature, contact - handwritten

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Targin - Narcotic

MOA: acts on opioid receptors in CNS and GIT, producing analgesia

Indications for use:
Severe chronic pain

Signs and symptoms:
- respiratory depression
- hypotension
- constipation
- n + v

Nursing considerations:
- assess sedation levels
- naloxone can reverse respiratory depression
- administer laxatives with narcotics
-Targin (oxycodone/naloxone) is a medication commonly used for the management of moderate to severe pain.

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1. Pain that radiates with movement and rated as 9/10 can be seen as severe pain especially on top of all Maximum PRNS given. alcohol has analgesic effect which could mean he has increased resistance to pain medication depending on usual doseage
2. how much alcohol would he drink daily
when was his last drink

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1. Do not combine Targin with alcohol or other medications that cause drowsiness. Doing so can cause additional drowsiness and reduced breathing which can potentially lead to life threatening conditions.

2.
How often do you consume alcohol (eg. frequently, once or twice) ?
When was the last time you consumed alcohol?

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Mixing alcohol and analgesics can cause liver toxicity, liver failure, and serve illness.
Patient education should be given about safe administration of analgesics and alcohol consumption - advice not to mix

questions to ask:
- when was the last time you drank alcohol?
- how often do you consume alcohol?
- have you taken anything else for the pain?

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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?