The researcher is an advanced nursing degree student with the adequate professional background. Being an international student; he has significant exposure to the real-life working environment having years of experience in working in the emergency department. The student worked in the emergency department back in his country where he had significant exposure to handling patients (including children) in critical condition requiring emergency care. As such, the student has experience working with the sickle cell pediatric patients, giving him the appropriate professional background to handle the case at hand. Having practiced nursing, and currently undergoing an advanced nursing degree, the patient has the required medical knowledge to understand the lab results, assess the condition of the patient, identify the best drug combination that is suitable for the patient, and understand the effects and implications of the administered drugs to the patients health and wellbeing (Mankad, 2001).
Case Analysis (Outline of chosen patient's history, assessment findings, and, diagnosis)
This is a pediatric case of a six years old boy with sickle cell anemia, an inherited blood chronic disorder, where the red blood cells (RBC) produced by the body are abnormally shaped causing RBC clumps and inadequate supply of oxygen in some parts of the body. The patient is currently on folic acid and Ospen (penicillin prophylaxis) prescription. Research shows that children with sickle cell anemia are at high risk of being infected with a life-threatening pneumococcal infection that increases the risk of mortality for this population (Pathare et al., 2003). As such, penicillin prophylaxis is prescribed as per the recommendation of the American Academy of Pediatrics (AAP) for the prevention of pneumococcal infection. The recommended dosage for the six years old is penicillin V potassium 250 mg administered two times a day. The administration of penicillin prophylaxis indicates that the patient is not allergic to penicillin, otherwise, he would have been prescribed for erythromycin 250 mg administered twice daily as an alternative drug to penicillin. Folic acid was administered to ensure adequate serum and erythrocyte foliate levels among children with sickle cell anemia. Research shows that significant clinical foliate deficiency is common among the population of children with sickle cell anemia, necessitating adequate dietary intake of foliates which is mostly provided by the folic supplements provided by the folic acid prescription. As such, the foliates intake is increased because of increased erythropoiesis among the population of sickle cell anemia patients (Wang et al., 2011).
The patient complained of lower back pain that was initially localized but has acquired progressive traits in the last 24 hours. The pain was described as an on-and-off symptoms that recurred every 2 to four months. The severe pains are significant symptoms of the sickle cell disease termed as sickle cell crisis. The sickle cell crisis is a characteristic pain attack that can quickly progress to a life-threatening situation. However, uncomplicated pain episodes are managed at home efficiently, as in the case of the patient, ibuprofen and comfort measure (warm compression) were applied at home without success. In the instance when home management fails it is crucial the patient should be taken to the hospital and, a full physical assessment is conducted through a rapid triage procedure (Raphael et al., 2011). In this case, the patient was presented in the ER where he received a comprehensive physical assessment. The examination revealed that the boy had normal heart rate, blood pressure, normal breathing and lung functionality, normal cardiovascular traits, but his hemoglobin level had dropped from 8 to 7.8. The observed hemoglobin level was expected as the levels tend to drop during pain episodes. The pain must be managed rapidly to reduce the risk of life-threatening complications. The administration of morphine for pain management was the optimal clinical process for this case, as the major problem was the pain that was not backed by any underlying condition or complication.
The 100 beat/per minute is considered a normal heart rate for a six years old child, as it falls within the 75 to 115 beat per minute bracket. Moreover, a body temperature of 37.1C is also optimal. The cardiovascular results exhibiting absence of heart murmur show that the heart valves function normally, and clear and equal entry of air in lungs show the absence of chest infection. The general tenderness at the back and lower limbs with the absence of swelling and redness show that there is no physical inflicted injury, as the pain experienced is likely due to the sickle cell crisis expressed through pain episode. The RBCP of 3.2 is slightly below the 4.7 to 6.1 bracket, and the mean corpuscular hemoglobin of 23 indicates that there is a significantly low mass of hemoglobin in every RBC in the drawn blood sample, though it is also expected in the individuals with sickle cell disease. However, the case analysis indicated that apart from the pain, the boy was in a health state considering his condition, necessitating no further drug prescription for the management of the disease apart from non-pharmacologic comfort-based intervention deemed efficient in enhancing blood flow and limiting the occurrence and impacts of the attacks (Wills et al., 2010).
