Case Study: Prescribing Considerations and Reflection Analysis Report

This case study presents a comprehensive analysis of a patient case involving cellulitis, focusing on prescribing considerations within a nursing context. It begins with a detailed patient assessment, including presenting complaints, medical history, and social factors. The case explores the application of the NPC Principles of Good Prescribing Framework, emphasizing the importance of considering the patient's needs and preferences. The prescription decision involves Flucloxacillin, with justifications based on its effectiveness, appropriateness, safety, and cost-effectiveness. The assignment highlights the negotiation of a treatment plan to ensure patient concordance and provides insights into the review and outcome of the treatment. The reflection section, structured using Gibb's reflective cycle, addresses the challenges encountered during the prescribing process, particularly the patient's concerns about medication management and the nurse's response. The reflection analyzes the situation, evaluates the experience, and proposes an action plan for future practice, emphasizing the need for adaptability and patient-centered care.

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Case Study Two Reflection Template
(please submit via turnitin and as a signed paper copy in Evidence Profile)
Prescribing Framework
(NPC Principles of Good Prescribing Framework 1999)
1 - Consider the Patient
(NPC Principles of Good Prescribe Framework 1999)
Patient name and dob/age Mr_ _ _ _ _, 49 years.
D.O.B: 00/00/1970
Presenting Complaint (PC) At the time of the admission the patient has
displayed following symptoms:
Redness and inflammation on the right lower
leg, tight and swollen glossy skin, fever, and
pain. The patient has also mentioned that he
has numbness around the area and had
difficulty put pressure on that leg.
History of presenting complaint
(HPC) (use appropriate
assessment tool e.g. PQRST)
P- Patient body temperature started rising
and also witnessed pain in the right lower
leg.
Q- Sever pain, high fever, and growing
rashes.
R- Symptoms of the health condition were
observed in the right lower leg region.
S- Patients pain score is 8 on the scale of 1

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to 10 and also explain the falling condition.
T- The condition of the patient started to get
difficult 3 days prior to the admission in the
hospital and fever started getting high last
night before admission to the hospital, and
pus formation was taking place.
Clinical findings and observations
(signs and symptoms, clinical
observations, wound assessment
etc)
Body Temperature: 38.90C. SpO2: 96%. BP:
135/86.
RR: 18. HR: 90 Regular
Presence of pus in the area.
Patient was in visible pain, observed with
drowsiness, high fever, warm skin, and
rashes.
Past medical history Asthma, obesity and lower leg bone fracture
Past surgical history Open reduction and internal fixation (ORIF)
surgery
Prescribed Medication history
(Name, Dose, Frequency, Reason
Started, whether effective)
Fluticasone and salmeterol for asthma
condition: 250-50 mcg/dose for every 12 hrs.
Lorcaserin for healing bone fracture:
200mg/dose for every 6 hours.
Over the counter products
(complementary, herbal and illicit
etc.)
Nil
Allergies
(To what and state nature of
Pollen dusts

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reaction)
Adverse reaction
(To what and state nature of
reaction)
Rashes, fever and shaking
Family history: Grandfather – Deceased – Asthma
Father – Deceased - Asthma
Any other issues:
(e.g. hepatic impairment, renal
impairment)
Nil
Social History
Home Situation Lives with his two children in a remote area,
divorced
Occupation Works in a coal mine
Hobbies Playing football, hiking and cooking
Pets None
Recent Travel None
Alcohol Occasionally
Smoking 6, 7 cigarettes a day
Recreational Drugs Never
Sexual History Recently divorced
Systems Enquiry
(Provide details where appropriate, or state nothing of note, but only if this is the case)
Cardiovascular Mild Hypertension
Respiratory Inflammation in the respiratory tract
Gastrointestinal None

