NOTE---This is only part of a 2500 word assessment. This case study is designed to develop knowledge and problem-solving skills that apply to decision-making and safe drug administration in complex health care settings. In-text references are included in the word count. Please use academic sources of information such as the texts used in this course and peer reviewed journal articles. Other trustworthy sites include Government-operated websites and NPS MedicineWise. Resources Australian Medicines Handbook (AMH) and AMH Aged Care Companion Braun, CA & Anderson, CM 2017, Applied pathophysiology: A conceptual approach to the mechansims of disease, 3rd edn, Wolters Kluwer Health, Philadelphia. Bryant, B & Knights, K 2015, Pharmacology for Health Professionals, 4th edn, Elsevier, Chatswood Craft, JA & Gordon, CJ 2015, Understanding pathophysiology, 2nd edn, Elsevier, Chatswood MIMS Online - available via USC library databases: Oxycontin FPI revised 2016.pdf ( I have attatched in Files) Endone FPI revised 2015.pdf ( I have attatched in files) Targin FPI revised 2017.pdf ( I have attached in files) Tiziani, A 2013, Havard's Nursing Guide to drugs, 9th edn, Elsevier, Chatswood Mr. Edward Hunter, an 89-year old widower, was admitted to your medical ward 5 days ago with end-stage idiopathic pulmonary fibrosis, hypoxaemia (oxygen saturations 82% in the ambulance) and a bacterial chest infection. He has been receiving intensive home support from the ‘acute care in the home’ nursing team for over 6 months, which includes home oxygen therapy. One month ago he suffered a myocardial infarct, which was preceded by frequent episodes of unstable angina. He had a coronary stent in 2007. Mr. Hunter’s condition continues to deteriorate. He is receiving 15 litres oxygen via the nonrebreather mask. Severe dyspnoea renders him immobile and barely able to eat. He has little appetite and is cachexic. At night, he becomes quite restless and distressed by his pain, breathlessness and cough. The palliative care team reviewed Mr. Hunter 4 days ago because he was experiencing increased pleuritic pain on inspiration. Subsequently, he was prescribed morphine 5mg (5mg/ml) solution nocté for the analgesic, cough suppressant and sedative (narcotic) effects. Yesterday evening, in handover given to the night duty nursing team, it was explained that the palliative care team had reviewed Mr. Hunter again and reduced the dose of morphine to 2-0 – 2.5mg nocté because he was becoming drowsy during the day but was easily roused and orientated once woken and maintaining oxygen saturations 92 -94%. Mr. Hunter’s prescribed therapy includes: Prednisolone 50mg PO BD Nicorandil 10mg PO BD Aspirin 75mg PO daily mane Ramipril 5mg PO BD Paracetamol 1 – 2 tablets PO PRN (Maximum 4gm/day) Simvastatin PO 20mg nocté Amoxycillin 500mg capsules PO TDS Clarithromycin 500mg PO BD Morphine 2.0 – 2.5 mg PO PRN Nocté 4-6 hourly Docusate 1 tablet BD Metoclopramide 5mg PO TDS Oxygen (high flow) to achieve oxygen saturation > 92% You arrive the next morning to find Mr. Hunter crying and distressed. He is refusing his medications and asking to be discharged. His family was called in because of his acute distress and Mr. Hunter’s niece discovers that when he became distressed during the night, he asked a nurse for his dose of morphine and she refused to give it. The nurse claimed that morphine was not written up on the prescription chart and that she felt that he was becoming addicted to it. You observe that Mr. Hunter is still very distressed and extremely dyspnoeic. The respiratory consultant arrives to examine Mr. Hunter after this distressing event and prescribes additional pain relief: Endone suppository 30mg rectally PRN and Oxycontin 10mg orally 12 hourly PRN. Collect information: pathophysiology Q1. Outline the pathophysiology of pain in relation to pleuritis. Include the generation and transmission of pain, pain mediators and classification of pain. Avoid writing about different conditions and keep your focus on pleuritic pain. Process information: Pain management Q2. Discuss the common fears and myths that interfere with health-care professionals providing adequate pain management to patients? Q3. Explain why is it important to recognise an opiate-naïve patient? Discuss how the nurse can mitigate the risk of adverse effects from administration of opiate medications in the opiate-naïve patient experiencing acute pain? Q4. The central principles of social justice in a health care context are self-determination, equity, access and rights and, participation. How do you interpret the actions of the nurse in withholding the prescribed morphine solution (nocté) from Mr. Hunter in relation to social justice principles? Discuss the potential impact on Mr. Hunter if he perceives his treatment for pain to be unfair and unjust?