Scenario:
Jenny is a 5-year-old girl who presents to A+E with a history of cough, wheeze and increasing shortness of breath over the last eight hours. Jenny is agitated and speaking in short phrases. She has a HR of 146 bpm, RR 41, oxygen saturation of 88% in air. Examination of the chest reveals intercostal and subcostal recession; auscultation reveals reduced breath sounds and widespread expiratory wheeze. Jenny is moved to resus and treatment is commenced for exacerbation of Asthma. Jenny is given an IV salbutamol bolus, as nebulised salbutamol has not reversed the exacerbation of Jenny’s Asthma. Jenny has had previous hospital visits but does not like being in hospital. Jenny is also worried about her cannula as she does not like needles. Jenny’s mother is a single parent and will not be able to stay with Jenny in hospital overnight as she also has a 4-week-old baby.
– Discuss the evidence supporting the nursing care given to Jenny
– Critically analyse the evidence underpinning the vital signs monitoring described and the interpretation of the findings
– Discuss the Absorption, Distribution, Metabolism and Excretion of Salbutamol.
– Critically evaluate the use of IV. Salbutamol, nebulised salbutamol or Salbutamol given via inhaler.
Tips:
• Focus on the pharmacology of Salbutamol.
• Focus on the role of the nurse in assessing the child before and following the administration of the drug.
• Include an overview of the pharmacological properties of the salbutamol, duration, and the management of potential side-effects.
• Critically analyse the nursing role in medicines management in relation to the administration of salbutamol, considering safety and nursing observations.
• Consider the implications of medicines management in relation to Jenny’s discharge.
• Discuss the communication with Jenny and her mother and how this may contribute to improved care for Jenny.
• Provide evidence to support this discussion with research-based evidence and critically analyse this to inform best practice.
Introduction
1. What is pharmacology?
Lying at the heart of biomedical science, pharmacology is the science of drugs and their effect on living systems (British Pharmacological Society, 2021). It links together chemistry, physiology, and pathology, to improve the lives of millions of people globally, while maximizing benefits and reducing risk and harm.
2. What is the importance of pharmacology and safe practice?
Pharmacology is considered an important branch of medicine, as there are a range of diseases and illnesses that require suppressants or cures. Without studying drug functions there is a lack of certainty as to whether the intervention is beneficial in reducing or eliminating ill health.
3. What is the role of a nurse in medicine management?
4. What is medicine optimization?
5. How do you monitor vital signs as related to pharmacology?
6. What are the pharmacokinetics and pharmacodynamics of Salbutamol?
Body
1. Explore the connection between medicine management, patient safety and improved health outcomes.
2. Ethics, explore how the nurse can act ethically in Jenny’s case? Jenny does not like being in hospital, she is worried about her cannula and does not like needles. How would you ethically resolve these facts?
3. Compliance, what should we consider here? What steps or actions can be taken in relation to this in Jenny’s case?
4. Explore the role of the nurse involving holistic care regarding medicine management. What does the role of the nurse look like in relation to the given scenario?
5. Explore how the nurse can work with the patient and family for safe and effective medication.
6. There are times when Jenny’s mum may be absent, what considerations need to be a made because of this?
7. Explore in greater detail vital signs, outline why we monitor these in relation to the condition and in particular pharmacology.
8. Jenny is receiving salbutamol, discuss the pharmacokinetics (Absorption, Distribution, Metabolization, Excretion) and pharmacodynamics.
9. How can medicine optimisation be achieved in this scenario?
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