Nursing Clinical Dosage Calculations - Click to Free Sample

Answer:

Introduction

This assignment is focused on the case study of a 32 years old male Malcolm Jones, who has undergone a surgery for inguinal hernia. After his surgery, the nurse has to document all of his vital signs as the part of post-operative management of the patient. Based on the post-operative documentation, the discharge planning of the patient is done. As pain is a common symptom after surgeries, pain assessment and management of the patient would be discussed here, along with the discharge panning and nursing documentation (King & Hawley, 2012).

Pain assessment

There are a number of pain assessment tools available for post-operative purposes. In this assignment, the visual analogue scale would be used for assessing Mr. Jones pain, as the nurse addressed an abdominal pain during the most recent postoperative assessment of Mr. Jones. In this condition, Mr. Jones will be assessed through the most common pain scale used for post-operative patients, the Visual analogue scale (VAS). In the process of assessment, the nurse has to ask questions related to the abdominal pain of Mr. Jones and records his answers, which is then assessed through the pain assessment instrument (Berman et al., 2015). The instrument include 0 (no pain) to 10 (worst pain) range. The psychometric response scale will collect data related to Mr. Jone’s severity of pain. The nurse would ask him such questions that can depict his level of pain, based on which, the intervention would be undertaken.

Figure: Visual analogue scale

(Source: Brotto & Rafferty, 2016)

According to Tiziani (2013) the continuous or “analogue” aspect of the VAS pain assessment tool makes it superior from the discrete scales, like Likert scale. Several evidences show that visual analogue scales include better metrical characteristics compared to the discrete scales, which helps to apply diverse range of statistical methods to the measurements. It has also been revealed that the sensitivity and reproducibility of VAS is somewhat superior to the others linear pain assessment scales (Daly, Speedy & Jackson, 2014). Thus, VAS is suitable for assessing Mr. Jone’s pain.

Pain management

The nurse found that in Mr. Jone’s medication chart, there were a valid order for paracetamol tablets 500mg to 1000 mg orally every 6 hours. Paracetamol is classified as the pain reliever and fever reducer. It is widely used post operatively for reducing pain. The dosage of the medication is decided based on the level of pain, the patient is experiencing. Before, administering the drug, the nurse calculated the required dosage for the patient. In this context, based on his severe pain, the nurse decided to administer 1000mg/dose in every 6 hours (Tiziani, 2013). As the patient had no history of alcoholism or liver disease, thus, it was safe to administer the highest dose of the pain reliever medication.

The first safety issue of administering paracetamol is giving the correct dose to the patient. As the nurse is going to administer the highest dose, it should be ensured that not more than 1000mg is administered to the patient, because it can have adverse effect. As the cupboard is a stock of 500 mg tablets, the nurse would give 2 tablets to the patient (500 X 2 =1000 mg/per dose) (Gatford & Phillips, 2011). Another safety issue for administering this medication to Mr. Jones is his previous history of allergy. In some cases, paracetamol can worsen the allergetic reactions. Thus, before administering, the nurse should consult with doctor about the dosage. The legal precautions that the nurse should undertake are, collecting informed consent from the patient and completing the discharge form with correct information.

Discharge planning

The patient is fit and well now for being discharged. His postoperative vital signs have been taken within four hours of his discharge and the vital signs showed no serious complication. The wound area has been assessed by the surgical specialist and has reported absence of infection and signs of recovery. The patient is able to eat, drink and ambulate, as desired. The patient and his family have been discussed about the entire special requirement for his faster recovery. Mr. Jones has been recommended not to lift heavy weight, more than 15kg. He can return to his work after at least two weeks and until then he should take enough rest. The patient and his family have gone through a session related to his awareness about hernia prevention in future (Brotto & Rafferty, 2016). An appointment was made for him after two weeks for a wound check with Dr. William. 

Nursing documentation

After assessing all the information, it has been revealed that the patient experienced no severe post-operative complications. The patient was admitted with a surgical emergency related to inguinal hernia. IN spite of having allergy to penicillin and GORD, the patient did not have severe medical history. The nurse before the surgery ensured his physical stability along with the assurance that the patient did not consumed food or any drink since last night. After the successful operation, the patient was transferred to the surgical ward. The postoperative assessment revealed that the patient was able to eat, drink and ambulate. To reduce pain, analgesia was ordered (Tollefson & Hillman, 2016). However, the patient informed an abdominal pain during the post-operative assessment. To measure the intensity of his pain, the nurse used the VAS pain assessment tool and based on the pain severity, the nurse administered 1000mg paracetamol. Before discharge, the nurse assessed all the vital signs and the surgical site for the presence of infection or any kinds of abnormalities. The patient was released with proper discharge documentation. Based on his post-operative status, he and his family was advised to reduce work load (Hayley, 2013). He was also prescribed not to lift heavy things for next 6 weeks. Follow up schedule was also provided.

Conclusion

Here, the post-operative nursing care was discussed with a special focus on the 32 years old patient Mr. Jones. The nurse completed all the assessment procedures very carefully, to avoid any kinds of miscommunication or errors. Before discharge, the medical team assessed whether Mr. Jones is fit for leaving the hospital or not and based on his status, the discharge planning was done.

Reference List

Berman, A., Snyder, S., Levett-Jones, T., Dwyer, T., Hales, M.....Stanley, D. (2015) Kozier & Erb's Fundamentals of Nursing (3rd Australian ed). Melbourne: Pearson education. 

Brotto, V., & Rafferty, K. (2016). Clinical Dosage calculations for Australia and New Zealand (2nd ed). Sydney: Cengage Learning. 

Daly, J., Speedy, S. & Jackson, D. (2014) Contexts of nursing, preparing for professional practice. (4th ed): Sydney: Elsevier. 

Gatford, J. & Phillips, N. (2011) Nursing calculations. (8th ed). Sydney: Elsevier. 

Hayley, C. (2013) Pilitteris child and family health nursing in Australia and New Zealand. Sydney: Lippincott Wilkins& Williams

King, J.K., & Hawley, R. (2012). Australian Nurses' Dictionary (6th ed.). Sydney: Elsevier. 

Tiziani, A.P. (2013). Harvard’s nursing guide to drugs (9th ed). Chatswood: Elsevier Australia. 

Tollefson, J. & Hillman, E. (2016). Clinical Psychomotor Skills: Assessment Tools for Nurses. (6th ed). Australia: Cengage.