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Compartment Syndrome: Leigh Richard Case

NURS2003 Pathophysiology & Pharmacology 2018

Exploration of Pharmacology Case Mode 

• We are looking for you to demonstrate that you understand pharmacology and its effects on the human body.

 • The use of headings is accepted and encouraged in this topic. Please set out your assignment clearly as it makes it much easier for tutors to read and assess your work accurately.

 Assessment Criteria 

Detailed explanation of the pharmacology related to the case patient.

• Demonstrate a clear understanding of the pharmacology presented in the case Explanation of two (2) signs/symptoms the case presented case 

• Accurate explanation of signs and/or symptoms related to pharmacological intervention

 • Display a clear, succinct understanding of the signs/symptoms demonstrated by the case in relation to pharmacological intervention.

Exploration of Pharmacology Case Critical Thinking and Rationale 

• Provide clear rationales that support the links between pharmacology context and theory. 

Writing Style 

• Introduction, body of essay, conclusion, and referencing is clear and correctly formatted.

 • The essay flows well, it is easy to read and follow the sequence of ideas. 

• No or very few spelling or grammatical errors throughout the essay. It has been carefully proof-read Referencing Weighting 10% 

• Referencing must be in line with the School’s referencing guidelines (Harvard referencing guide).

 • Reference lists will not count towards the word total – but ‘in-text’ citation is included in the word count. 

• References from consumer-based websites & Wikipedia WILL NOT be accepted, this includes but not limited to: o MyDR o Better Health Channel o Health Direct o WebMD 

• Minimum eight (8) credible references are EXPECTED to be used including a mix of textbooks, websites & evidence-based literature. ANY BREACHES IN ACADEMIC INTEGRITY WILL BE IDENTIFIED AND ACTIONED, RESULTING IN THE STUDENT BEING PLACED ON THE ‘ACADEMIC INTEGRITY REGISTER’ WHICH MAY AFFECT FURTHER STUDY 

 Exploration of Pharmacology Case 

The Questions are as Follows: 

Case Study 1 - Jessica White One of Jessica’s cousins is a second year student nurse. He tells you he doesn’t understand the pharmacology of asthma and how it affects the respiratory system. Explain the use of pharmacology in the treatment of asthma in relation to the respiratory system using the correct medical and nursing terminology. 

Case Study 2 - Leigh Richards Leigh's daughter is a second year student nurse. She tells you she doesn’t understand the pharmacology of orthopaedic trauma. Explain the use of pharmacology in the treatment of orthopaedic trauma in relation to the musco-skeletal system using the correct medical and nursing terminology. 

Case Study 3 – Greta Balodis Greta’s grand-son is a second year student nurse. He tells you that he doesn’t understand the pharmacology of stroke. Explain the use of pharmacology in the treatment of stroke in relation to the neurological system using the correct medical and nursing terminology.

Answer

CASE STUDY OF LEIGH RICHARD

(COMPARTMENT SYNDROME)

INTRODUCTION

An adult man of 39 years of age named as Leigh Richard (having wife and three children in the family) had met with an accident. Consequently, he had suffered fracture in his left arm as well as humorous bone. There was severe displacement, small subdural hematoma as well as left side pneumothorax. The patient has undergone surgery for cure of bone and it was found after surgery that Leigh Richard suffered from compartment syndrome also. 


PHARMACOLOGY OF COMPARTMENT SYNDROME

Pharmacology is the classification of drugs and related explanation as well as effects on the patient. It may be noted that various kinds of drugs are used for treating the disease. As said above, the doctor had prescribed for Mr Leigh the analgesic, antibiotics as well as anti-inflammatory drugs for treating the cause of compartment syndrome and for relieving the worst signs or symptoms which were seen and that were believed to have inflammatory process. The classification as well as the explanation of drugs prescribed for Leigh may be given as follows:

FENTANYL

This drug is believed to be the strong analgesia. It is used as anesthesia also and is generally given with kinds of drugs. The generic drugs coming in this category are named as Actiq, sublimaze and durogesic. This drug was is given to Mr Leigh after his surgery of fractured arm. The reason behind this that said drug is good quality of painkiller. It also believed to slow down the major activities of human being’s central nervous system to all nerves and connectors of body that may result in suppress the pain (Rauf, Iohom and O’Donnell, 2015).

