Nursing Management Report: Case Study of a Patient with Chest Pain

This report provides a detailed analysis of a nursing management case study involving a 76-year-old patient presenting with chest pain and shortness of breath. The report begins by describing the patient's presenting problem, focusing on the pathophysiological issues, including the initial symptoms and demographic details. It then delves into a literature review to explain the pharmacokinetics of the prescribed medications, including aspirin, morphine, fentanyl, and low molecular weight heparin, and their indications. The report examines drug-drug interactions and the importance of understanding how these medications work within the body. Further, the report discusses appropriate nursing management based on evidence-based literature, considering the patient's age and medical history. Finally, the report addresses how to educate the patient about the interactions and long-term effects of the prescribed medications, providing detailed information to be shared with the patient regarding the safe and effective use of the medications. This report is a valuable resource for understanding the complexities of patient care in an emergency setting.

Running head: NURSING MANAGEMENT 1
Nursing Management
Name
Institution

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1. Describe the patients presenting problem focusing on the pathopsychological issues
The presenting problem, in this case, is the amount of physical and psychological
discomfort that the patient exhibits. The case study presents a Mr. Fugerson exhibit heavy
breathing, paleness and short of breath. The initial symptom for which a person seeks helps from
a doctor, and in this case is the service provider at the emergency room (Groth, 2003). He has a
history of 2/24 chest heaviness, and on the attack, he administered himself the pump spray.
Apart from being pale and having short breaths he also appeared diaphoretic. However,
we first have to look into his demographic details to know and be sure to issued rugs that would
work for him. Being 76 years old makes it easier to see the amount of dosage at that particular
age is to be administered (Jones et al., 2006). The presenting problem can also necessarily not be
the real problem. The patient might exhibit symptoms that may later disappear or not appear at
that particular time and be shown at a later time.
When Mr. Fugerson was being admitted, he had chest heaviness and up entering the
emergency department bed, he appeared to be pale, diaphoretic and at the same time had
shortness of breath. While presenting, the problem the patient's history is also a crucial matter to
look. , before the diagnosis of the patient, a close analysis should be done to identify the source
of pain, as well administer drugs in case of an emergency. There is need actually to check on the
demographic information of the patient.
His regular medication indicates specific dosage that he was given upon arrival at the ED
he was also administered the drugs. The first symptoms and physical symptoms are the doctor or
nurse see and draw a conclusion. The case study of Mr. Fugerson exhibits conditions that are
critical and needs medical attention as soon as possible (Linnebur et al., 2005).

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2. Review and use literature review to explain the pharmacokinetics of the prescribed
medications and indications
Pharmacokinetics is an area of pharmacology concerned with the time course of
absorption, distribution, metabolism and the excretion of drugs from the biological system to
fully comprehend the effect of an administered drug or the impact of the drug administered to a
given individual or subject.
INTRODUCTION
Pharmacokinetics can be defined as the study of absorptions, the overall distribution,
modification and transformations and eventually excretion of drugs in the human body National
Center for Biotechnology Information (Long, 2013).
For the safe and efficient admission of drugs, clinical pharmacokinetics has to be applied
in a therapeutic application with the primary aim being the elimination or minimization of the
toxic effects of drugs on patients under therapy. To develop a relationship between the drug
concentration and their impact, the clinicians ought to apply the principles of pharmacokinetics
which entail distribution quantity, bioavailability and exposure duration (Krantz, Kutinsky,
Robertson & Mehler, 2003). The effects of a drug are often directly related to its concentration
generally in the human body and on the receptor sites. However, it is not possible to practically
measure the level of a drug directly through these sites and therefore the incorporation of blood,
plasma or other body fluids samples for analysis. This yields kinetic homogeneity which entails
the relationship between the drug concentration on the sample and that of the receptor site where
a change in the sample content depicts a change in the receptor site concentration (Guay, 2007).
Most of the drug’s side effects are related to their concentration on the receptor site
except for a few other factors such as receptor density regulatory factors and modes of signal