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Genitourinary None
Nervous system None
Endocrine None
Musculoskeletal Normal
Skin hair & Nails Tight and swollen glossy skin and redness
and inflammation on the right lower leg
Other None
Working diagnosis
(pathophysiology and evidence to support
diagnosis)
The pus was secreted from the affected
region as a result of infection after receiving
the person and affected area and skin was
further tested as a result of deficiency of the
immune system. A biopsy of the skin and a
gram staining process were conducted to
detect the organism that causes the
infection. Obesity, diabetes and the age of
the patient may have also affect the cellulite
defence mechanism which further
exacerbated the situation (Bandaru,
Rajkumar and Nappanveettil 2013).
Prescribing Considerations
2 - Consider the appropriate strategy: consider your competence to
prescribe, legal, ethical and professional issues.
Prescription Decision
After a severe condition was observed, Flucloxacillin 500 mg QDS for 7 days had
been approved for the person. After the drug was administered, the wellness

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situation would be supervised to evaluate the changes in the patient's indications
and structures and conditions. (Lwin et al. 2018).
Strategy & Competency
Being a nurse, I have a greater responsibility to provide appropriate and effective
care and treatment focusing on the correct administrative route and dose of the
medicine (Mitchell and Golden 2012). The nursing code of conduct guides the
nursing staff to provide better understanding and education to the patient and the
family member to provide then the ability to take their own health care decisions
(Edge and Hoffman 2013). Flucloxacillin administration was conducted to the
patient and also the effects and outcomes of the medication were properly
described to the patient in order to generate awareness and knowledge (Lwin et al.
2018).
3 - Consider the choice of product/ treatment plan
(apply EASE to product, using up to date supporting evidence/guidelines used)
Effectiveness
It is medication which belongs to penicillin class and it has a role is restricting the
growth of bacteria causing the health complication. The drug blocks the synthesis
of cell walls of the bacteria which leads to restricted growth of the infection and
death of the organism (Chaudhuri and Wade 2018).
Appropriateness
The drug has been proved to be the most effective drug for the condition of
Cellulitis. The medication has few side effects and has a minor rate of complication
occurrence (O'Connor, Lee and Fong 2018).
Safety
The medication has been observed to have fewer side effects than other

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medications and the side effects are not serious. The medication shows lesser rate
of complication occurrence when administered with other drugs (Muilwijk et al.
2017).
Cost Effectiveness
The cost of Flucloxacillin 500mg is found to be less costly than any other drugs
that can be administered to patient suffering from Cellulitis. The medication has a
rate of effectiveness higher than any other medication and is easily available for
the patients (Weng et al. 2017).
4 - Negotiate a contract to achieve concordance with the patient
(communication and consultation skills, how was the patient involved in decision making,
what information was given to the patient e.g. dose schedule, duration of treatment, when to
start/stop the medication etc)
After the diagnosis of the health condition, the patient was involved in a
discussion along with the nursing staffs, general practitioner, and the family
members in order to provide them with the exact knowledge regarding their health
condition (Ferrell et al. 2017). The patient was made aware and informed
regarding the treatment, medication, and care that will be provided as well as
consequences of the condition if not treated appropriately. An effective and better
therapeutic relationship was developed in order to make the treatment process
much easier and also to understand the needs and requirement of the patients to
provide best quality of service (Ko et al. 2018).
5 - Review and outcome
(by who, when, where and why; was the treatment effective)
The condition of the patient was better treated by the nursing staffs during the
admission as well as after the treatment. The infection was assessed and cleaned
by the nursing staff. The pain assessment was conducted by the nursing staff and

