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Requirement
Need to answer the question based on the case study of Jordan.
Solution
Introduction
The given assignment is based upon a specific case study for exploring the responsibilities of nurses for Crhon’s disease and how the administration o pharmacological agents in a safe and effective procedure can affect the preoperative care of a patient.
Question 1
Jordan needs pethidine as prescribed by the gastroenterologist. But few responsibilities and rationales need to be followed when nurse is supposed to administer this particular medicine. Te rationales are to be considered prior to the administration, during it as well as after the administration. These responsibilities to be carried out on the part of the nurse allotted to Jordan are as follows:
Responsibilities Prior to Administration
The nurse must check whether the order as given by the registered medical practitioner is appropriately signed by him
The six rights of medicine administration must be checked prior to administering the medicine pethidine
Prior to administration of pethidine the nurse must consult with another registered nurse about the site and the dosage (Sandborn, 2010)
Jacob’s condition as documented in the patient record must be gone through by the nurse
The vital signs of Jacob should be checked
As Jacob is suffering severely, his level of consciousness must be taken into consideration also before pethidine is administered to him
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Responsibilities during Administration
A registered nurse except the one allotted for Jacob must be present while the pethidine is administered
The nurse must double check the dosage and administer it accordingly
Responsibilities after Administration
The vital signs of Jacob should be kept under monitoring
Pain levels as experienced by Jacob after 15 minutes of administering should also be monitored by the nurse
Nurse should check if any side effects and complication has arisen
The nurse must put on her record that administration has been done along the drug chart dedicated for Jacob
Adverse reactions in Jacob if any must be informed to the supervisor or the residential medical officer (Dignass, 2010)
The nurse must document the abnormalities in Jacob if any arises
Finally the nurse must enter the number of pethidine left in total in the ward stock book
Question 2
Jacob, identified with Crohn’s disease in his adolescence, is now subjected to severe ileal stricture and severe weight loss also. Both of these are contributed by the history of Chron’s disease. There are some structural and functional changes in Jacob that has further deteriorated his condition.
Jacob is faced with diarrhoea and vomiting. Diarrhea settles itself with watery stool along with which vital nutrients are lost from the body. On the other hand, Jacob experiences vomiting also, which is a reflux of the in-taken food items. This denotes failure of the body system to digest foods. These two particular effects of the disease are responsible for the weight loss in Jacob as these effects prevent the nutrients derived from the foods Jacob eat to get absorbed in his body and perform their functions in growth and development which in turn results in failure of Jacob to gain weight.
The stricture in Jacob’s ileum is an effect commonly seen in Crohn’s disease as contributed by the development of fibrosis in the elementary system. The small intestine is the most affected part in Crohn’s disease. In this disorder, the intestine becomes narrow due to the frequent oedema and spasms. The fibrosis gradually manifests itself as a luminal narrowing. The inflammation process also causes the narrowing of the intestine. All these complete the process of fibrosis formation which poses as the barrier in the ileum. Thus the stricture forms which currently Jacob has been identified with (Baumgart, 2012).
Question 3
The intravenous fluid prescribed to be administered to Jacob is the Hartmann’s Intravenous Infusion solution. It is a solution of sodium lactate. It also contains sodium and potassium chloride and calcium chloride dihydrate. It is a sterile and non-phylogenic solution. Water in this solution is the sole excipient ingredient. The fluid does not contain any buffer or other microbial agents. The Hartmann’s solution is an intravenous solution with isotonic property. Its pH belongs to the range of 5.0-7.0. The solution possesses osmolarity.
Administration of Hartmann’s fluid requires some rationale to be followed. These are as follows-
The package must be checked for proper and intact sealing and the fluid inside must be clear
Jacob must be checked for presence of lactic acidosis as this IVF is unsuitable for it
The channel used for infusion must not be used for sequential administration; instead it should be flushed in between with appropriate compatible fluid (Craven, 2012)
Dosage level must be checked and maintained as over or under dose might become fatal foe Jacob.
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The assignment successfully explores the principles of nursing care in reference to the case study. Rationale to be followed while administering drugs and taking care of patient taking into consideration the patient case history.
Reference
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Van Assche, G., Dignass, A., Reinisch, W., van der Woude, C. J., Sturm, A., De Vos, M., ... & Ardizzone, A. (2010). The second European evidence-based consensus on the diagnosis and management of Crohn's disease: special situations. Journal of Crohn's and Colitis
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Colombel, J. F., Sandborn, W. J., Reinisch, W., Mantzaris, G. J., Kornbluth, A., Rachmilewitz, D., ... & Tang, K. L. (2010). Infliximab, azathioprine, or combination therapy for Crohn's disease. New England Journal of Medicine
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Baumgart, D. C., & Sandborn, W. J. (2012). Crohn's disease. The Lancet
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Baert, F., Moortgat, L., Van Assche, G., Caenepeel, P., Vergauwe, P., De Vos, M., ... & D'Haens, G. (2010). Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology
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Craven, M., Egan, C. E., Dowd, S. E., McDonough, S. P., Dogan, B., Denkers, E. Y., ... & Simpson, K. W. (2012). Inflammation drives dysbiosis and bacterial invasion in murine models of ileal Crohn’s disease. PLoS One
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