Emergency Department Nursing Management

This study discusses the nursing management of a patient in the emergency department, examining the drugs administered and their effects, as well as nursing interventions to manage adverse effects. The article also covers pathophysiological issues affecting the patient and evaluation of management plans.

Running Head: EMERGENCY DEPARTMENT NURSING MANAGEMENT 1
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Table of Contents
Pathophysiological issues affecting the patient...............................................................................3
Pharmacology into practice.............................................................................................................4
Aspirin 300mg Po........................................................................................................................4
Morphine sulphate IV 2.5mg administered on.............................................................................4
Low molecular weight (LMW) heparin infusion.........................................................................5
Fentanyl 50mcg IV, x2 STAT doses............................................................................................5
Drug interactions.............................................................................................................................6
Nursing Management of Mr. Ferguson and the adverse effects of drugs used...............................6
Nursing interventions...................................................................................................................6
Management of adverse effects of the drugs...............................................................................7
Aspirin 300mg Po.....................................................................................................................7
Morphine sulphate IV 2.5mg administered on.........................................................................7
Low molecular weight (LMW) heparin infusion.....................................................................7
Fentanyl 50mcg IV, x2 STAT doses........................................................................................8
Evaluation of the Management Plans..............................................................................................8
Information to share with Mr. Ferguson..........................................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

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Introduction
Mr. Ferguson, being 76 years old. He has a heavy chest and presents signs of high blood
pressure and his heart rate is abnormal. Ferguson has history of Angina, Non ST Elevated
Myocardial Infarction, hypertension, and hypercholesterolemia. He has sprayed x2 sprays of his
glyceryl trinitrate pump spray totaling 800mcg for his heavy chest but without help. Other
medications for the condition are aspirin, metoprolol, and rosuvastatin. He is fully conscious
with a GCS of 15. This study is a critical discussion paper related to the nursing management of
Mr. Ferguson’s addressing; the physiological processes through which the disease progresses and
the functional changes resulting from the disease, examines the drugs administered to alleviate
the patient’s deteriorating condition by analyzing the functioning of the drugs, the effects and the
expected results from the use of the drugs and his nursing care plan.
Pathophysiological issues affecting the patient
Mr. Ferguson is experiencing chest heaviness which has resulted in paleness, diaphoresis
and shortness of breath. His blood pressure is not within the normal range. Systolic pressure is
172 which indicates hypertension stage two while diastolic pressure is 86 which is within the
prehypertensive range. Hypertension experienced by the patient may be as a result of an angina
attack which had experienced in the past (Sanjay & Peter, 2014).His heart rate indicates that he
has tachycardia (from his hypertension). The patient’s blood oxygenation level is within the
normal range (Craig, 2013). The patient’s respiration rate is above the normal range which is
indicative that he is hyperventilating and is a sign of possible greater effects which need
monitoring.

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Pharmacology into practice
As already discussed, Mr. Ferguson admitted to the hospital the medical team caring for
Mr. Ferguson varied his medication. The variation was indicative of the physiological changes
that had occurred in his body resulting in his ill health. The medication prescribed was intended
to reverse the physiological changes that had occurred.
Aspirin 300mg Po
Aspirin is administered orally as the patient is conscious as indicated by his 15/15 rate on
the Glasgow coma scale. Administration of aspirin is indicative of the patient’s chest pains
which can be relieved by aspirin which is an analgesic drug. It is also indicative of
cardiovascular problems which are alleviated by aspirin. (Lippincott nursing center, 2018). It has
a half-life of fifteen to twenty minutes after which it breaks down into salicylic acid which
remains in ones’ body for six hours (Electronic Medicine Compodium, 2013) (Karen & Terry,
2015). Aspirin works by reducing the action of enzymes in order to inhibit prosaglandins
synthesis and, thereby, performing its analgesic function.
Morphine sulphate IV 2.5mg administered on
The use of morphine sulphate indicates pain and respiratory depression which is line
with Mr. Ferguson’s chest heaviness and shortness of breath. It is used in relieving pain by
Patient Controlled Analgesia (PCA) (Electronic Medicine Compodium, 2013). Morphine is
broken down and absorbed mainly in the liver and undergoes fusion with glucuronic acid. The
drug acts on the Central Nervous System and smooth muscles. It increases smooth muscle tonus
especially pyloric sphincter, anal sphincter, lower esophageal sphincter and ileocecal sphincter.
Morphine is a depressant but it may at as a stimulant to certain parts of the CNS resulting in
nausea and vomiting. (Stitzlein, Opiods for pain management in older adults, 2017).

