Biophysical Aspects of Pharmacology - Essay Example

Introduction to Pharmacology Generally, patients having trouble eating and swallowing due to a neuromuscular disorder need to be cautioned in taking oral medications (McCance & Huether, 2009). Oral medications are usually small in size, thus increasing the risk of aspiration. If possible, the prescriber and the pharmacist need to be consulted to prescribe medications in their alternative forms other than oral administration. When the symptoms are eventually alleviated at a functional level, the prescribed drug therapy may be changed back to orally administered medications for home use (Lewis et al, 2007). Patient must be instructed on effective ways to prevent aspiration and promote safety during eating or taking oral medications. This would include careful placement of the medication on the buccal area of the oral cavity first before swallowing along with a thick fluid (Smeltzer & Bare, 2006). Meanwhile, the physician may prefer to insert a gastroscope to promote safety in the delivery of food and medications for patients who developed increased difficulty of swallowing. With the insertion of the tube, assessment must be carefully performed to ensure the correct placement of the tube and prevent accidental dislodgment. Specifically, placement of the tube can be checked by listening to a gurgling sound over the epigastric region of the abdomen while injecting a small amount of air into the tube. In addition, it might also be useful to aspirate a small amount of stomach content and test for pH. An acidic pH provides accurate information that the tube is in the stomach. Furthermore, abnormal breathing patterns suggest that the tube has been dislodged and is possibly blocking the airway. While the presence of any foreign material can be very uncomfortable, the tube should be remained in place unless the physician orders for its removal. Lastly, the assessment of drug allergies and adverse reactions remains an important part of management (Smeltzer & Bare, 2006). Biophysical Aspects of Pharmacology Practically, the health care professionals should take the subjective data from the patient as truth aside from considering the objective signs manifested by the patient (Ignatavicius & Workman, 2010). Thus, the patient really is experiencing pain at the moment. The patient’s report of pain should be the primary data to assess pain. This data would be further validated using an appropriate pain rating scale. Moreover, the patient’s behavioral manifestations can also be important factors in determining the patient’s pain tolerance. The medication chart should also be consulted to prevent over and under dosage of pain medications. In this case, the patient’s history of illicit drug use may have affected his response to pain medications. While relaxation and distraction techniques may facilitate relief, the physician must be consulted and informed about the patient’s response. The patient should not endure unnecessary pain due to under medication (Lewis et al., 2007). Patient Tyler’s manifestations indicate the presence of narcotic toxicity which includes decreased respiratory rate and deteriorating level of consciousness. As individual differences occur with response to narcotic administration, the adverse reaction may be due to over dosage. In contrast, the therapeutic dosage for patient Gordon may be higher because of his history of alcohol use. Research has confirmed that people with a history of alcohol use and abuse may require increased dosage of narcotics to achieve the desired effect (Craig & Stitzel, 1997). Drugs Affecting the Blood Abdominal pain, nausea, palpitations, and tachycardia are commonly observed with nitroprussides (Craig & Stitzel, 1997). When these symptoms are associated with very low blood pressure, the infusion may be put on hold to prevent dangerous hypoperfusion to the tissues and internal organs. With the achievement of the treatment goal, the infusion rate may be continued or an alternative long- acting antihypertensive is considered to maintain the therapeutic effect. The nurse needs to assess the client’s level of consciousness and vital signs (Lewis et al., 2007). The blood pressure monitoring is very important since nitroprussides cause systemic hypotension due to arterial and venous vasodilatation. The intravenous insertion site may show bright red blood than usual and the patient may experience dizziness and decreased level of consciousness as a result of hypoperfusion to the central nervous system. While this response is anticipated in patients taking nitroprussides because of the fast- acting vasoactivity of the drug, the nurse should take proper precautions in ensuring the safety of the patient. The patient should be secured to prevent falls (Smeltzer & Bare, 2006). Most importantly, the nurse should determine