Assessment 1: Short Answer Topics

Overall Weighting: 40%

Due Date: Thursday, 23^rd April 2020 at 6pm (Week 6)

Learning Outcomes:

1. Explain the principles of quality use of medicines (QUM) relevant to nursing practice.

2. Describe the pharmacodynamics and pharmacokinetics of particular drugs.

4. Demonstrate accountability in relation to safe administration of medications.

Word Count: Topic 1: 800 words (+/- 10%)

Topic 2: 800 words (+/- 10%)

NB: The total word count is considered from the first word to the last word of each topic (excludes topic headings). The total word count includes in-text references and direct quotations. It excludes the cover page and reference list.

Instructions: Assessment 1 requires you to write 2 (two) separate responses – one for each topic.

Step1: Read the case summary and resources provided which are available under the ‘Assessment for this Unit’ tab: Under ‘Assessment 1’.

Step 2: Use the information in the case summary and write two (2) separate responses addressing the information in each topic as listed below. You are to attempt both topics.

Step 3: Presentation and formatting of your responses:

You are required to present your two (2) separate responses using the following set-out and format.

- First page: Cover Page. The cover page needs to include the title of the assessment and assessment number, your student name and number, unit name and unit code, lecturers’ names, due date (extension due date), and actual word count of your paper per topic.

- Next page: Your two (2) separate responses:

Include the following names of the topics that are underlined – no other headings to be used in your responses. This will allow for each topic to be easily identified.

o Topic 1: Understanding Pharmacokinetics and Pharmacodynamics

o Topic 2: The Clinical Decision-Making Process

- Last page: References - The reference page is to include all references used in Topics 1 and 2.

Formatting:

• Size 12 font size - Times New Roman

• Double-line spacing

• 2.54cm margins

• Each page needs to have a page number and your name and student number, on each page as a footer or a header.

Referencing Style: APA referencing 6^th edition (this can be found on the unit Moodle site under 'Assessment' tab or via the CQUniversity library). Please note that referencing is worth 15% of your overall mark for this assessment.

• The study guide, unit profile, and PowerPoint slides supplied on the unit Moodle site are NOT to be used as reference sources but are good resources to guide your responses.

• Journal articles, and other sources less than 5 years old, and textbooks less than 10 years old should only be used.

• Moodle e-Reading list can be used and referenced as per the sourced textbook.

NB: This assessment contributes to 40% of your overall marks for this unit (both assessments combined will give the final grade).

Case Study

Mrs Nobal is a 75-year-old lady who has presented to the emergency department via ambulance with abdominal pain, nausea and vomiting. The ambulance officer proceeds to handover the patient as you are the attending nurse for Mrs Nobal.

SBAR Handover

Situation: Mrs Nobal has called the ambulance due to complaints of abdominal pain that has worsened today.

Background: The pain has been increasing in severity over the past three (3) weeks.

Medical/Surgical History:

• Removal of a tumour from descending colon about two (2) years ago. No evidence at this time of any residual cancer.

• Hypertension

• Osteoarthritis right knee

• Mild renal impairment

Current Medications:

• paracetamol CR 665mg (Panadol Osteo) – 2 tabs (1330mg) every 8 hours (to relieve pain from osteoarthritis)

• perindopril 2.5mg daily (to treat hypertension)

Assessment: Mrs Nobal has described the pain as cramping in nature, with occasional episodes of nausea and intermittent vomiting. She states she is unable to keep anything down. Mrs Nobal’s abdomen is also distended. She also reports that on the two (2) previous days she had several episodes of diarrhoea, but her bowels have not opened today.

Observations (Most recently taken by the ambulance officer):

• Respiration rate (RR): 22 respirations per minute

• Heart rate (HR): 105 beats per minute

• Blood pressure (BP): 165/95

• Pain 4/10 and constant, increases to 8/10 with episodes of cramping pain

• Weight: 60kgs (estimated)

Response/Recommendation: An intravenous cannula has already been inserted by the ambulance officer and an opioid medication has been administered to treat Mrs Nobal’s pain. The ambulance officer reports that she has not complained of nausea or vomiting en route to the hospital. Based on this information it is possible Mrs Nobal has a bowel obstruction.