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Low molecular weight (LMW) heparin infusion
The use of this drug indicates myocardial infarction and the likely hood of blood clots.
The drug is administered subcutaneously and is almost completely absorbed. The level of spread
of the drug in the body is close to the blood volume. It is partially metabolized by desulphatation
and depolymerization. (Sarah & Sandra, 2013). The major side effect is that as an anticoagulant
it may hinder clotting hence cuts or surgical operations must be avoided after administration of
the drug.
Fentanyl 50mcg IV, x2 STAT doses
Administration of fentanyl indicates that Mr. Ferguson is experiencing some pain which
requires relief and is also experiencing respiratory depression. Approximately, the volume of the
level of distribution between 60L to over 300L, estimates of terminal half-life range from about
1.5 to 6 hours and total elimination from the body ranges from 0.4 to over 1.5 L/min. Around
10% of the dose is excreted through the kidneys; the rest of the drug would seem to be
eliminated mainly through the hepatic with contributions from other tissues. (Stitzlein, Opioids
for pain management in older adults: Strategies for safe prescribing, 2017).
Drug interactions
Morphine increased patient exposure to aspirin (Bartko, 2018). This is of great
importance to patients as aspirin is imperative in preventing the formation of blood clots hence
greater exposure enables the drug to be more effective. The combination of aspirin, morphine,

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low molecular heparin and fentanyl is common practice in treating cardiovascular diseases. The
combination of pain relieving drugs that is aspirin, morphine and fentanyl increases the analgesic
effect and reduce the side effects particularly the gastrointestinal problems caused by aspirin
(Abate & Buttaro, 2015)
Nursing Management of Mr. Ferguson and the adverse effects of drugs used
The nursing care plan needs to will focus on subjective and objective data. It will further
need to focus on monitoring the patient’s vital signs to bring attention to any impending risks.
(Teresa, Sherry, & Nitish, 2018). In Mr. Ferguson’s case, subjective data includes chest pains,
shortness of breath, paleness and diaphoresis while objective data includes tachycardia and
respiratory depression.

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Nursing Management and Prevention of adverse effects of drugs
Aspirin 300mg Po
Short term use of aspirin results in gastrointestinal discomfort (Baron, et al., 2013). This could
further cause nausea, vomiting and the occurrence of ulcers. Management plan here should
include counter measures against these or opting for morphine sulphate in the management of
pain.
Morphine sulphate IV 2.5mg
Side effects of the drug include nausea, vomiting, difficulty in defecating, dizziness, drowsiness
or diaphoresis. Most of the side effects subside with time. However, to prevent constipation
patients ought to modify their diet to include foods high in fiber and water. A laxative may also
be prescribed (Drug guideline: morphine, 2014).
Low molecular weight (LMW) heparin infusion
The major side effect of the drug is uncontrolled bleeding. Nurses must educate the patient on
the risk of uncontrolled bleeding. They should further monitor the patient. This includes
measurements of coagulations, such as activated partial thromboplastin time, whole blood
clotting time, activated clotting time and a complete blood count (CBC) to monitor platelets and
assess for bleeding. (Abby, et al., 2016).
Fentanyl 50mcg IV, x2 STAT doses
Common side effects of the drug include difficulty in defecation, respiratory depression, vertigo
and fatigue (Kenn, Gayle, & Elizabeth, 2015).

