Ondansetron Case Study Essay
CASE STUDY: MRS POTTER
Current Medications Tenormin | 50mg/day | antihypertensive | Asprin | 100mg/day | antiplatelet | Metformin | 500mg TDS | antidiabetic | Lasix | 40mg/day | diuretic | Slow K | 600mg BD | potassium | Metoclopamide(maxalon) | 10mg QID PRN oral/IV | antiemetic | Ondansetron wafer | 4mg TDS PRN | antiemetic | OxycodoneSR | 10mg BD | Opoid analgesic | Oxycodone | 5mg PRN | Opoid analgesic | Paracetamol | 1g strict 6/24ly oral/prn | Antiinflamatory, antipyretic |
Known Allergies: NIL
Pre Op Vital Signs BP | 140/85 | Pulse | 60 | Respirations | 18 | Temperature | 36.8 | BSL | 5.0mmol |
Handover Report
Uneventful post L)THR. Pain well controlled with oral analgesia.
Pt able to sit out
of bed for short period with assist of 2 nurses; now resting in bed. Dressing in tact to wound with no ooze. Bowels not open since pre op. No IVT or IDC. Pt is voiding on a pan with assistance.
Current Vital Signs BP | 130/80 | Pulse | 64 | Respirations | 22 | Temperature | 37.2 | BSL | 7.1mmol | O2 sats | 95% on RA |
On commencement of your shift Mrs Potter complains to you she is feeling nauseated and “full in the stomach”. On assessment you observe her abdomen to be distended and bowel sounds to be absent on auscultation. 10 mins later she starts vomiting.
Question 1: Discuss the likely problem and the potential contributing factors.
Problem: On assessment of Mrs Potter the likely problem is that she has retained food/fluid post surgery. She may also have post op constipation or faecal impaction. Now that she has started vomiting there is a risk of electrolyte imbalance and dehydration.
Rationale: Gastrointestinal activity is slowed down by general anaesthesia and the inactivity associated with surgery. Depression of gastrointestinal activity predisposes the individual to retention of food/fluids and therefore to abdominal distension and/or vomiting. It also contributes to post operative constipation or faecal impaction. The period of fasting in which all oral foods and fluids are withheld aims to prevent and alleviate gastrointestinal problems.
Question 2: Discuss the rationale for nasogastric tube insertion.
By inserting the naso gastric tube Mrs Potter can receive medication and nutrition whilst she remains nil orally.
Question 3: Best Practice for insertion of a nasogastric tube and the subsequent nursing care requirements using evidence based practice (not in dot point) (500 words)
Question 4: Best Practice technique for insertion of an indwelling urinary catheter using evidence based practice (not dot point) Also discuss the potential complications of urinary catheterisation. (500 words)
Question 5: Discuss the rationale for each of Mrs Potters medications: * Include the type of drug, indication for the medication and why the may be prescribed. * Consider the potential interactions and contraindications (1000 words)
Current Medications Tenormin | 50mg/day | antihypertensive | Asprin | 100mg/day | antiplatelet | Metformin | 500mg TDS | antidiabetic | Lasix | 40mg/day | diuretic | Slow K | 600mg BD | potassium | Metoclopamide(maxalon) | 10mg QID PRN oral/IV | antiemetic | Ondansetron wafer | 4mg TDS PRN | antiemetic | OxycodoneSR | 10mg BD | Opoid analgesic | Oxycodone | 5mg PRN | Opoid analgesic | Paracetamol | 1g strict 6/24ly oral/prn | Antiinflamatory, antipyretic |
Known Allergies: NIL
Pre Op Vital Signs BP | 140/85 | Pulse | 60 | Respirations | 18 | Temperature | 36.8 | BSL | 5.0mmol |
Handover Report
Uneventful post L)THR. Pain well controlled with oral analgesia.
Pt able to sit out
of bed for short period with assist of 2 nurses; now resting in bed. Dressing in tact to wound with no ooze. Bowels not open since pre op. No IVT or IDC. Pt is voiding on a pan with assistance.
Current Vital Signs BP | 130/80 | Pulse | 64 | Respirations | 22 | Temperature | 37.2 | BSL | 7.1mmol | O2 sats | 95% on RA |
On commencement of your shift Mrs Potter complains to you she is feeling nauseated and “full in the stomach”. On assessment you observe her abdomen to be distended and bowel sounds to be absent on auscultation. 10 mins later she starts vomiting.
Question 1: Discuss the likely problem and the potential contributing factors.
Problem: On assessment of Mrs Potter the likely problem is that she has retained food/fluid post surgery. She may also have post op constipation or faecal impaction. Now that she has started vomiting there is a risk of electrolyte imbalance and dehydration.
Rationale: Gastrointestinal activity is slowed down by general anaesthesia and the inactivity associated with surgery. Depression of gastrointestinal activity predisposes the individual to retention of food/fluids and therefore to abdominal distension and/or vomiting. It also contributes to post operative constipation or faecal impaction. The period of fasting in which all oral foods and fluids are withheld aims to prevent and alleviate gastrointestinal problems.
Question 2: Discuss the rationale for nasogastric tube insertion.
By inserting the naso gastric tube Mrs Potter can receive medication and nutrition whilst she remains nil orally.
Question 3: Best Practice for insertion of a nasogastric tube and the subsequent nursing care requirements using evidence based practice (not in dot point) (500 words)
Question 4: Best Practice technique for insertion of an indwelling urinary catheter using evidence based practice (not dot point) Also discuss the potential complications of urinary catheterisation. (500 words)
Question 5: Discuss the rationale for each of Mrs Potters medications: * Include the type of drug, indication for the medication and why the may be prescribed. * Consider the potential interactions and contraindications (1000 words)