the possible lowest limit of blood pressure to prevent shock and other systemic adverse reactions. Drugs Affecting the Autonomic Nervous System Scopolamine transdermal patch, an anticholinergic medication, may be helpful to prevent motion sickness (Craig & Stitzel, 1997). While it may be reasonable for the nurse to consult with the physician about the possibility of prescribing the patch, it is important to consider that the drug may also cause adverse reactions such as dry mouth and arrhythmias in vulnerable individuals. Furthermore, the patient may actually experience drowsiness as a result of the anticholinergic effects of the drug (Lewis et al., 2007). In fact, these adverse reactions may be more troublesome than helpful for some people. Since there is a possibility that the patient will have to drive a car for the fishing trip, the nurse and physician must further evaluate the patient about safety issues. Otherwise, scopolamine transdermal patches may not be recommended this time. The eye problems experienced by the patient may be due to the mydriatic effects of the scopolamine patch (McCance & Huether, 2007). The resulting blurred vision and photosensitivity are very common with the use of anticholinergic drugs. Pupillary dilation increases the entry of light in the eyes which could have been normally controlled through ocular accommodation. Photosensitivity is also experienced as a consequence. Drugs Affecting the Central Nervous System The prn dosage of morphine must be given as ordered because the patient is having a severe pain as reflected on a 7 on a 1 to 10 visual analogue scale. Although morphine has traditionally been known as an addictive substance, the patient’s well- being should not be compromised by holding the dosage (Craig & Stitzel, 1997). Pain can be difficult to control at extreme levels. Legally, the drug may still be administered because of the standing order to administer morphine every 3 hours and prn or “as necessary”. Aside from administering the morphine, the nurse may also teach relaxation and distraction techniques to block the pain perception at the sensory level (Smeltzer & Bare, 2006). The respiratory status is the most important assessment data to be considered in this patient. Narcotics toxicity can be potentially dangerous because of respiratory depression which is noted as having a respiratory rate below 12 cycles per minute. When the respiratory rate falls below this critical point, the antidote for narcotics toxicity may be administered. Although rare, respiratory support may be needed in severe cases. Increasing the dose of morphine may not be recommended this time because the respiratory rate lies on the low critical limit (Lewis et al., 2007). Case study 1 References Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, P.G., Bucher, L. (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (7th ed). St. Louis: Mosby. McCance, K.L. & Huether, S.E. (2009). Pathophysiology: The biologic basis for disease in adults and children (6th ed). St. Louis: Mosby. Smeltzer, S.C. & Bare, B.G. (2006). Brunner and Suddarth's textbook of medical-surgical nursing (12th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Case study 2 References Craig, C.R. & Stitzel, R.E (1997). Modern Pharmacology with Clinical Applications (5th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Ignatavicius, D.D. & Workman, M.L. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed). St. Louis: Mosby. Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, P.G., Bucher, L. (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (7th ed). St. Louis: Mosby. Case study 3 References Craig, C.R. & Stitzel, R.E (1997). Modern Pharmacology with Clinical Applications (5th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, P.G., Bucher, L. (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (7th ed). St. Louis: Mosby. Smeltzer, S.C. & Bare, B.G. (2006). Brunner and Suddarth's textbook of medical-surgical nursing (12th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Case study 4 References Craig, C.R. & Stitzel, R.E (1997). Modern Pharmacology with Clinical Applications (5th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, P.G., Bucher, L. (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7th ed. St. Louis: Mosby. McCance, K.L. & Huether, S.E. (2009). Pathophysiology: The biologic basis for disease in adults and children (6th ed). St. Louis: Mosby. Case study 5 References Craig, C.R. & Stitzel, R.E (1997). Modern Pharmacology with Clinical Applications (5th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, P.G., Bucher, L. (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7th ed. St. Louis: Mosby. Smeltzer, S.C. & Bare, B.G. (2006). Brunner and Suddarth's textbook of medical-surgical nursing (12th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Read More