Nursing Management and Pharmacological Application for Mrs Grace

This article discusses the nursing management and pharmacological application for Mrs Grace, an 80-year-old lady who fell and has a fracture on the neck of the femur. It includes a discussion on the patient's vital signs, past medical history, and prescribed medicines. The article also highlights the importance of proper medication management and risk assessment for the patient's cardiac condition.

Running head: NURSING KNOWLEDGE
NURSING KNOWLEDGE
Name of the Student
Name of the University
Author Note

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Introduction
In case of Mrs Grace an 80 year old lady it has been found that she fall unwitnessed
and at present she does not remember any occasion leading to the fall. Her present vital signs
are BP 147/77 which is regular, heart rate is 112 which is high and irregular, respiration rate
is 24 which is also high, oxygen saturation is 99 percent which is normal and temperature is
37.2. However, her GCS score is 13/15 which highlights that she is not properly conscious
and also cannot remember the cause of the fall. At the ambulance she has been administered
Fentanyl 100 Mcg by nasal prongs. Her regular medication includes Rivaroxaban 15 mg,
Thyroxine 50 mcg, Amiodarone 100mg, Metoprolol 25 mg and after the admission to the
emergency department she has been administered Bupivacaine + fentanyl femoral block,
Panadol 1 g, Neurofen 400 mg, Morphine 5 mg. She has been reported to experience high
level of pain in ED and also the right hip X-ray showed that she has fracture on the neck of
the femur. It has been also reported that she has an allergy to Penicillin. She has a history of
hypothyroidism, hypertension, arterial fibrillation, ischemic heart disease along with multiple
falls as well. On this context it can be stated that the risk of the patient is now fracture, pain
and the trauma she is experiencing. Thus based on this case scenario in the following section
the nursing management and the pharmacokinetics along with the treatment flaws and the
changes would be discussed.
Nursing Management
Based on the above discussion the factor of the vital signs showed some abnormalities
for the patient as the blood pressure is in slightly higher range based on the age of the patient
however, the heart rate and the respiratory rate are severely high which can be marked as red
flag symptom for the patient. Thus it can be stated that the condition of the cardiovascular
and the respiratory function is showing some abnormal condition. On the other hand the past

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medical history of the patient highlighted that she had IHD, RF, hypothyroidism and also
HTN issues. Hence, the need of the pathological tests could be seen which refers to the
investigation of the cholesterol level, blockage in the vessel system and also the assessment
of the respiratory system would be required as well. The pain management of the patient
would be the primary focus of the nurse in case of the treatment of the patient (Smith et al.,
2018). The pain management here would be focused on the medication management of the
patient (Curl et al., 2016). On the other hand the nurse should also focus on the past medical
history of the patient. The prescribed medicines in the ED would be assessed on the basis of
the previous medicines as all the medicines would be affecting on the cardiac muscles of the
patient. On the other hand the age of the patient should also be considered in terms of the
medication process. On the other hand the consoling skills that is the communication skills of
the nurse (Giuliano & Hendricks, 2017). Thus it can be stated that the holistic approach of the
registered nurse should be used in this process of the treatment of the patient (Malec &
Shega, 2015). On the other hand the process of the communication and the observation of the
vital signs would be prioritised as well. Mrs Grace admitted in the ED with a high heart rate
and respiratory rate thus the abnormality in the cardiac function of the patient should also be
consulted with the supervising doctor or the physician in order to provide a patient centred
care.
Pharmacological Application
Based on the medication of the patient it can be sated the registered nurse should be
able to administer the medicines properly by means of administering pathway, dose, timing
and also the absorption process of the medicine should also be assessed by the nurse. Hence,
it can be stated that the nurse should have the knowledge about the proper medication and the
pharmacokinetics or pharmacodynamics of the medicines along with the side effects of each
medicine prescribed to the patient as well.

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Mrs Grace has been prescribed with the medicines in the ED in order to decrease the
negative condition of her. The medicines including with Bupivacaine + fentanyl femoral
block, Panadol 1 g, Neurofen 400 mg, Morphine 5 mg. The registered nurse should possess
the knowledge about all these drugs prescribed by the supervising doctor or physician. The
knowledge would be helpful in the assessment of the side effects and also the proper dosage
of the medicines as well. Hence, on this context it can be outlined by the proper assessment
of all the drugs prescribed for the patient. Bupivacaine is the common local anaesthetic which
has been administered by the spinal injection process and it helps in the pain reduction for a
prolonged time up to 20 hours. It is commonly used after surgery or prior to total hip
arthroplasty. It works as the blocker of the nervous impulses by increasing the threshold for
the electrical excitation in the nerve thus the pain of the patient reduces. Pain, temperature,
touch, proprioception and skeletal muscle tone are the excitements of the nerve that can be
reduced by implementation of this anaesthetic (Ma, Zhang & Yao, 2016). Fentanyl on the
other hand also an anaesthetic however, it works as an analgesic developer in order to block
the nerve impulses. The process of the fentanyl includes the binding with mu opioid receptor
and thus binding with G proteins and exchanges the GTP production with GDP. Hence, the
cAMP concentration reduces and cAMP dependent influx of the cell reduces and thus the
hyperpolarisation of the cell leads to the inhibition of the nerve activity (Yu et al., 2017).
Thus Bupivacaine + fentanyl femoral block used for the pain reduction of the neck of femur
condition of the patient. Panadol is a paracetamol classified drug which would be termed as
the non-steroidal anti-inflammatory drug and thus it inhibits the cyclooxygenase pathway and
the analgesic reaction of this drug leads to the reduction of the nervous impulses and helps in
the reduction of the pain sensations as well. As the patient felt a high level of pain after the
fall in the Ed the pain management of the patient prioritised by the supervising physician and
also by the registered nurse. The combination of the anaesthetics and the paracetamol has