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transmission. On the contrary, there exists a case of tolerance where the continued use of the
drug exhibits a decrease in its effectiveness which is usually as a result of increased metabolism
with the intake of a specified dose over time (Linnebur et al., 2005). A case of
pharmacodynamics tolerance can also be reported where the same amount of drug concentration
at the receptor site produces a lower effect over a continued exposure (Herr, 2002).
Pharmacokinetics, therefore, brings us to the concept of DDI- Drug-Drug Interaction.
This is to what extent a given drug when administered works efficiently with other medications
to be able to function correctly without an effect or negative impact on the patient. Morphine
appears to have negligible interaction with aspirin (McCarthy et al., 2016).
According to (Amsterdam et al. (2014), it appears clinically relevant whether morphine
also affects the pharmacokinetics (PK) and pharmacodynamics (PD) of aspirin. According to
(Bruce and Bing (1965), majorly in medical terms morphine has been used for pain relief in the
clinical management of myocardial infarction. A Morphine Sulphate IV 2.5 mg/4cc PRN to Mr.
Fugerson. Morphine has been for a while been administered for chest pains relief to patients with
the symptoms. Use of aspirin reduces the mortality rate among patient (Gordon et al., 2004).
Mr. Fugerson regular medications include;
 Aspirin 100mg PO, OD
 Metoprolol 50mg, PO, OD
 Rosuvastatin 10mg, PO, OD
 Glyceryl Trinitrate Pump Spray PRN
 The medicines administered upon arrival at the Emergency Department include;
 Aspirin 300mg PO

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 Morphine Sulphate IV 2.5 mg/4cc PRN
 Low Molecular Weight LMW Heparin Fusion.
 Fentanyl 50mcg IV, X2 STAT doses.
 The indications he exhibited were also as follows;
 Blood pressure indicated that it was 172/86
 Heart rate 103bp that appeared to be irregular a sign by the massive chest pains he
exhibited.
 The SPO2 appeared to be 97% RA
 Respiratory Rate was 24b/min
 Temperature 36.8C tympanic
 Glasgow Coma Scale indication was 15/ 15 E4V5M6
With the above data, this brings us to the pharmacokinetics of the medication that he was
offered. The pharmacokinetics of these various drugs administered for the medication indications
of the patient has to be given in doses that will work efficiently (Clark, 2002).
DRUG ADMINISTRATION
Often the goal is to attain a therapeutic drug concentration in plasma from which drug
enters the tissue. This will, in turn, bring us to enteral routes. For Mr. Fugerson, he uses his pump
spray for his chest pains. Intravenous injection was used for him to administer the IV infusion.
This injection is usually administered (Chau & Mason, 2005). The intravenous injection is

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generally administered for rapid asthmatic conditions and other chest cavity problems (Hughes,
1998).
Drug-drug Interaction for Aspirin and Morphine
Drug-drug interaction
This is usually a change the body exhibits when the drug is taken together with
another second drug. It may have an effect of delay, decrease, or even facilitate and
enhance the fast drug absorption. It majorly improves and promotes the rate of drug
absorption into the plasma of the patient’s body or the individual taking the drug (Lanken
et al., 2008)
Aspirin
This drug is known to interact with a total of approximately 507 drugs. Its
classification includes platelet aggregation, inhibitors, and salicylates. Its treatment usage

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ranges from many diseases. Back pain, heart attack, ischemic stroke, rheumatic factors
among other infections and diseases.
Morphine Sulphate
This drug too has a wide range of interaction with other medications. It is mainly
classified as narcotic analgesics. Its usage for treatment ranges on chronic pain and just
pain.
Fentanyl
This is administered via injection to patients in varying doses when a patient is
sick. The doses are given after prescription by medical personnel. It is an opioid analgesic
used in high doses when patients require assisted ventilation in case of a respiratory
depressant as well as the severe pain of myocardial infarction. Route of administration is
usually via injection.
The pharmacodynamics properties of this drug are 50 to 100 times more than that
of morphine. This drug action is rapid and short last. It relieves pain, some constipation,
ventilator depression among other treatments.
Low molecular Weight Heparin Fusion
This is anticoagulant administered for angina and usually administered for the
acute coronary syndrome.
Drug Interaction Classification; the relevance of a particular drug interaction to a
specific patient depends on various factors that the patient. The drugs interaction are
classified into
Major; this means the interaction should be highly avoided as the risks exceed the
benefits present. This is termed as a highly clinically significant.

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Moderate; this drug interaction is to be avoided but under particular circumstance
is supposed to be utilized for the drug administration to the patient. This is considered to
be clinically significant (Chau, Walker, Pai & Cho, 2008).
Minor; take the alternative drugs that have been assessed and seem to interact
together. This means that the risks associated is minimal or no there at all (Gabrail,
Dvergsten & Ahdieh, 2004).). If the drug interaction has been chosen, a monitoring plan
is invented or placed to ensure the drug works efficiently for the patients at regular
intervals as the doctor may assign the nurse or the nurse to tackle it for him or herself
(Tedeger et al., 2006).
1. Discuss the nursing management appropriate for the patient using the evidence-
based Literature
Mr. Furgerson is administered with a combination of opioid drugs aspirin,
morphine and fentanyl alongside a Low Molecular Weight Heparin fusion. Being a
senior man of age 76 years, the pain he has m already been determined as a myriad of
pharmacological, physiological. This due to his medical history makes it easier for the
administration of drugs (Davies, Kingswood & Street, 1996). These drugs tend to have a
pharmacokinetic activity that is similar, and their absorption rate varies in ages. The
young adults, the aged and the in facts, the metabolic rate to is affected and that in turn
affects its pharmacodynamics approach in administration (Furlan, Sandoval, Mailis-
Gagnon & Tunks, 2006). The rate of drug absorption is crucial as the administration and
absorption of these drugs will reduce. (Linnerbur et al., 2005).

