Morphine is a widely known drug that is administered into a patient’s body for the purposes numbing the pain. In other terms, these can be said to be painkillers that are widely used in hospitals and other health clinics. Usually, the medication is used for the treatment of severe pain and belongs to a class of drugs that are known as opioid (narcotic) analgesics. It has the ability to alter brain signals and make the person upon which the drug is administered feel and respond differently to pain. Usually, the given medication is administered into the patient’s body injected via his vein, a muscle, or is injected under the skin.
There is another category of morphine, which is preservative-free, which may be injected into the area around the spinal cord, also termed as epidural by a doctor. The substance can also be administered into the fluid-filled space that contains the spinal cord, also known as intrathecal. The method of administering the dosage is usually done in hospitals under close observation, which can be later told to use at home as well according to the medical case.
In the given case study, William Tran is a man who is 33 years old and admitted to the surgical ward. During the period of admission, it was seen that he has a past history of Crohn’s disease. He has been prescribed Prednisolone, Metronidazole, and Balsalazide. In addition, narcotic analgesia infusion is being administered on him by the doctors. The continuous infusion rate was 3 ml per hour, along with an analgesia demand dose of 2 mg that is patient-controlled. Before being transferred to the ward, he had been prescribed and administered a loading dose of intravenous morphine (5 mg).
Pathophysiology of acute pain generally occurs in response to injury of tissue. It results from the peripheral pain receptors when being activated. If to be told in a more specific way, specific A-delta and C sensory nerve fibres, also known as nociceptors, are associated with the peripheral pain receptors (Bron et al., 2017).
Chronic pain is related to on-going tissue injury, which is caused by the activation of these fibres persistently. It is not always necessary to judge the severity of chronic or acute pain by determining the severity of tissue injury. It is also possible for chronic pain to arise due to on-going damage to or malfunction of the central or peripheral nervous system. The pain caused due to this is known as neuropathic pain (Heymsfield & Wadden, 2017).
There is an endogenous analgesic system in the body that is responsible for preventing excess amounts of pain from interfering with normal body functions. The dorsal horn of the spinal cord is responsible for the pain sensations, and the pain fibres are located in it. The primary pain fibres transmit the pain sensations from the periphery, synapse with the help of neurons, which further transmits the pain to higher sections (Schwartz & Henry, 2019).
Administering an opiate drug like morphine can interact with opioid receptors. This helps to produce analgesia utilizing a similar mechanism as that of encephalin. In other terms, it can be said that hyperpolarization of interneurons and depressing the release of transmitters that are responsible for pain transmission. Additionally, morphine can also interact with opioid receptors that are located in the supraspinal skeletons and activate the system. They also have the capability of production of analgesia. It has been seen that morphine interacts with the adrenergic system in order to come up with analgesia (McCance & Huether, 2018).
At the site of injury, tissue damage occurs that releases biochemical substances, which lead to neurochemical reactions. The reaction is responsible for stimulating the free nerve endings of the nociceptors. It then initiates an impulse of the nerve of the sensory neurons. Anterograde axonal conduction is responsible for conducting the impulse via the spinal cord and synapses with the neurons in the upper motor.
Discuss THREE types of nursing assessments in order of priority that would be appropriate for Tran's deterioration (excluding vital signs) and provide a description of each of these in the context of Tran's complaint with rationale as to why these would be your priority.
Nursing assessment refers to the process of gathering and collecting information about a patient's physiological, physiological, spiritual, and sociological status by a nurse who is licensed and registered. It is considered as the initial step in the process of nursing, and a nursing assessment section might be delegated to certified nurses’ aides (Rennke & Denker, 2019).
The initial assessment, which is also known as triage, provides aid to identify the nature of the problem and prepare the procedures in order to ensure stages of the assessment. The initial assessments are carried out much more thoroughly than the other nursing assessments. The components of the initial assessment may include getting a patient's medical history or making him undergo a physical exam (Huether & McCance, 2016). A psychosocial assessment might be carried out, that may be effective for a mental health patient.
It is considered as a stage where the problem gets exposed and is treated. They are monitored continuously during the entire process of assessment due to their ever-changing nature and the importance of vital signs. Initial treatment for pain and long-term treatment for the malady’s root cause is monitored after being administered, that can solely depend on the malady.
A nurse has to identify the root causes of the concern in a rapid and careful way during emergency procedures. She has to assess the airway, breathing, and circulation (ABCs) of the diagnosed patient. An emergency assessment can be turned into a focused or initial assessment once the perspectives of ABCs are stabilized.
After judging the patient conditions and medical facts, it can be said that focused assessment is best suited for the case study (Pelliccia et al., 2017).