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been prescribed to the patient depending on her age and the condition of the pain sensation as
well (Waris et al., 2017). Neurofen 400 mg is comprised of Ibuprofen which is an analgesic
and absorbed in the gastrointestinal tract and reach the plasma concentration about 1 to 2
hour. However, the medicine effect is dose dependent as the 400-800 mg would be for
analgesic action, 1600-2400 dose would be acting as an anti-inflammatory drug (Tong,
Raynor & Aslani, 2018). By this process it reduces the nervous activity and thus the analgesia
occurs which would be helpful in the process of the reduction of the severe pain of Mrs Grace
Post fall and admission in ED set up. Morphine is also an analgesic and comprises of the
opioid which binds with the opioid and blocks the transmission of the nociceptive signalling
and activates the signalling of the pain modulating neurons in the spinal cord. Hence, on the
basis of the pharmacological assessment of the prescribed medicines for Mrs Grace in the ED
highlights that the focus of the medication process in this case is to provide support to the
pain of the patient and reducing the severity of the condition. However, over dose of these
above mentioned analgesics would leading to the heart rate decrease in a drastic amount
which would lead to the condition of sudden myocardial infarction as per her medical history
she also had hypertension, arterial fibrillation, ischemic heart disease (Smits et al., 21017).
Hence, it can be stated that the analgesic effects of all the medicines provided to the patient
should be assessed by the registered nurse in order to prevent the negative impact of the
medicines on the cardiac condition of the patient (Anderson & Morrow, 2017).
Mrs Grace found to have the regular medication which included with Rivaroxaban 15
mg, Thyroxine 50 mcg, Amiodarone 100mg, Metoprolol 25 mg. The registered nurse should
be able to assess the effects of these drugs on the basis of the pharmacokinetics of these
drugs. Rivaroxaban is a drug administered through the oral way and it binds with the Xa
factor of the body in order to amplify the coagulation cascade and thus negating the
formation of thrombus in the veins. This drug is prescribed to the patients with hip or knee

5NURSING KNOWLEDGE
replacement in order to reduce the risks of the deep vein thrombosis and also pulmonary
embolism.10 mg dose can be administered without any other consideration however, the 15
mg should be administer after taking food. This drug is very much effective in comparison to
warfarin however any kind of major bleeding would not have any antidote to control the
event (Spyropoulos et al., 2018). Thyroxine is basically a hormone however, in case of Mrs
Grace it has been prescribed as a medicine and the medicines comprising of Thyroxine would
react in the liver and its common name is antihyperlipidemic based on its function. It
stimulates low density lipoprotein and leads to the removal of bile acids and also the
cholesterols. It actually happen to be working on the excretion process of the cholesterol of
the body (Wang et al., 2017). Amiodarone 100 mg on the other hand works as the antianginal
and antiarrhythmic drug. Amiodarone inhibits the sodium and potassium activated
myocardial adenosine triphosphatase activity which helps in the duration increase of the
ventricular and atrial muscle action. This drug administered by the intravenous way and after
entering the body the amiodarone reduces the resistance in the peripheral vascular system by
relaxing the smooth muscles of the vascular system (Kudenchuk et al., 2016). Metoprolol 25
mg is one of the most common beta blocker. It impacts over the subject after the
administration of the medicine by the reduction of the heart rate and the cardiac output as
well. The impact of the medicine found to effective as it comprises of diuretic compounds
and thus reduces the cardiac excitability, cardiac output and the myocardial oxygen
requirement. It has been found that the effect of the Metoprolol is more effective than the
diuretics after administration to the subject’s body in cases of the sudden cardiac death or the
myocardial infarction. Metoprolol is basically a beta-1-adrenergic receptor which produces
the chronotropic and inotropic effects that reduces the cardiac output (Thapaswini et al.,
2015).

6NURSING KNOWLEDGE
Based on the pharmacological discussion it can be stated that the regular medicines
and the prescribed medicines in the ED would be assessed by the registered nurse for the risk
assessment of the patient for the over dosages of the analgesic drugs and also the beta
blockers would lead to the severe condition of the myocardial infarction. Thus it can be stated
that the knowledge of the registered nurse would be required in the proper medication
management and also the factors of the treatment as well.
Conclusion
Based on the above discussion about the process of the nursing care to the patient
should be provided with proper patient centred care to the patient. The process of the
pharmacological assessment of the medicines of the patient would be required by the nurse in
order to provide a high quality care to the patient. On the other hand the risk assessment of
the medicine administration to the patient would be required as well as the past medical
history of the patient is also highlighting the issues of the cardiac condition. On this context it
can be stated that the proper assessment of the medicine and also the pain of the patient
should be done with the priority to the patient’s condition of health.

7NURSING KNOWLEDGE
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