 This drug may be given to the patients intramuscularly, intravenously, intradermally in form of lozenges and in form of patches. In case of Mr Leigh, this drug is being given through intravenous route in the doses of 100mcg/hour. It may be said that the dose of any drug depends on severity of the disease coupled with age of the patient. It can’t be ignored that there are side effects this drug too. It may be also that the patient get habitual to any drug and this drug is not the exception. Hence, the caution has to be excercised while giving the drug to the patient. It may also be noted that the aged and old people are not able to bear that much pain as well as the side effects caused by any drug. It has been found in the case of instant drug, the people may feel the drowsiness, bradycardia, nausea, dry mouth, tachycardia as well as confusion (Stanley, 2014). 

It can’t be denied that some people may be hypersensitive and allergic to fentanyl, secondly, some may suffer from respiratory depression as this drug has the tendency of slowing down the rate of respiration (Fennessy and Crowe, 2015). Hence, the doctor prescribing this drug to any patient must enquire the breathing and related disease history so that unforeseen problems may be avoided and injury suffered by the patient may heel at the earliest. It is required to mentioned here that the fentanyl has the tendency of increasing the cerebrovascular fluid and it may lead to the risk of brain damage also in case the patient has suffered in head injury. 

The pharmacokinetics of a drug is said to have four things namely absorption, metabolism, distribution and excretion. The term “pharmacokinetics” is also related to movement of the drug in human body. It may be correlated with the amount of dose and requirement of the body for it. The researches have proved that fentanyl is absorbed through plasma proteins, metabolized through liver, the excretion it through urine and the rest of the part of the drug is absorbed in the body. 

As discussed above, the drug named Fentanyl can be given to a patient in combination of other drugs of category opioid, depressants of central nervous system, sedatives as well as anti-psychotics. In these cases, the effect of the drug is increased. But, this drug is never recommended for a cancer patient because it may result in harmful affects when given in combination with the chemotherapy drugs. 

The nursing care while handling this drug is that all sorts of due care is to be exercised, the physical as well as neurological assessment of the patient is to be done. Not only this, the therapeutic response is also to be assessed after giving the drug to the patient. The repeated doses are to be avoided to prevent respiratory damages. If the drug is be given in the form of intravenous, it should be administered very slowly. In case of oral intakes, the patient should have clear guidance from the nurse and it should be advised by the nurse that it should never be chewed. The advice regarding possible moderate fever should be given and the regular check up of the patient should be done. 

ANAGESIC:

This drug also relieves the pain. It may be used to moderate to severe pain reliefs. The doctor had advised Mr Leigh to take strong painkiller because he had severe pain. Additionally, Leigh had been given fentanyl intravenously.

ANTI INFLAMMATORY DRUGS

It may be added once more that Doctor had advised Mr Leigh to take anti-inflammatory drugs for reducing inflammation. It was believed that the inflammation was due to pressure created in the bony muscles. As the name suggests, the anti-inflammatory drugs has the tendency of reducing inflammation and this inflammation may be due to the injury or due to the dead tissue. The anti-inflammatory drug taken by Mr Leigh is ibuprofen. 

IBUPROFEN 

It is worthy to put here that Ibuprofen is a non-steroidal anti-inflammatory drug. It is also used as analgesics as well as antipyretics. It comes in various generic forms such as Advil, Novoprofen or Actiprofen. It helps in inhibiting the cyclo-oxygenase and may be said to produce prostaglandin (Nichol and Allen, 2015). This prostaglandin helps in inducing the pain, the inflammation as well as the fever.  

It may be found that the this drug is used in treatment of may symptoms such fever, rheumatoid arthritis, dysmenorrhea, tooth ache, musculoskeletal disorders etc. It has been found that ibuprofen may be used to treat moderate to severe pains of inflammatory disorders which are caused after injuries (Harris, 2015). It reduces the inflammation.

Ibuprofen is taken mostly in oral form. It can be found in the medicine shops in the form of tablets. It is metabolized in liver and then it reaches through portal circulation and finally excretes from the body via kidney in the urinal form. It reaches its minimum dose in 2 to 4 hours (Rainsford, 2015).

