The aim of the assignment is to give an account of medication administered safely to a patient.
The discussion will focus on one patient I have cared for in clinical practice with a drug that was prescribed to the patient ensuring safe administration. Interpreting the patients pathophysiological condition, linking it to their clinical signs and symptoms and their medical diagnosis.
To maintain confidentiality and protect anonymity, I shall be referring to the patient as Mr X. This is done in accordance with The Nursing and Midwifery Councils Code of Professional Conduct (2008) guidelines.
Mr X is a young male of 20 years; he had been admitted to the ward via Accident and Emergency. He was showing the following symptoms; temperature of 38.5C, difficulty in opening his mouth, bad breathe, difficulty speaking, earache, swelling of the neck and a feeling generally unwell. On examination by myself, Mr X had an enlarged and tender ipsilateral lymph node. Mr X informed me that he was very thirsty but was able to take fluids due to the pain and had only manged to swallow limited amounts. He was showing clinical signs of dehydration, suken eyes and was feeling more lethargic than usual. If dehydration is not corrected adequately complications such as electrolyte and acid base disturbances, ultimately hypovolaemic shock can occur resulting in end organ failure. (Gorelick et al 1997).
On examination by a doctor the medical diagnosis was Peritensillar Abscess. Peritonsillar, also known as Quinsy, it is a complication of acute tonsillitis. Tonsillitis is inflammation of the pharyngeal tonsils. In peritonsillar abscess, there is pus trapped between the tonsillar capsule and the lateral pharyngeal wall. ( Hames 2005 )
The most accepted theory is that if an episode of exudative tonsillitis is untreated or treated inadequately, it can progress to an abscess developing. It usually starts with acute follicular tonsillitis, progressing to peritonsillitis and results in formation of a peritonsillar abscess. It can however develop without previous tonsillitis. ( Brook 2004 )
Alternatively ( Brook 2004 ) suggests a further theory involving the Weber glands. The Weber glands area group of salivary glands, directly above the tonsillar area in the soft palate. They are known to play a minor role in clearing any trapped debris from tonsillar area. Tissue necrosis and formation of pus produce an abscess between the tonsillar capsule, lateral pharyngeal wall and supratonsillar space. There is scarring and obstruction of the ducts that drain the glands. They swell and progress to abscess formation.
Mr X was given intravenous fluids to correct his dehydration. Analgesia was also prescribed, paracetamol and ibuprofen. Also, intravenous antibiotics where prescribed, in this case Benzylpenicillin sodium, also known as Penicillin G. Benzylpenicillin is normally given by perenteral route because it can be unstable in the hydrochloric acid in the stomach. (NHS Evidence 2013)
It is estimated that 30% of cases are caused by bacterial infections, of which the most common and significant is group A beta haemolytic streptococcus. ( Cooper 2001)
Some straphylococci have become resistant to benzylpenicillin because they produce penicillinases, in such circumstances’ flucloxacillin should be used, it is not inactivated by emzymes and is thus effective in infections. ( BNF 2012)
Benzylpenicillin is a very important and useful antibiotic, as mentioned above, it is inactivated by the gastric acid and absorption from the gut is low, it is therefore best to be given IM or by slow intravenous infusion. (BNF 2012)
Penicillins are distributed widely across the whole body, including the lungs, liver, kidneys, bones and muscles. They are metabolized to a limited extent in the liver to inactive metabolites and are excreted 60% unchanged by the kidneys. Penicillin are usually