Acute pain can be referred as a type of pain, which lasts more than 3 to 6 months, or it can be referred as a pain, which is directly related to some of the pain in soft tissue damage like a sprained ankle or have a paper cut. However, it has gone away when there will be no underlying cause for the pain (Goadsby et al., 2017). The nursing diagnosis of acute pain can be referred to as unpleasant sensory as well as an emotional experience that arises from actual or potential tissue damage. Moreover, describe in terms of such damage there will be a slow onset related to the intensity of the pain that can be mild to serve as well as it can be anticipated or predictable, as it will end in the duration of fewer than six months. This is one of the most unpleasant pains, which are highly subjective in the mature, and the patient can experience it (Donath, Meier & Böni-Schnetzler, 2019). This kind of pain can be served as a protective function, which will make the patient informed as well as knowledgeable, related to the presence of any pain. According to the case study, Willam Tran was admitted due to the formation of the temporary ileostomy. There are some of the intervention, which can be provided to Tran, related to the acute pain which has been mentioned below:
The proper nursing assessment related to acute pain, which is imperative, related to the development of an effective pain management plan. Moreover, the nurse can play an important role in the assessment of the pain (Iwakiri & Groszmann, 2020).
Intervention: First Intervention of Acute Pain will be foreseeing the need for pain relief.
Rationale: To prevent pain is one thing, and by early intervention, which may decrease, the total amount related to analgesia is required.
Intervention: It is required to acknowledge the reports related to the pain immediately.
Rationale: It is required to have an immediate response to the report related to pain, which may decrease anxiety among the patient. Moreover, the main concern for patient welfare as well as comfort that will foster the development related to the trust relationship.
Pharmacological methods: Use of Local anaesthetic agents will help the patient because it will reduce the pain by blocking the transmission and it will be used for the pain in the specific areas related to the distribution of nerves. Moreover, Nonopioids, which is a no selective NSAID that will work in the peripheral tissues and somehow it blocks the synthesis of the prostaglandins that can stimulate the nociceptors.
Morphine can be considered as the golden standard related to the analgesic to manage the pain in humans unless it provides any contradiction (Gotts & Matthay, 2016). One of the route related to the administration in the oral is related to the convenience as well as it will be painless. However, it is required to provide morphine with an injection if the oral route has been contraindicated. It has been seen that the intermittent IV morphine will be given as the IV morphine APP on the wards at starship. Moreover, it allows small blouses related to morphine need to be administrated in every 5 minutes to understand the effect of the medicine.
Administration: All the registered nursing staff that has completed their intravenous administration competency as well as they have attended the pain study of administrator IV morphine APP. The syringe of IV morphine APP has to be prepared by the registered nurses. Moreover, medication has been additive level should be implemented in the syringe with the details of the medication in which date, time and the signatures of the nurses have to be implemented. Registered nurses should administer the first dose in proper attendance that will be followed by the medication administration guideline (Francis & Tang, 2019). All the subsequent dozers should be monitored and administered by either the registered nurses who have prepared those syringes.
Benefits: Morphine can be considered as one of the classic opioid analgesics as compared to other painkillers that can be considered. There are some other painkillers which are available at the market. However, one of the benefits of this medicine is that it has effects by binding the mu-opioid receptors within the central nervous system. One of the effects related to morphine is that they activate the inhibition of nociceptive inhibitory pathways related to CNS.
Risk: There are some of the risk related to morphine as it has some of the side effects of medications such as NauseaNausea, vomiting as well as increased sweating. Risk can be more if the monitoring will be less (Drossman, 2016).
Contradiction: Morphine is one of the useful medications that can be used in acute pain. However, there are some specific situations where medicine can be strongly contradicted. That is why it is required to take extreme caution with severe cases of respiratory depression are some of the cases that have been found while using this medicine. In the case of hypersensitivity reaction morphine should be avoided and it should be immediately discontinued if there is a presence of active reaction.
There are some unwanted effects related to the use of morphine like constipation. It can occur via stimulation of Mu of- opioid receptors that can turn inhibit gastric emptying as well as it will reduce the peristalsis (Almeida et al., 2017). There are some Other Side Effects that can be seen among the patients like William; this side effects will include the central nervous system depression, NauseaNausea, urinary retention for vomiting. If William is being through respiratory depression then it is a serious adverse reaction, which needs to be monitored in the postoperative patient population. If any kind of respiratory depression is found, it is required to inform the doctor as soon as possible. Apart from that if the body of the patient becomes tolerant tomorrow feeling it does not mean that it will be tolerant to other opioids. Therefore, it is required to consult the doctor in which they will calculate a new dose of another opioid and it’s Overdose. If the patient will often report NauseaNausea or vomiting it is required to administer with an antiemetic like ondansetron. Apart from that, more often can also affect the patient cardiovascular system in which it has been reported that it can cause high flushing potential or any kind of syncope (Berman, Maderal & Raphael, 2017).
Based on the above section it can be concluded that acute pain is one of the broad terms that can describe a mild to a sharp pain that comes suddenly and it can last for a few seconds to a few months. However, this pain is not permanent. According to the case study, William does have acute pain, and it is required to provide the better intervention that will help him to improve his present condition. Moreover, morphine is one of the medicines that can be used to reduce the pain related to any kind of tissue damage. However, it is required to have proper administration while providing the drug to the patient.
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