Case Study Assessment for Ruth in Aged Care Facility

ASSESSMENT 1
Case Study
Ruth is a female resident in an aged care facility. She has been transported to the hospital with a productive cough
and dyspnoea. During one of her coughing fits, she fell down, resulting in her sustaining bruising to her ribs. She has
been diagnosed with community-acquired pneumonia.
Below is a summary of her medical history, current medications prior to hospitalisation and her management plan
since arriving at the hospital.
Patient Name: Ruth Summer Allergies: NKA
UR: 12345
DOB: 20.09. 1938
Past Medical History: Medications:
 Osteoporosis
 Osteoarthritis (knees)
 Hypertension
 Type 2 Diabetes Mellitus
 Chronic Back Pain
 Diclofenac 25mg BD/PRN
 Paracetamol 1g QID
 Gliclazide 40mg mane
 Perindopril 8mg mane
 Norspan Patch 10mg weekly
Hospital’s management plan:
Diagnosis: Moderate community-acquired pneumonia
Diagnostic Tests:
Radiology: CXR showing right lower/middle lobe pneumonia
Pathology: increase in white cell count indicating infection, sputum result pending and blood cultures pending.
Treatment Plan:
Intravenous cannula
Benzylpenicillin 1.2g IV 6 hourly until significant improvement
Doxycycline 100mg orally BD for 7 days
IV therapy
Ventolin inhaler or nebuliser to relieve shortness of breath
Oxygen therapy to maintain saturation above 92%
Regular medications
Eat and drink as desires
Monitor for red flags:
Respiratory rate higher than 30 breaths per minute
Systolic blood pressure lower than 90 mmHg
Acute confusion
Oxygen saturations lower than 92%
Heart rate higher than 100 per minute
PAGE \* MERGEFORMAT 1

ASSESSMENT 1
It is day two (2) of Ruth’s admission and she is in your patient allocation for the shift. She is due for her 0800hr medications.
1. You need to review her National Inpatient Medication Chart (NIMC) (Appendix 1), to discover which of her medications are due. Then complete the table below:
Trade Name Dose Frequenc
y Route Used to
Treat Action (Pathophysiology)
Side/Adverse
Effects
(List 4)
Nursing interventions, special
considerations, precautions,
contraindications
(If required)
Gliclazide 40mg mane oral Type 2 diabetes
Gliclazide stimulates insulin secretion
with the help of Beta cells
sulphonylurea receptor and direct
effect on intracellular calcium
transport. It also improve the
abnormal insulin release in type 2
diabetes which also have impact on
second phase.
Nausea, vomiting,
diarrhoea,
constipation,
stomach ache.
There is need to ensure about
monitoring the blood sugar level
while taking this medication.
Paracetamol 500mg QID oral
Pain and ache
and elevated
body
temperature
Paracetamol has central analgesic
effect through the activation of
descending serotonergic pathways
and they also inhibit the
prostaglandin. (Scuderi et. al., (2018))
Control
hyperthermia.
Avoid to use on regular basis. The
regular consumption may cause the
nephrotoxicity.
Perindopril 8mg mane oral Hypertension
It is ACE inhibitor like perindopril
which have prevent body from
creating any harm. It also works as
Angiotensin converting enzyme and
widen blood vessel which can help to
reduce the amount of water in blood
by kidney.
Weakness,
headache, cough,
stomach pain,
upset stomach
Nursing staff to ensure about a
reporting low blood pressure case
when patient experience dizziness. It
is also need to monitor symptoms
including weakness, numbness,
fatigue and tingling.
Satisfactory Not Satisfactory
PAGE \* MERGEFORMAT 1

