Nursing Response to Suspected Excessive opioid Overdose in Palliative Care Patient - Research Paper Example

? Nursing Response to Suspected Excessive opioid Overdose in Palliative Care Patient and number: submitted Flowchart for Nursing Response to Suspected Excessive opioid Overdose in Palliative Care Patient NO L 1 YES L 2 YES Most patient outcome is highly connected to the competence of nurses. In practice, the method of assessing the quality of nursing care is difficult and complicated as it rely not only on the skills and practices of the nurse as an individual, but also on specialized and administrative structure that is practiced within. For this reason, professionals have implemented more technology in health care field for efficacy in different departments (Vimont, 2012). In this scenario, we study some of the technologies that have been included in the emergency room. The paper focuses on Emergency Severity Index (ESI); a triage tool used by health care providers in the emergency department. ESL algorithm produces fast, reproducible, and clinically stratification of patients into five steps. It is better to operationalize a case scenario to demonstrate health flow use of ESI. Consider the case scenario represented in the flowchart above, The patient is Opioid overdosed and is admitted into the ER. For the ER staff to assist the patient they will have to create an ESL module that will facilitate the optimal care of the patient (Vimont, 2012). ER staff initiates the drafting of the flow chart above using ESI triage tool. The tool aide the staff to formulate a sequence of analytical steps to assist the patient. ESI triage tool groups patients into five categories 1= most serious and 5= less serious. ESI postulate a method of classifying patients in ER by both resource needs and acute. ESI in the ER is to prioritize all incoming patients to denote those who can not wait to be seen. The staff in ER perform a quick, determined assessment, and assigns the patient a triage level, which is the key measure of how much longer a patient can safely hold on before treatment (Nielsen, Siersma, Nielsen, and Rasmussen, 2012). For decision section A, in the flowchart above the triage staff asks, “does the patient need instant life saving interventions?” If the answer was positive then the triage progress could have finished, and the patient could have been categorized as ESI level 1. However, in this case the answer was negative and the triage process was moved to decision section B. Decision section B, the triage staff, decides whether the patient can safely wait or can not to be given medical attention. If the patient is not able to hold on then the process is moved to decision section C. However, in this scenario, the patient can not wait much longer and thus the patient is categorized as ESI level 2. In ESI level 2, Three chief question are put into consideration. These questions are: (1) Is the patient in serious risk situation? (2) Is the patient disoriented? (3) Is the patient in serious distress? The triage healthcare provider obtains patient subjective and objective assessment to respond to these questions. From the short and quick interview, gross examination, and the six sense from the triage, healthcare provider in ER identifies the patient to be at high risk (Nielsen, Siersma, Nielsen, and Rasmussen, 2012). In ESI sub level1a above, the healthcare provider perform the assessment of the patient. It is extremely complicating and of high risk when taking care of a patient under the overdose of the opioid. The triage healthcare provider has the responsibility of assessing the patient for any suspicion of the narcotic overdose. Some of the symptoms for a suspected opioid overdose the staff comes up with in this case are; slowing level of consciousness, low respiratory rate, decrease of the pupils in size, and poorly reactive pupils. Overdose of Opioid weakens the respiratory and the CNA. In the flowchart above the second step, ESI sub-level 2b, is the stimulation of the patient, it clearly suggest the patient to be stimulated by administering oxygen 51/min nasal prongs if available (Nielsen, Siersma, Nielsen, and Rasmussen, 2012). Supportive ventilation often is sufficient to save a life of the patient overdosed with opioid. Application of ventilator support to an overdosed patient is the most vital intervention that can be provided by healthcare providers. This lessens the likelihood of precipitation of severe lung injury. The nurse should count the respiratory rate per minute unless patient’s (RR) is extremely depressed (Keohane, Bane, Featherstone, Hayes, Hurley, Bates, Gandhi, Poon, and Woolf S, 2008). Third step is ESI sub-level 2c, the administration of the medicine to the patient. From the existing literature, patient with suspected Opioid overdosed should be treated with naloxone. Naloxone is Opioid antagonist and should be the refurbishment of sufficient spontaneous ventilation. If the patient’s (RR) is less than 5/min, the triage staff/healthcare provider should stop any ongoing opioid administration e.g. discontinues any infusion; take out Duragesic patches and wipe skin clean. The ER healthcare providers should administer naloxone (Narcan) 1 ml (0.4 mg) IV stat. The nurse should repeat naloxone 1 ml (0.4) IV/SQ q 2-3 min until the patient rouses, and the respiratory rate is more than 1o/min. If the patient's respiratory rate is 5-7/min the healthcare provider has the responsibility to stop any ongoing administration of the opioid (e.g., discontinuing of infusion; removing of Duragesic patches and wipe the skin clean) (Vimont, 2012). The triage healthcare provider should dilute naloxone (Narcan) 1,01 in Normal Saline by drawing up 1 ml (0.4) mg into 10 ml syringe and adding 9 ml sterile NS. Next the triage healthcare provider, is to administer 1 ml of the of the 0.04 mg/ml naloxone dilute STST IV/SQ and call the MD. The administration of naloxone 1 ml should be repeated q 2-3 min until the patient rouses and RR>10/min (Vimont, 2012). The last step, sub-level 2d is progressive checkup of the patient. Most patients with respiratory rate of 8-10/min easily get back their consciousness by application of oxygen. It is advisable, to give multiple doses of naloxone or contact MD if the patient does not recover. In addition, if the patient get their consciousness back and have RR>10, it is recommended that the nurse to notify and bring in MD to review and consider other option (Vimont, 2012). Naloxone produces no clinical effects when administered even in large doses to non-opioid. Naloxone safety profile is extraordinarily high especially when used in small doses. Patient with habit of overusing naloxone they can be encouraged to withdraw. Even though, it hardly life-threatening, patient reaction may be unpredictable and opioid withdrawal can be extremely damaging for both the patient and staff. Estimation of time on, how long the patient can wait to get medical attention is an element of most triage system at the present time. Most triage system necessitates patients to be attended to by healthcare providers within a certain amount of time duration. ESI do not specify time standards that patients should be given medical attentions. Though, patient who meet the requirements for ESI level 2 should be seen as quickly as possible. In conclusion, it is vital to identify the workflow in ER can be extended further to achieve functionality that is not addressed by the external presentations included in the above levels. This can be postulated by programming new external application of certain problem. This new application may offer: (1) easy access to legacy systems within various representations. (2) Communication to exterior web services. (3) And offer an interface to innovative analytical factors Reference Keohane A. C., Bane D. A., Featherstone E., Hayes J., Hurley A., Bates B. W, Gandhi K. T., Poon G. E., and Woolf S. (2008). Quantifying Nursing Workflow in Medication Administration. Journal of nursing administration, 38(1), 19-26 Nielsen SL, Siersma V, Nielsen K, and Rasmussen LS. (2012)Treatment of opioid toxicity in physician-based hospital. Resuscitation, 82(11), 1410-3 Vimont C. (2012). Opioid Overdose Prevention and Treatment. Retrieved from: http://www.drugfree.org Read More