...Concept Analysis Carrie G. Alexander Chamberlain Concept Analysis The concept of comfort is one that nurses provide every shift; however, it is not always easy to define. Katherine Kolcaba’s Comfort Theory will be used. Walker and Avant’s method for concept analysis will be used. The first step is to select a concept, which is comfort. The next step is determining the purpose of the analysis. The purpose is to define what comfort means and what comfort measures are and how they are used in nursing. The third step is to identify the uses of the concept of comfort. This includes definitions of term comfort and a literature search. The fourth step is to determine the defining attributes of comfort. This allows for insight into the concept and includes the characteristics of comfort. Comfort can mean many things to many people. Comfort can be caring words, caring touch, warm blankets, pain relief or encouragement. The fifth step is a model case or a real life example of the concept that includes the attributes of the concept and a borderline and related case. The sixth step is to identify consequences and antecedents and consequences. The final step is to define empirical referents or measurable ways to show the occurrence of comfort. Purpose The concept of comfort is used frequently in nursing practice; however, it is not always clearly defined. It is a basic value of nursing care and interventions and is frequently described as comfort measures. A basic understanding...
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...It has been estimated that 5% of terminally ill patients cannot be relieved of their pain despite the use of massive doses of opioids. Because this group would otherwise die in agony, palliative sedation (“PS”) has evolved. There is broad clinical, ethical, and legal consensus that PS is appropriate at the end of life to treat intractable and intolerable symptoms such as extreme pain, dyspnea, nausea, and vomiting as long as the intent is to treat patient symptoms and not to hasten death. PS is a spectrum of interventions where sedatives and opioids are used to relieve the physical pain and distress of a dying patient at the end of life. In some cases, the patient must be sedated into unconsciousness to relieve pain. In these situations PS is legally acceptable when: 1.) the administered medication offers legitimate patient benefit, 2.) the intention is not...
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...Nothing MEDICATION ANALYSIS Patient Medication Medication from List Date and Specific Order:10/26/15 Hydromorphone 1mg IVP q 3hours PRN | Generic/Trade Name :hydromorphone/Dilaudid | Classification(s): narcotic, analgesic | Usual Dosage/Administration Protocol:(based on rationale for use) 0.2-1 mg q 2-3 hours | Action: Potent opiate receptor agonist that does not alter pain threshold but changes the perception of pain in the CNS. | Specific Rationale for Use in this Patient: bone and tissue pain due to trauma and surgery | | At bottom of page: Add additional information in different color ink. Include pt. info, date, and dosage, specific implications related to why med ordered for. pt. Major Side Effects | Based on pharmacokinetics, side effects, and patient-specific data, explain the nursing implications related to care of this patient (assessments, interventions, lab data to monitor, effect on maternal/fetal status/labor pattern, patient teaching, overdose management etc.) | GI: Nausea, vomiting, constipationCNS: Euphoria, dizziness, sedation,DrowsinessCV: Hypotension, bradycardia or tachycardiaResp: Respiratory depressionSpecial: blurred vision | Obtain baseline respiratory rate, rhythm, and depth.R 16 eupnea, evenNote the size of pupils 3 bilateralMonitor VS regularlyBP 116/60 T36.8 P 85Assess effectiveness of pain relief 30 min after administrationPain decreased from 4/10 to 2/10Monitor bowel patternBS active x4, last BM 10/25Onset...
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...Assignment 3.1: Health Care Crimes Analysis Overview Mr. Jones is a pharmacist employed by ACME Drug. He has a known drug problem and his drug of choice is Mepergan. Maria Smith is a cancer patient and customer of ACME drug company. Ms. Smith has been receiving Mepergan Fortis, a schedule II narcotic, as part of her scheduled pain treatment. The last time Ms. Smith had her prescription for Mepergan Fortis filled, Mr. Jones was the pharmacist on duty. Ms. Smith noticed that the medication was not working as it had in the past and returned to the pharmacy. The pharmacist on duty determined that the wrong medication was given to Ms. Smith, 28 Mepergan Fortis and 32 Feldene. Since the stock bottle of Mepergan Fortis remains in a locked drawer, the video was reviewed and it was discovered that Mr. Jones had transferred the Feldene capsules into the Mepergan Fortis bottle, and put the Mepergan Fortis capsules in his pocket. The amount charged to Missouri Medicaid for the Mepergan Fortis prescription for Ms. Smith was $117.00. The amount that would have been charged to Missouri Medicaid for the Feldene that was dispensed would have been $8.97. Further investigation by ACME Drug revealed that Mr. Jones had likely billed for a higher cost controlled substance and dispensed a lower cost non-effective medication to more than five other patients. Issues One of the immediate issues is the fraudulent Medicaid billing. According to USA today, there have been 14,663...
