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Morphine has to be used with extra caution and several nursing responsibilities are related with morphine administration. Morphine falls under the category of opioiad analgesic drug used to treat severe unbearable pain. 15mg of morphine IM QID is planned to be given to 48 yrs old Eleanor for relieving her lower abdominal pain caused by ulcerative colitis. Prior to administration of morphine, it is required that the patient and caretakers are given all the required information related to the medicine. By using effective verbal and non verbal communication skills, they should be delivered relevant information and their queries must be answered. The patient must be informed about minor side effects like drowsiness, change in sleep patterns, constipation, nausea, etc and also that the drug is addictive and thus, must not be withdrawn suddenly or unintentionally. Further, it is also required to take a good medical history of patient. Information regarding other medical conditions, medicines, allergies, sleeping patterns etc must be taken and few tests like liver function tests must be carried out. All these are important to prevent drug interactions, drug allergies and unwanted side effects and to ensure healthy drug metabolism in body. In addition, it is essential that patient’s rate and depth of respiration and pupil size are noted before giving morphine to compare the changes and to check drug toxicity. Since, morphine is respiratory depressant, slight decrease in respiratory rate is expected but if this rate decreases to 12/minute along with extreme pupil constriction, this indicates toxicity. In such a case it is recommended to immediately stop the drug and to consult the doctor. Close observation of patient is essentially required after drug administration which would include checking vital signs regularly and keeping a record of pain relief pattern. In case of signs of rebound pain, disturbed vital signs, anxiety, or dizziness, doctor must be immediately consulted with.
Inflammation of colon and rectum leading to ulcers in large intestine is known as ulcerative colitis and it leads to abdominal cramps, diarrhea and bleeding. Although an exact cause is not known, but an overactive immune system along with some genetic factors and environmental factors causes this inflammatory reaction in colon and rectum. It has been proposed that immune system starts acting against normal intestinal flora or other bacteria and viruses and this inflammation eventually damages the internal lining of intestine leading to sores or ulcers. These ulcers tend to bleed and are the cause of bleeding. Further, branching starts in intestinal crypts and size and shape of these crypts gets change. There is increase in the number of chronic inflammatory cells in the lamina propria and due to this damage of internal lining, absorption of digested food and water is greatly hampered that eventually leads to watery diarrhea. Due to this malabsorption, the patient with ulcerative colitis starts losing weight and get cachexic over time. In fact, over time due to long standing inflammation, the ulcers get infected and pus is formed. This pus is also eliminated with bloody and watery diarrhea.
Eleanor has been prescribed with 1 liter of Hartman’s solution every 6 hourly. This solution is made up of sodium chloride, sodium lactate, potassium chloride, calcium chloride dihydrate and anhydrous glucose.
Due to severe diarrhea, Eleanor’s fluid and electrolyte balance has been disturbed. To restore this balance, this solution has been prescribed. Since, it is a combination of multiple electrolytes along with alkalizing agent sodium lactate, the acid base balance of the body is also restored along with maintenance of electrolyte balance. Where sodium, potassium and chloride helps in maintaining fluid, electrolyte balance, water distribution and osmotic pressure of body, calcium is useful in maintaining nervous, muscular and skeletal system integrity and glucose provides the required energy.