ASSESSMENT 1
2. You perform a patient assessment on Ruth prior to administrating her 0800hr medication, resulting in the following:
 Blood Pressure 100/60
 Pulse 78
 Temperature 37.1
 Respiratory Rate 20
 Sp02 90% room air
 Blood glucose level 6.7 mmol
Do you proceed with giving all of the medications due? Yes or No. Provide an explanation for your answer.
While taking the analysis of test report, there is no need to provide other medication. In the context with the report, the condition of
hypotension is evaluated. In addition, midodrine is initially used to elevate the BP on normal range. After that the other medication are
prescribed with the test of situation within patient. (Parisien et. al., (2020)).
Satisfactory ☐ Not Satisfactory ☐
3. You report the findings to the Registered Nurse who asks you to inform the Medical Officer so that the patient can be reviewed. The
Medical Officer reviews Ruth and recommends to commence oxygen therapy.
a) What type of oxygen device should be used and why?
Hyperbaric oxygen therapy because it provide three time more oxygen to the lungs.
b) What is the maximum L/min for this device
There is about 4 L/min for this device (van Haren et. al., (2022))
.
Satisfactory ☐ Not Satisfactory ☐
PAGE \* MERGEFORMAT 1

ASSESSMENT 1
4. In order to ensure the safe administration of medication there are eight (8) rights of medication administration. List the eight (8) rights
and demonstrate your understanding of each by briefly explaining what they mean.
There are eight rights of medication administration which are going to be discussed further.
The right person- This is the one in which it is need to ensure that medication is taken by the right person which can help to
ensure about the proper medication.
The right medication- It includes verification of medication that is provided to the patient via self-administration or by licensed
staff member.
The right time- This implies to verification of physicians medication order which should be provided at the scheduled time.
The right dose- This includes the proper amount of drug administered to the patient for pharmacological effect (Bardia et. al.,
(2019)).
The right route- This is the one which includes method of aadministration like oral, IV, IM and many more.
The right position- This includes better therapeutic effect within the body.
The right documentation- It includes the proper method of recording on the drug regimen that provided to patient.
The right to refuse- It includes staff responsibility to encourage compliance and patient have the right to refuse the
administration of drug.
Satisfactory ☐ Not Satisfactory ☐
5. Using the NIMC, match all of the medications prescribed with the correct schedule of medication:
a) Schedule 2 Pharmacy Medication
PAGE \* MERGEFORMAT 1

ASSESSMENT 1
Paracetamol, Gliclazide
b) Schedule 3 Pharmacist Only Medicine
Paracetamol, Perindopril
c) Schedule 4 Prescription Only Medicine
Alprazolam, Clonezepam, clorazepate, diazepam
d) Schedule 8 Controlled Drug
Norspan Patch (Bradley et. al., (2018))
Satisfactory ☐ Not Satisfactory ☐
6. It is almost lunchtime and Ruth’s buzzer is going. You attend to her. She reports that she is having pain on the right side of her chest
wall.
a) List 3 questions you would need to ask Ruth about her pain to determine the interventions you need to perform to help
relieve the pain?
PAGE \* MERGEFORMAT 1

ASSESSMENT 1
1: location of the pain and analyse the unit of pain? In this, the IV or oral drug are prescribed to patient.
2: Is pain persist for longer time, evaluate duration? The analysis help to confirm the amount of dose that prescribed.
3: Is the pain metastatic? In order to analyze the pain that persist on overall body to provide proper medication.
b) List 3 factors which should be considering when assessing pain which may influence the person’s perception of pain.
Physical change
Change in emotion like anger or anxiety
Patient behavior such as feeling discomfort. (Schlegl et. al., (2020)).
Satisfactory ☐ Not Satisfactory ☐
c) Reviewing the provided NIMC, which drug or drugs are available for Ruth to take in order to relieve her pain.
Your answer needs to cover:
 Route
 Dose
 Maximum Dose:
 Pharmacodynamics (how the drug acts in the body)
 Pharmacokinetics (how the drug circulates)
Drug Name Aspirin
Route: oral
Dose: 450mg
Maximum dose: 650 mg
Pharmacodynamics mechanism
of action:
Aspirin is non selective and irreversible inhibit both. But
they are weakly more selective for COX-1. They usually
acetylating the hydroxyl of the serine residue.
PAGE \* MERGEFORMAT 1