Documentation of Intervention and the Rationale for the Pharmacological and Non-Pharmacological Therapies
Pharmacological Therapy Option
Morphine infusion 10mcg /kg/hour was administered for pain relief. The diagnosis revealed that the patient was in progressive pain and a means to elevate the pain was necessary for mitigating the development of pain-related complications. Given that pain control is a basic procedure in containing sickle cell crisis, the IV infusion of the drug directly into the blood vessel of patients provides an immediate effect in pain relief. The physiological and pathological processes of the drug are based on its metabolic processes occurs through the conjugation with glucuronic acid, a process aided by the enzyme uridine diphosphate glucuronosyltransferase 2B7. The process leads to the formation of morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). Given that M6G is an active form of morphine, it exhibits high analgesia contribution that binds to m-opioid receptors those results in the effective pain relief process (Pack-Mabien & Haynes, 2009).
The administration of IV fluids maintenance and half D5% + 0.45 normal saline is necessary for maintaining hydration. The hydration helps in removing clogs in the blood vessels that causes sickle cell crisis. The use of the 0.45 normal saline solution is a hypotonic solution that encourages osmosis such that water flows from the nearby cells into the blood vessels. The progressive pain in the back means that the complications from the on-and-off localized pain are developing due to a prolonged state of vessel blockage that limits the oxygen supply in the surrounding cells. As such, hydration becomes one of the emergency procedures for ensuring that the clogged cells are disc logged and that blood can flow freely in the vessels. However, the IV fluid maintenance approach is advisable among patients in critical condition, mostly the ones who are considered unable to drink the extra fluid, in which case, the patient should have been given fluids to drink as opposed to the drip (Riker & Fraser, 2005).
The administration of morphine is likely to cause a serious case of constipation, which are the main side effects of morphine. In the case of a child with the sickle cell disease, the constipation is associated with the accumulation of the morphine metabolites which may results in life-threatening complications such as renal failure. As such, the administration of Lactulose 10 ml three times daily is a necessary precaution in avoiding constipation. The active ingredient of the drug is lactose that promotes osmosis such that water is drawn in the intestines promoting bowel movement. The improved bowel movement is achieved through increased peristalsis and the increase in the fecal bulk. The colon bacteria break the lactose into acetic and lactic acids that result in improved peristalsis. The whole process is complete within a two-day period (Dean et al., 2003).
Non-Pharmacological Therapy Option
Several non-pharmacological interventions are applied to mitigate the pain caused by the attacks. The prescribed therapies entail heat treatment using heating pads, hot showers and bath, massage, guided imagery, and distraction. The non-pharmacological approaches take the sensory-therapy approaches that apply the required pressure, heat, and tension-release techniques to pressure points and the affected region in a bid to stimulate the pain-relieving property on the sensory system. Moreover, the techniques elevate stress that aggravates the pain effect of the sickle cell attacks (Platt et al., 2016). In most cases, patients experience a high level of stress and anxiety during the pain episodes. Such state of mind makes it difficult to control the pain and may facilitate the development of a complication. The comfort based treatment provided by the non-pharmacological therapy provides tension and stress relieving property that forms the best psychological and emotional state for the patient to respond well to medicine.
The massage and the heat treatment using the heating pads are carried out by skilled practitioners. The results of these strategies are supported by scientific evidence as heat treatment results in expansion of the blood vessels and the fluids resulting in an improved flow of blood and unclogging of cells. The unclogging of the red blood cells results in immediate pain-relieving effect as the clogging is the primary cause of the pain episodes. Additionally, the improved blood flow results in optimal oxygen supply to the body tissue resulting in significant health improvement. Moreover, the masseuse applies the right degree of pressure on identified pressure points which alleviates the tension causing the pain, and also facilitate blood flow (Sesso et al., 1998).
The distraction approach is effective in warding off fear and eliminating the obsession with pain. Since fear increases the impact of pain, distraction through entertainment is beneficial, as the child may be engaged in video games among other favorite activities that demand high concentration. Moreover, the application of non-pharmacological therapies teaches the patient coping strategies as they realize that they do not necessarily need medication to feel recover from chronic pain. Such an attitude gives the patient hope as they believe that their health condition is not as serious as it can easily be managed by non-pharmacological strategies. The use of guided imagery helps the practitioners to understand the exact physical area that needs attention. Such a technique is used to apply the right kind of intervention on the right place for optimal results. Non-pharmacological options are adopted for pain management and pain control in reducing the frequency of the attacks and the pain degree. Moreover, they increase the response to pharmacological pain relieving techniques. Adoption of non-pharmacological therapy options improves the quality of life of patient and enhances patients outcome in the management of the disease (Sinatra, 2009).
The Pharmacokinetics, Pharmacodynamics, and Formulation of Prescribed Medications
Morphine infusion 10mcg /kg / hour for pain relief
A critical look of the pharmacokinetics and pharmacodynamics mechanism of the administered medication administered is vital in the ass...
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