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With the above changes comes the change in drug distribution. For example, in
older persons, the hepatic flow reduces hence increasing the metabolic rate of drugs in
the body system (Ferrell, 2004).
Because of these appearing effects, to the aging, the drug doses should be
administered in small doses about 25%- 50%9 Clark, 2001). There are sometimes of
opioids to be avoided for the elderly due to their hyperactive activity. Administration of
these drugs will have to be limited being that he is aged and his chest cavity (Mason,
2005).
There is a basic drawing that shows the relationship that exists in the drug
absorption the pharmacokinetics and the pharmacodynamics of the drug administered and
the various variables that affect the victims (Cherny et al., 2001). As seen above;
pharmacodynamics is just the drug concentration at the suite faction and the effect it has
when multiple factors such as time and other demographic factors are considered before
administration of the drug to the patient (Gil et al., 2003).
Table1.1 Table 1.2
.
Drug concentration
versus time tttime.

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1. How would you educate the patient about the interactions of the long terms effects of
the medication prescribed in the ED? Describe in details the information you would share
with the patient.
MORPHINE, ASPIRIN, AND FENTANYL
Morphine, Aspirin, and Fentanyl are prescribed to treat severe pain; these are the
commonly used strong opioids that work on the patients’ nervous system and brain to reduce the
amount of pain felt. They can be taken as a liquid by mouth, as quick-acting tablets, or as slow-
release tablets and capsules, they are also available as injections (Bueno & Fioramonti, 1988).
Before taking the drugs
Some medicines are not suitable for people with certain conditions, and sometimes
medication may only be used if extra care is taken. For these reasons, before taking these drugs,
it is essential the doctor know:
• If the patient is pregnant, trying for a baby or breastfeeding.
• If the patient has liver or kidney problems
• If the patient has prostate problems
• If the patient has any breathing problems
• If the patient has epilepsy
• If the patient has had a severe head injury
• If the patient has an allergic reaction to medicine
How to use the drugs
Before the start of the treatment, read the manufacturer's printed information leaflet from
inside the pack. The manufacturer’s leaflet will give more information about the specific brand
of the drug that has been prescribed to the patient.

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Slow-release tablets of morphine should be swallowed whole with a drink of water- do
not break or crush the tablets. Slow-release capsules can generally either be swallowed whole or
opened, and the contents sprinkled on to soft foods such as yogurt.
Morphine can be taken before or after meals, if the patient forgets to take a dose, they
should be made as soon as he or she remembers and continue as before.
Aspirin consists of prescription, and nonprescription, prescription aspirin comes as an
extended-release (long-acting) tablet. Nonprescription aspirin comes as a regular tablet, a
delayed-release (releases the medication in the intestines to prevent damage to the stomach).
Nonprescription aspirin is usually taken every 4 to 6 hours as needed to treat fever or pain. The
extended-release are swallowed with a full glass of water (Ballantyne & Mao, 2003).
Fentanyl is prescribed for primarily for use in people who have pain from cancer; the
patients tend to take higher doses and get the effects as quickly as possible.
Effects of the drugs
The short-term effects of the drugs are:
• Drowsiness.
• Constipation
• Feeling sick.
• Dry mouth.
The long-term effects of the drugs are:
• Feeling confused
• The abrupt change of mood
• Disturbed sleep
• Difficulties are passing urine

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• Flushing
• Rash
• Breathing system
2. What clinical considerations would be considered to combat the adverse effects of the
medications?
In any event, the effects escalate, then a diagnosis is to run, and an alternative drug is
administered to the patient. Mr. Fugerson being an old man has irregular breathing. Opioids side
effects can be adverse and if in an event, a patient is exhibiting allergic reactions, severe nausea,
and breathing difficulties. Perhaps administering the dosage in different quantity might alter the
clinical effects of the drug (Lanken et al., 2008).
References
Ballantyne, J. C., & Mao, J. (2003). Opioid therapy for chronic pain. New England Journal of
Medicine, 349(20), 1943-1953.
Bueno, L., & Fioramonti, J. (1988). 7 Action of opiates on gastrointestinal function. Bailliere's
clinical gastroenterology, 2(1), 123-139.
Chau, D. L., & Mason, M. N. (2005). Methadone in end-of-life pain management. Journal of
opioid management, 1(5), 244-248.