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also the medication administration was conducted by them in better and alters way
(Sutherland and Parent 2017). The nursing staffs have the chief role in connecting
the patient and the health care professionals in order to provide better treatment.
6 - Record keeping
(where and why)
The patient health and treatment information was recorded by the use of electronic
health record system. The electronic health record system is used in order to
record a patient’s medical history, provided treatment and medication, the recent
updates and the result of the treatment. The system is used in order to avoid any
complication or error in care delivery and treatment of the patient. The record is
accessible by the nursing staffs along with the other health care professionals
(Madden et al. 2016).
7 - Reflection on scenario:
(you may use a reflective model of your choice to structure your reflection, approx. 750-1000
words)
I would reflect on the process of the non - medical prescription in an ethical way
and the influences that can be able to affect the prescription process. The
reflection process would follow the Gibb’s reflective cycle.
Description:
The incident that I will be reflecting upon on this scenario has happened during the
non- medical prescription process of the patient after the assessment of the
patient’s condition. The patient was administered with Flucloxacillin 500 mg QDS
for 7 days in order to provide him with improved condition. However, the patient
has difficulty understanding the dose and timing of the current drug. The reason
behind this condition is that the patient has already taking three medication due to
his past medical history which is asthma and obesity. The patient has conveyed

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his concern that he has trouble understanding process and he might mix up his
medication due to the administration of more than two or three pill. However, the
situation was handled by the incorporating his sons who are 24 and 20 years old
so that they can help their father to take correct drug in correct dosage and they
help their father if he forget about his medication plan.
Feelings:
This situation presents a dilemma as administration of wrong dose of a medication
in a wrong time might have adverse effect on the patient. My first feeling was to
what should be done to provide a safe medication plan to the plan so that the
patient does not mix up his medication as one of the primary objective of the non-
medical prescription is to provide safe administration practice to the patient as well
as to aware them about the consequence of the administration of the wrong
dosage and wrong drug (American College of Sports Medicine 2013). At that time
of the occurrence of this incident, I panicked a bit as I have not faced this type of
the situation earlier in my short experience. I was bit hesitant about my next step of
the action. Finally, I remember my training to keep calm and finally managed to
resolve the situation by incorporating the patient’s sons in the situation (S Astroth
et al. 2013). This has a positive effect on my psyche as I understand that I will be
able handle difficult situation in my coming years as nurse.
Evaluation:
This experience has both good and bad aspects in respect to the safe nursing
practice. The bad element of this situation is that I was hesitant about the situation
and was unsure about my next. This might have a negative effect on the nurse-
patient relationship. I might have lost the patient trust on the dealing the situation
and in direct consequences, the patient might have lost his trust on the treatment

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(Kourkouta and Papathanasiou 2014). On the other hand, I have faced with a
situation new scenario in my nursing practice and I have managed overcome it
without significant difficulty and this will positively act as a confidence boosting
experience in my forthcoming nursing year.
Analysis:
One of the required skills of the nursing practice is to adapt to the new situation
which might have arisen during every day practice. In addition to that, the health
care will also have to handle those situations effectively (Winland-Brown, Lachman
and Swanson 2015). In those terms, I have managed to handle the situation and I
have managed provide a way in which the patients can take correct medication
without the fear of wrong medication. There is also a little bit hesitancy from my
end while handling the situation and this might have affected the patient’s
dependency on me (Wolf 2012). Therefore, in future, I have to take this situation
into consideration and prepare myself better for this kind of situation.
Conclusion:
From the above situation, it can be stated that, I have learned a new and valuable
experience regarding non- medical prescription process. I have learned that
situation might arise which is completely new to me and I have handle it
nonchalantly. In addition to that I am also aware that nursing staffs have to act
immediately and there is no place for hesitancy in the health care profession.
Action Plan:
This situation has provided me with a valuable experience, make me understand
about my weakness and the area that I need to be strengthen. One of this area is
that I have to be ready for any kind of situation that might arise and I have to be
much more proactive while dealing with the patients. In addition to this, I will also

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have deal with a new situation without showing my hesitancy so that I can provide
best possible health care service as well as to safe, legal and ethical non- medical
prescription process.
Student signature
DMP signature
Date

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American College of Sports Medicine, 2013. ACSM's guidelines for exercise testing
and prescription. Lippincott Williams & Wilkins. Retrieved from:
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