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...12 had used prescription drugs for a non-medical reason (National survey on drug use, 2011). The most commonly abused prescription drugs are pain relievers. Why are people abusing these drugs and where do they get them? This paper will attempt to answer those questions as well as pose a possible solution on how it can be corrected. Analyzing the Problem To begin, we must first take a look at why so many American citizens are abusing prescription drugs. Most will probably tell us that they became addicted to pain relievers after some sort of horrible accident or surgery. They were prescribed these medications by their Primary Care Provider and told to take them in the correct manner, which are usually one or two tablets/pills every four to six hours apart, as needed for pain. What they were probably not told by their Primary Care Provider is that they should not take them sooner than directed, nor should they take them whenever they are not experiencing pain. The directions on the bottle may read to take one or two every four to six hours, but that doesn’t mean that they have to be taken every four to six hours. If the person is not in pain, then taking a pain reliever should not be necessary. The consumption of these, and other, types of medications whenever they are not needed constitutes abuse. In fact, the consumption of any medication outside of the directions...
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...revenue offset provision, and administrative simplification requirements (Physicians Billing Associates International, 2006). The article that I had read was about a woman who was a nurse and started to use the narcotic from the patient and it was also between an individual’s right to privacy. It shows the process of which the administrator determines a course of action is reviewed but his context of workplace realities through an ethical analysis. This article was about a woman named Jackie that was a nurse and she was overwhelmed with her job. She tried talking to her husband but was convinced to continue working because who pay check was making their saving grow extremely large. To make her husband happy she continues to work as a nurse. She was working in different units that she started to use the narcotic that were prescribing to the patient that she was caring for. She started to take the patient pain medications that weren’t asking for their medications. Then Jackie started to replace the medications with the saline. Jackie had an addiction to pain medication. The administrative Michelle found out because Jackie was working in the surgical unit and the pharmacist had notice there was errors on the medication log sheet. Michelle had requested for the entire narcotic log sheet and the names of...
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...Mills in South Florida Abstract This paper examines the legality and ethics of the George brother’s pain medication clinics in South Florida. It explains the legality of the pain medication supply that is available for consumers that medically need it and how its source can also be an easy access to addicts. Although it is considered legal, is it ethical? In this paper we study different theories in ethics, including Kantian and Utilitarian ethical models. These models provide clear analyses that guide us in deciding if pain medication distribution from pain clinics is ethical. Finally, we review and conclude if the George brother’s pain medication clinics were acting socially responsible within their communities. Given the rise of pain medication abuse and illegal reselling, pain clinics in South Florida should adhere to strict rules to provide services to those that need it and not turn their businesses into pill mills. Introduction Purposes of Paper The intent of this paper is to provide a detailed and analytical examination of the George brother’s pain medication clinics. Throughout this paper all approaches will be examined such as the legality and ethics of the case, and how social responsibility plays a role. In the past few years in South Florida, there has been a rise of pain medication addiction and the reselling of these narcotics. Pain medication clinics have done more harm than good to our communities especially ones like the George brother’s. This...