On the similar lines of many allopathic drugs, the side as well as adverse effects of the Ibuprofen can’t be ignored and it can be said that this drug may cause headache,  tachycardia, nausea, palpitations, drowsiness, anxiety, rashes as well as depression to some patients. In practice, it has found that ibuprofen exhibit minimum of the side effects cited above. However, it is always advised that this drug should not be taken without prescription by the doctor. It should also not be taken for the longer period of time. It general is can’t be undermined that the anti-inflammatory drugs have the tendency of affecting gastrointestinal tracts. In some cases, it may cause the situations like stomach bloating, acidity, gas formation, diarrhea, heartburn, nausea and vomiting. Hence, while prescribing this drug, the care is to be taken to advise the patient to take this drug with milk and only after having some food because it will reduce the side effects to much higher level. 

It may be noted that if this drug is taken with other non-steroidal and anti-inflammatory drugs like aspirin, the ibuprofen may not be able to achieve its aim. The effect may not be seen and may be very minimal. In this case, the side effects in form of gastrointestinal reactions like acidity, cramping, etc. may be experienced heavily. Some commonly used kitchen materials such as garlic, clove, ginger etc. are prohibited to be taken along with Ibuprofen other the chances of internal bleeding may be increased.

It may also be added there that the ibuprofen is not to be prescribed or administered to the patients having the history of allergy or hypersensitivity to the anti-inflammatory drugs. In patients having respiratory problems or asthma, pregnancy in advanced stages, the drug named ibuprofen may not be prescribed at all because in case of pregnancy the danger to the mother along with the baby may be faced. It may also cause the hepatic as well as the renal damages. It is highly advisable to doctors and medical practioners including the nursed to discuss and record the history of the patient before prescribing the medicine. In the case of Mr Leigh, it can said that he can take this drug as his history does reveal any symptom related to allergy or hypersensitivity. 

It may be reiterated once more that the nurse and all concerned medical professionals must perform their duties and assessing the risks that the patient may be exposed. Without due care no medicine may be prescribed. In the instant case, Mr Leigh has been advised to take ibuprofen by his physician when he was discharged from the hospital and the nurse has given all necessary advice regarding intake of the drug. 

SIGN AS WELL AS SYMPTOMS

In the present case, Mr Leigh has been suffering from the problem of compartment syndrome. It has the symptoms of pain, numbness, sinus tachycardia of moderate nature, tingling sensation in left arm as well as left leg (Gutfraynd and Philpott, 2016). This is coupled by weakness of muscles of left arm as well as leg. The compartment syndrome may be defined as the stoppage of blood supplies to the tissues or to the muscles towards some bone area. It happens due to excessive pressure which may be the aftereffect of the orthopedic trauma, plaster, tight bandage or fracture and in this tissue necrosis has the tendency of causing severe nerve damages or may lead to loss of sensation in the affected part

Leigh has complained of severe ache, numbness of left leg as well as arm and muscles, acute weakness of injured part. He also suffered due to sinus tachycardia of mild nature. He also has complaints of mild tachypenia. Doctor had prescribed antibiotics to treat infections and anti-inflammatory drugs for reducing inflammation. It was expected that the pain would be reduced because it is the most important symptom indicating compartment syndrome.

It has been found various researches by the medical professionals that main cause of the pain is inflammation as well as tissue damage (Sander and Weil, 2016). It may occur due to application of force on the affected part of the body. This application of force may be due to accident, fracture or surgery. The patient of instant case, Mr Leigh had also met with an accident and he had suffered of open bone fracture of arm. He had undergone  surgery for that and later suffered from compartment syndrome. It was found that this was due to the excessive force was applied on the bony muscles as well as tissues in the fracture. Due to this reason only, Mr Leigh has been found to suffer from severe pain caused by inflammation as well as tissue necrosis.

Other symptom observed in the present case is the numbness and muscles’ weakness because of tissue damages and nerve damages. In the instant case, Mr Leigh has also been found to have difficulty in movement of left arm as well as leg. 

CONCLUSION 

The study of Mr Leigh’ case reveals that compartment syndrome is such a situation where severe nerve as well as tissue damage may be suspected and it may be treated on priority. Mr Leigh had suffered many criticalities as mentioned above and he had been advised by his doctor to take analgesic in form of fentanyl intravenously, anti-inflammatory drug in the form of ibuprofen for cure of inflammation along with antibiotic in the form of cephalothin for reducing the possibility of infection. Apart from these, Mr Leigh has been prescribed for light body movements for increasing the muscle power and for maintaining the muscle integrity.

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