After your handover from the ambulance officer, Mrs Nobal complains of nausea has an episode of vomiting.

Most recent Laboratory Tests (additional information found in patient’s notes):

• Full blood count – no abnormalities detected (NAD)

• Urea and electrolytes: sodium, potassium, chloride and bicarbonate - NAD

• CrCl (creatinine clearance) - 45ml/min (Normal: >50ml/min)

• Liver function tests (LFTs) - NAD

DISCLAIMER:

This case discussed here is a fictitious event based on real-life scenarios. Any reference to real events or individuals is merely coincidental. If you become distressed by any information in this document, please contact CQU counseling services immediately.

Topics

Nausea and vomiting are common and distressing symptoms experienced by patients and are caused by a range of conditions. As the nurse caring for Mrs Nobal you assess that she would benefit from the administration of an antiemetic to alleviate her nausea and vomiting. One medication used commonly to alleviate nausea and vomiting is metoclopramide. Further resources to assist with this topic can be found on the Moodle site within the ‘Assessment 1’ area.

Topic 1: Understanding Pharmacokinetics and Pharmacodynamics (800words)

Before you administer medications to Mrs Nobal there needs to be adequate knowledge of the medication. Having a good understanding of the pharmacokinetics (what the body does to the drug) and also the pharmacodynamics (what the drug does to the body) of medications is important to ensure safe and effective administration of medications.

1. Discuss the pharmacokinetics (Absorption, Distribution, Metabolism, Excretion) of metoclopramide.

Include in your response:

a) Absorption:

• Clarify how metoclopramide can be absorbed i.e. routes of administering.

• Explain the difference in the onset of action between administering metoclopramide via the oral and intravenous routes.

• Discuss which is the most appropriate route to administer this antiemetic to Mrs Nobal and provide an evidence-based rationale for your decision.

b) Distribution: After absorption, some of the drug, metoclopramide, binds to plasma proteins.

• Discuss your understanding of ‘protein binding’.

c) Metabolism:

• Identify the importance of the metabolism of this drug into glucuronide and sulfate conjugates and where this occurs.

d) Excretion:

• Briefly discuss the organ responsible for the excretion of metoclopramide and the importance of monitoring its function.

• Identify the half-life of metoclopramide and your understanding of this term.

2. Discuss the pharmacodynamics (mechanism of action) of metoclopramide.

• Discuss how metoclopramide works to produce its pharmacological effects to reduce nausea and vomiting.

• Discuss two (2) major side effects and/or adverse reactions of metoclopramide specifically relating these to Mrs Nobal.

Topic 2: The Clinical Decision-Making Process (800 words)

Underpinning the Quality Use of Medicines (QUM) principles is ensuring that if medications are required that they are chosen wisely, administered safely and obtain the desired effect. Therefore, by utilising the clinical decision-making process, it allows nurses to apply these principles and individualise care that takes into account all aspects of the person’s situation and condition.

Mrs Nobal feels nauseous and vomits and you feel she would benefit from administering an antiemetic. You approach the doctor to obtain an order to relieve her nausea and vomiting.

The doctor writes a PRN order:

Provide a response that explains how you would apply the clinical decision-making process to ensure the safe and effective administration of metoclopramide to Mrs Nobal.

Your response is only to cover the specific sections of the clinical decision-making process as listed below (nursing diagnosis and planning although important in this process, is not required to be covered separately here).

Include in your response:

a) Assessment:

▪ Two (2) pieces of information that would need to be collected and why these are important to consider prior to administrating metoclopramide.

▪ The most appropriate route of administration of metoclopramide for Mrs Nobal.

b) Implementation:

▪ Two (2) aspects/strategies/processes to safely administer metoclopramide.

▪ One (1) non-pharmacological intervention that could be implemented to assist with the effectiveness of metoclopramide.

c) Evaluation:

▪ Two (2) aspects that are relevant to evaluating the administration of metoclopramide.

Assessment 1 Marking Criteria

*up-to-date= journal articles and other sources (including internet sources) less than 5 years, textbooks less than 10 years