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...got the patterns down. Pill brokers and dealers reported congregating in open air drug markets typically strip mall and pharmacy parking lots, and outside methadone clinics to buy, sell, and trade prescription drugs. These markets were reported to involve a variety of transactions, including the purchase of prescription drugs for cash, as well as trades for crack and heroin. Pill brokers also reported the purchase of used fentanyl patches from nurses who have stolen them from pain patients or from disposal containers in hospitals. Some individuals frequenting the drug markets also barter their oxycodone for other opioids or benzodiazepines, typically alprazolam. Doctor Shopping focus group participants indicated that even in a small state like Delaware, doctor shopping appeared to be fairly easy. The vast majority of abusers reported obtaining medications through doctor shopping, and most reported frequenting at least four physicians in order to obtain sufficient amounts of their desired medications. Occasionally clinics and hospital emergency rooms were reported as locations for doctor shopping as well. A heavy user stated: Another focus group member was saying about the doctors, it’s out of control. I had 8 doctors that would give me four or five different kinds of painkillers at one time” (Beard, Cicero, Inciardi, & Surratt, 537-545). On the other hand, in 2008 W.C. Becker, R. A. Desai, D. A. Fiellin, L. E. Sullivan, & J. M. Tetrault stated, “{Data on licit and illicit...
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...FDA approved narcotics are not just a threat in themselves, they also pave the way for the use of street drugs. Street drugs are a problem, but the bigger one is lying in our own homes. Among persons aged 12 and older in 2010-2011 who used pain relievers non medically in the past year, a survey indicated that they obtained the drugs from a friend or relative for free. 81.6 percent of those friends or relatives acquired the drugs from just one doctor. Every day 2,500 people abuse a pain reliever for the first time (Drug abuse). In the U.S alone, more than 15 million people abuse prescription drugs, which is more than the combined number who reported abusing cocaine, hallucinogens, inhalants and heroin. On the same not, depressants, opioids and anti-depressants are responsible for more overdose deaths (45%) than cocaine, heroin, methamphetamine and amphetamines (39%) combined (Drug free...
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...health plan requirements, revenue offset provision, and administrative simplification requirements (Physicians Billing Associates International, 2006). The article that I had read was about a woman who was a nurse and started to use the narcotic from the patient. It shows the process in which an administrator determines the course of action that will be taken. Also the context of workplace realities through an ethical analysis. This article was about a woman named Jackie that was a nurse and she was overwhelmed with her job. She tried talking to her husband but was convinced to continue working because who pay check was making their saving grow extremely large. To make her husband happy she continues to work as a nurse. She was working in different units that she started to use the narcotic that were prescribing to the patient that she was caring for. She started to take the patient pain medications that weren’t asking for their medications. Then Jackie started to replace the medications with the saline. Jackie had an addiction to pain medication. The administrative Michelle found out because Jackie was working in the surgical unit and the pharmacist had notice there was errors on the medication log sheet. Michelle had requested for the entire narcotic log sheet and the names of the nurses that were working on those days. Michelle had to inform Karen who was another administrative and explain to her...
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...Each year, more than half a million people go to emergency rooms for kidney stone problems. It is thought that one in ten people will have a kidney stone at some time in their lives. The number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4% of the population had kidney stones; by the early 1990s, more than 5%. The rates are continuing to increase. The peak age for stones is between 20 years and 50 years. White Americans are more prone to develop kidney stones than African Americans, and men are much more likely to develop stones than women. Other disease like high blood pressure, diabetes, obesity, osteoporosis, chronic diarrhea, or kidney cyst might increase the risk of stones. Diabetes increases the risk of developing kidney stones, especially in younger women. Only about 25% of kidney stones occur in people with a family history of stones (Finkelstein, 2006). A kidney stone is a solid mass made up of tiny crystal. One or more stones can be in the kidney or ureter at the same time. Kidney stones can form when urine contains too much of certain substances. These substances can create small crystals that become stones (Cameron, 2007). The biggest risk factor for kidney stones is dehydration. Kidney stone are common. A person who has had kidney stones often gets them again in the future. Some types of stones tend to run in families. Certain kinds of stones can occur with bowel disease...
