NUR330 - Emergency Nursing Case Study: Medication Management Analysis

This case study examines the medication management of a 70-year-old female, Gail Peters, who presented to the Emergency Department following a fall resulting in a fractured femur. The assignment analyzes the prescribed pharmacological pain management for Gail, who has osteoarthritis, hypertension, and severe joint pain. The study recommends a combination of Paracetamol and Ketorolac for pain relief and discusses the potential use of Morphine if pain persists. It also addresses patient safety concerns, particularly the risks associated with prolonged stays in the emergency department, especially for elderly patients. The case study highlights the importance of assessing pain using tools like the Brief Pain Inventory and emphasizes the potential adverse events linked to overcrowding and congestion in the emergency room.

CASE STUDIES 1
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CASE STUDIES 2
Medication management
Gail Peters has osteoarthritis, inflammation in her right leg, severe joint pain, and
hypertension. The fall has resulted in a fracture of the right femur. The ECG shows AV block
that may have resulted in the blackout and fall leading to the fracture.
The Brief Pain Inventory, a fundamental tool of nursing is used to assess Gail Peters’
pain status (Chiarotto et al., 2019). It provides a more in-depth analysis of pain and discomfort
such as intervention in activities, history or location. Pain is measured on a scale of 10, with 0
being painless or no discomfort and 10 denoting terrible pain. The important part is that it is
based on emotional or affective perception instead of physical symptoms and thus has a
screening capacity.
Ms. Peters should be prescribed a combination of oral Paracetamol and Ketorolac (typical
NSAIDs) for pain management (Glyn-Jones et al., 2015). This is currently advised for first-line
pain treatment. Only Paracetamol is not enough for the management of Ms. Peters’ severe pain.
Ketorolac will prevent prostaglandin synthesis to reduce inflammation and pain. A calcium
channel blocker antihypertensive drug may be administered which has no contraindication with
Ketorolac. If the pain persists, Morphine will be administered and if the pain seems under
control, reduction of doses may be considered depending on the signs of side effects (Villafañe,
Valdes, Pedersini, & Berjano, 2019).
Patient safety
The emergency department is described as the provision of health and social support
services around the clock for those who may require unplanned or unscheduled urgent care,

CASE STUDIES 3
therapy, and advice. In elderly patients, multiple problems often arise following the diagnosis
and treatment of osteoarthritis. The fractured femur may also make the condition of Ms. Peters
more critical (Källberg, Ehrenberg, Florin, Östergren, & Göransson, 2017).
The studies of patient safety have established that elderly patients can be classified in the
high-risk category for adverse events. Often as emergency room users, they are susceptible to the
adverse consequences of overcrowding the emergency room (Lennox, Braaf, Smit, Cameron, &
Lowthian, 2019).
Prolonged stay in the emergency room increases the risk of adverse events in healthcare
centers. Prolonged stay in the emergency department reduces the acute care bed availability
while increasing the congestion of the emergency department (Eriksson, Gellerstedt, Hillerås, &
Craftman, 2018).
Even though the emergency department patients are already at risk due to a critical
illness, the patient's general physical and mental reserve can be reduced further by an extended
stay in the emergency room. This also increases the chance of an adverse event (Eriksson et al.,
2018; Huynh, Basic, Gonzales, & Shanley, 2018). The occurrence of an adverse event may be
related to conditions and factors in the emergency room. As the extreme effects of overcrowding
and congestion in the hospital emergency department grow, this issue should be seen as a reliable
and growing threat to patient safety.

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References
Chiarotto, A., Maxwell, L. J., Ostelo, R. W., Boers, M., Tugwell, P., & Terwee, C. B. (2019).
Measurement properties of visual analogue scale, numeric rating scale, and pain severity
subscale of the brief pain inventory in patients with low back pain: a systematic review.
The Journal of Pain, 20(3), 245-263.
Eriksson, J., Gellerstedt, L., Hillerås, P., & Craftman, Å. G. (2018). Registered nurses’
perceptions of safe care in overcrowded emergency departments. Journal of clinical
nursing, 27(5-6), e1061-e1067.
Glyn-Jones, S., Palmer, A., Agricola, R., Price, A., Vincent, T., Weinans, H., & Carr, A. (2015).
Osteoarthritis. The lancet, 386(9991), 376-387.
Huynh, E., Basic, D., Gonzales, R., & Shanley, C. (2018). Structured interdisciplinary bedside
rounds do not reduce length of hospital stay and 28-day re-admission rate among older
people hospitalised with acute illness: an Australian study. Australian Health Review,
41(6), 599-605.
Källberg, A.-S., Ehrenberg, A., Florin, J., Östergren, J., & Göransson, K. E. (2017). Physicians’
and nurses’ perceptions of patient safety risks in the emergency department. International
emergency nursing, 33, 14-19.
Lennox, A., Braaf, S., Smit, D. V., Cameron, P., & Lowthian, J. A. (2019). Caring for older
patients in the emergency department: Health professionals’ perspectives from Australia–
The Safe Elderly Emergency Discharge project. Emergency Medicine Australasia, 31(1),
83-89.

CASE STUDIES 5
Villafañe, J. H., Valdes, K., Pedersini, P., & Berjano, P. (2019). Osteoarthritis: a call for research
on central pain mechanism and personalized prevention strategies. Clinical
rheumatology, 38(2), 583-584.