You will be assigned an anonymous case study (written and submitted by a fellow student). Your task is to assess the case study based on criteria in the peer assessment form.Fill-up the peer assessment form by shading/ticking the relevant boxes and provide written comments. References are not required.
You will be assessed on your ability to critically appraise the case study report.
ASSESSMENT 3 (Peer-Review) Case study number: Your name: Your ID: Section A (highlight or bold your response) 1. Overall structure (select one): • Unclear • Vague • Organised • Very well structured 2. Demonstrates good theoretical knowledge on the problem presented (select one): • Poor • Fair • Good • Very Good • Excellent 3. Contains relevant information showing insight in the problem. The solution offered is based on theoretical background and scientific analysis (select one): • Poor • Fair • Good • Very Good • Excellent 4. Shows ability to plan and complete all parts of a written report that fit into the requirements of reporting the case (select one): • Poor • Fair • Good • Very Good • Excellent 5. Meets the standards of technical writing (select one): • Poor • Fair • Good • Very Good • Excellent 6. Your overall impression: • Poor • Fair • Good • Very Good • Excellent 7. General aspects of the report (select as many as apply): • Too hurriedly written • Report not set out in formal order • Poor spelling • Poor grammar • Difficult to follow arguments: muddled, disorganized Section B Personal comments/considerations (200 – 250 words) 4514989947 4514989947 NUR231 Assessment 2: Case study 1. What happens to pain threshold and behavioural response to pain in the older people and discuss briefly the effectiveness of NSAIDs for pain in the elderly. Despite multiple studies to determine what happens to pain threshold in aging people, results are inconclusive (Craft et al., 2014). Some studies have indicated that there is evidence of an increase in the pain threshold with advancing age, which may also depend on the type of pain (Alan D. Kaye, 2020). Older adults are more likely to experience pain, however, a behavioural response to pain is to accept it as a natural part of aging and not report it ("Treating Pain in the Elderly", 2020). Other studies have found that more severe pain is associated with aggressive and agitated behaviours and that there is generally a relationship between pain and disruptive behaviours (Ahn & Horgas, 2013). NSAIDs are often used to treat inflammatory type pain in the elderly and can be effective, however, they pose an increased risk of gastro intestinal toxicity, renal and cardiovascular side effects and cause adverse interactions with other drugs commonly used by the elderly ("Pain Management and the Elderly", 2020). 2. Following the MRI report, and the pain being persistent, which analgesics should be prescribed to Mr Jack? Support your answer with evidence. Mr Jack’s pain is severe and persistent enough to restrict his usual activities and affect his job meaning that it is diminishing his quality of life and he has not had relief from NSAIDs. The World Health Organisation has developed a three step analgesic ladder for pain relief and these principles should be followed (WHO, 2020). The general recommendations are to give drugs by the clock, by mouth and to follow the analgesic ladder (Ali et al., 2018). According to these guidelines, treatment commences with the oral dose of drugs in the following order: non 4514989947 4514989947 opioids such as aspirin and paracetamol, then as necessary mild opioids such as Codeine, then strong opioids such as morphine, until the patient is pain free (WHO, 2020). Given that his pain is not responding to NSAIDs, following the principles of the WHO analgesic ladder, paracetamol should be given regularly in conjunction with a short acting opioid (Ali et al., 2018). Once titrated, a slow release opioid can be trialled and adjuvants such as aperients or additional drugs to calm anxiety may be added (Ali et al., 2018). Cancer patients very rarely have long term addiction to opioids, but the patient should be made aware of the side effects of these drugs and reviewed after 48 hours (Mercadante, 2014). Long term systemic corticosteroids are helpful for patients with metastatic bone pain (Mercadante, 2014) Dexamethasone is recommended for analgesia in cancer patients and reduces oedema (Alan D. Kaye, 2020). 4514989947 4514989947 References: Ahn, H., & Horgas, A. (2013). The relationship between pain and disruptive behaviors in nursing home resident with dementia. BMC Geriatrics, 13(1). https://doi.org/10.1186/1471- 2318-13-14 Alan D. Kaye, J. (2020). Pain Management in the Elderly Population: A Review. PubMed Central (PMC). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/. Ali, A., Arif, A., Bhan, C., Kumar, D., Malik, M., & Sayyed, Z. et al. (2018). Managing Chronic Pain in the Elderly: An Overview of the Recent Therapeutic Advancements. Cureus. https://doi.org/10.7759/cureus.3293 Craft, J., Gordon, C., Tiziani, A., Huether, S., McCance, K., & Brashers, V. (2014). Understanding Pathophysiology - ANZ adaptation (2nd ed., pp. 492-493). Elsevier Health Sciences. Mercadante, S. (2014). Managing Difficult Pain Conditions in the Cancer Patient. Current Pain And Headache Reports, 18(2). https://doi.org/10.1007/s11916-013-0395-y Pain Management and the Elderly. Practical Pain Management. (2020). Retrieved from https://www.practicalpainmanagement.com/treatments/pain-management-elderly Treating Pain in the Elderly. WebMD. (2020). Retrieved from https://www.webmd.com/pain- management/treating-pain-elderly. WHO | WHO's cancer pain ladder for adults. Who.int. (2020). Retrieved from https://www.who.int/cancer/palliative/painladder/en/. https://doi.org/10.1186/1471-2318-13-14 https://doi.org/10.1186/1471-2318-13-14 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/ https://doi.org/10.7759/cureus.3293 https://doi.org/10.1007/s11916-013-0395-y https://www.practicalpainmanagement.com/treatments/pain-management-elderly https://www.who.int/cancer/palliative/painladder/en/