Pharmacology

Pharmacology

Instructions
For each topic, you are required to write 500 – 600 words (+/- 10%).
Each topic is an individual topic and needs to adhere to the stipulated word count (500-600 words). The total word count for all three topics: 1500-1800 words (+/- 10%). • In-text referencing is excluded in the word count.
• Academic essay format is required which includes an introduction and conclusion for each topic you select which is included in the word count. As each topic is 500 – 600 words, a general rule of no more than 10% of the total word count should apply to these (50-60 words). For help with
• APA referencing is required (please click this link to access the APA abridged guide available via this link or on the course Moodle site under the ‘Assessment’ tab). Please note that referencing is worth 15% of your overall mark for this assessment.

Topic 1:
Read the clinical summary found regarding the case study originating from a coronal inquest. Write 500-600 words addressing the following questions:
a) Discuss and describe the type of medication error that occurred in this scenario.
b) The Director of Medical Services gave evidence that a number of measures had been implemented following an investigation using a root cause analysis of this incident.
Discuss 1 (one) or 2 (two) safety measures that you feel would have been implemented to minimise the risk of such an error in drug administration occurring again.

CLINICAL SUMMARY
Mrs C was a 69-year-old female with a complex medical history of stroke with a residual left side weakness and ongoing risk of aspiration, atrial fibrillation, and insulin-dependent diabetes mellitus. She was more recently diagnosed with a suspected left ear tumour. Mrs C had a planned admission to a metropolitan hospital for a biopsy.
Mrs C was commenced on oral antibiotics (ciprofloxacin) after the biopsy results suggested an infection. One day after the procedure, her oxygen saturation levels dropped and staff suspected she had aspirated. A nasogastric tube (NGT) was inserted but was pulled out by Mrs C a day later. Despite advice from healthcare professionals about the risk of further aspiration and sub-optimal oral nutrition, neither Mrs C nor her immediate family would consent to the reinsertion of a NGT.
Three days later, following another episode where Mrs C’s oxygen saturation levels dropped, x-rays showed acute pulmonary oedema with right lower lobe consolidation and an ECG demonstrated Mrs C had rapid atrial fibrillation. For these reasons, Mrs C was transferred to the Intensive Care Unit (ICU), where a NGT was re-inserted.
The nurse-in-charge (NIC) left instructions that Mrs C’s oral ciprofloxacin ought to be crushed and administered through the NGT tube. Later that same evening, blood tests were required, and the nursing staff realised that Mrs C’s evening medications, including the oral ciprofloxacin and intravenous frusemide, had not yet been administered.
The nurse (RN. R) looking after Mrs C was asked to take the bloods via a peripherally inserted central catheter (PICC), and to administer the medications. As she had not had prior experience of PICC lines, she was supervised by another nurse (RN. C). RN. R was instructed to crush the ciprofloxacin to enable NGT administration, but then drew the paste into a standard sized non-luer lock syringe even though she intended to administer the medication via the NGT, which required a larger nozzle. RN. C drew up the frusemide and both medications were placed into a kidney dish. At the bedside, RN. R took blood from the PICC line, and administered the intravenous frusemide. The NIC was present at the time, attending to Mrs C’s NGT feeding. The NIC informed RN. R that medications administered via a PICC needed to be drawn up in a luer lock syringe. RN. R returned to the drug room and transferred the crushed up ciprofloxacin into a luer lock syringe, injecting it into the PICC line.
A short time later, Mrs C became cyanosed and hypoxaemic, then unresponsive. Since Mrs C was subject to a NFR (not for resuscitation) order, a code blue was not called. She was pronounced deceased soon after.
Topic 2
Understanding pharmacokinetics (PK) is important for safety administrating medications to patients. However the PK of drugs are altered by age i.e. in the elderly population group, when compared to adults.
Discuss PK i.e. absorption, distribution, metabolism and excretion that includes one aspect (for each part) that differs in the elderly in comparison to adults. Include in your discussion at least 2 (two) to 3 nursing implications/interventions to ensure safety in administering medications to this population group.

Topic 3
After reading the case study below, discuss in your answer, the questions that follow.
Case Study:
Mr. Benjamin Brown is a 16 year old male who has been admitted to hospital with a diagnosis of new–onset diabetes. His initial symptoms prior to his admission included a 10kg weight loss over the past few weeks, nausea, increased thirst and urination. He is stabilized, then placed initially on regular insulin – Humulin R.
Provide a discussion, with reference to Mr. Brown, that includes the following:
a) Discuss the pathophysiology of Type 1 Diabetes (T1DM) vs Type 2 Diabetes (T2DM).
b) State which type of diabetes (T1DM or T2DM) Mr. Brown has most likely been diagnosed with and why. Explain the rationale for why insulin is prescribed as the preferred medication to treat his diabetes.
c) Describe the mechanism of action of insulin prescribed for Mr Benjamin Brown.
d) Discuss considerations the nurse may need to be aware of when insulin is ordered and/or administered.

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