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...every house the family medicine cabinet is fully stocked with various items for both medicinal and non-medicinal purposes. Some households keep their cabinets uniformed by organizing items by color, name, or date. Although, there are others in the world, that are lucky if they can find anything in their medicine cabinet without having to spread everything out on the counter. The one thing that has remained rather constant, generally speaking, is that a person’s medicine cabinet undoubtedly presents a perfect way for any curious, maybe even unwanted, snoop to take a peek into the personal and intimate details of an individual’s life such as; age, gender, income, pain tolerance, and much more. According to CBS News Denver, “The most popular [drugs]: high blood pressure and heart pills, statin drugs to lower cholesterol, pain pills, antidepressants, diabetes pills…” (Hnida). All of these items listed by CBS News seem to be fairly generic and rather normal household items, how can they distinguish one person from another? While many households have several similar items, such as Tylenol or Advil, in their medicine cabinets, some more specific items, for example an inhaled or...
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...chose to review an article related to the treatment of chronic pain for a plethora of reasons. To begin with it will be on my first test, secondly it is one the reasons most people go to the emergency room and see their doctors. And finally in my opinion pain along with mental health illnesses may be the most often misunderstood and mistreated diagnosed in health care today; therefore as a nurse and patient advocate it is imperative that I attain a wide knowledge base on the subject of pain and its complimentary treatments. The article discussed a variety of complementary and alternative methods to manage and treat varying types of pain. The article was not inclusive of all CAMs, only the most common practices of complementary alternative medicine. Including on the list discussed was acupuncture, acupressure, homeopathy, naturopathy, and tai chi. These are the more common modalities of CAM, as well as other CAMs that were new to me such as Jin Shin Jyutsu, lymphatic therapy, myofascial therapy and craniosacral therapy. Also included were reviews and evidence base practice regarding some of these therapies. Though the article made mention of several research and clinical trials. For example, “In randomized clinical trials, qigong has been shown to be effective in significantly reducing pain when compared with the general pain care.” (Schulenburg, 2015, p. 322), it was not a research paper or clinical analysis. It is a journal article written by a registered nurse for the...
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...Define physical and psychological dependence. Physical Dependency refers to a state of chronic Dependence on a medication or drug resulting from prolonged abuse. The state is characteristically defined by an increase in Tolerance and Dependence in which negative consequences occur despite continued use. It is additionally defined by symptoms of withdrawal when cessation of the drug takes place. Physical Dependence can occur from prolonged use of sedatives, pain killers, or stimulants, but is defined by similar sets of consequences. Psychological Dependence is an emotional need for a drug or substance that has no underlying physical need. For example, people who stop smoking recover physically in a short time. The emotional need for nicotine, however, is much more difficult to overcome. They continually think they need the nicotine to stay calm even though there is no physical need. The drug for the addict is similar to what a security blanket would be for a child (or some adults). Name two type of synthetic opiates and describe how they are typically used. The opium poppy seed plant contains natural pain relieving substances known as alkaloids, according to Princeton University. Natural opiate drugs come from natural opium alkaloids, which include – * Demerol- Demerol is a drug used to control pain and Demerol is also known as meperidine. Demerol is the brand name for meperidine which is a member of the opioids drug class. Other Opioids that are similar to Demerol...
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...after an accident as she had never such a relevant past history. Her case study needs a thorough analysis which can be done through answering some important questions keeping in view the case study of Ms Angie Taylor. There are some important questions and queries in this case which needs to be resolve through proper analysis of the case study of Ms Taylor by looking at the literature. There are many complications seen in the case of Ms Angie Taylor, therefore it is very much essential to address all the questions regarding the case study of Ms Angie Taylor. Epidural infusion for pain relief in the post operative care of Ms Taylor Epidural infusion of pain relief in the post operative care can be define as the supervision in the epidural space of Opioid analgesics, mixture of opioid analgesics and local anesthetics, local anesthetics and it also supervise into many Alpha-2 agonists, for example, as an add-on to epidural clonidine might be seen in future. For pain relief in the post operative care of Ms Taylor, the use of epidural infusion can be very much effective. If it is taken as the pain reliever in the post operative care then it can be very much useful to reduce the pain. After the operation, Ms Angie Taylor direly needs a pain reliever which can provide her immense relief in pain (Bollish SJ, 1985). Therefore, Epidural infusion is very much effective and functional for pain relief in the post operative care of Ms Angie Taylor. The epidural infusion is applied in the...
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