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Nursing interventions
a) Administration of aspirin.
b) If it fails to relieve pain then this is followed up with morphine sulphate.
c) Cardiac monitoring.
d) This may be through a administering an electrocardiography test to the patient to monitor
the patient’s condition so as to inhibit deteriorating of the patient’s condition such as
cardiac arrest.
e) Monitoring of the blood pressure
f) Administration of heparin to prevent blood clotting which is likely.
g) Monitor cardiac enzymes.
Evaluation of the Management Plans
The aforementioned nursing interventions like administration of aspirin, and having a
backup (morphine sulphate) incase aspirin fails is a wise management plan that can help
effectively relieve Mr. Ferguson’s pain. Other interventions that have been mentioned have
minimal effects on Mr. Ferguson and hence effective. On the management of the negative effects
of the drugs used, it is good to consider whether they outweigh the positive effects. For example,
research undertaken specifically in older age groups have shown in both acute and chronic users
of aspirin, that infrequent use of a proton pump inhibitor (PPI) brings down the likelihood of
occurrence of gastrointestinal bleeding and chances of contracting of peptic ulcer disease.
(Mechcatie & Rosenberg, 2018). Morphine use can cause constipation but the management plan
for Mr. Ferguson includes caution against that. Low molecular weight (LMW) heparin infusion
may be more risky considering the age of the patient (76). Advanced age is a vulnerability for

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morality (Gavrilov, Gavrilova, & Krut'ko, 2017) and in case there is uncontrolled blood loss then
Mr. Ferguson will be predisposed to a much more risk of death. The side effects of Fentanyl like
fatigue and constipation are not as serious and can be easily managed (Kenn, Gayle, & Elizabeth,
2015).
Information to share with Mr. Ferguson
The emergency department nurse needs to explain to the patient the changes in the
medication and the reason for the change of each medication. Of greater importance is the need
to explain to the patient the side effects of each of the drugs and the necessary steps to counter
the more disconcerting side effects. The patient should be comprehensively advised on the
adverse effects of the medications especially when the dosages are not adhered to. Educating on
the need for lower-does prescribing is important as that reduces the side effects of
pharmaceuticals (Daughton & SueRuhoy, 2013). The long term effects of drug use, for example
aspirin and its fatal risk of gastrointestinal bleeding, should be emphasized and ways to manage
them like seeking prompt medical intervention (Huang, Strate, Ho, Lee, & Chan, 2011).
Conclusion
Health management in the emergency department requires proper knowledge of patient
history as well as ability to detect the pathophysiological issues facing the patient. All drugs
administered to the patient need to be well explained to them and all side effects within
manageable bounds should be managed so as to ensure patient ability to follow through with
treatment. It is a common practice to prescribe an array of medication to be administered
together particularly analgesic drugs as the interaction of these drugs is harmless if patients

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adhere to the prescribed doses. Any side effects should be explained by the health practitioner to
the patient and any side effects out of the ordinary ought to be communicated to the nurse.

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Baron, Senn, S., Voelker, M., Lanas, A., Laurora, I., W., T., . . . McCarthy, D. (2013).
Gastrointestinal Adverse Effects of Short-Term Aspirin Use: A Meta-Analysis of
Published Randomized Controlled Trials. Drugs in R and D.
Bartko, J. (2018). Morphine Interaction with Aspirin: a Double-Blind, Crossover Trial in Healthy
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Electronic Medicine Compodium. (2013, 06 115). Aspirin Tablets BP 300mg (POM) - Summary
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Gavrilov, L. A., Gavrilova, N. S., & Krut'ko, V. N. (2017). Historical Evolution of Old-Age
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Stitzlein, D. P. (2017). Opioids for pain management in older adults: Strategies for safe
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