NUR231: Neospinothalamic and Paleospinothalamic Tract - Nursing Case Study Assessment Answer

Subject Code: NUR231 Internal Code: 1AGFDD

Nursing Case Study Assessment Answer

TASK: David is an elderly gentleman describing symptoms of nociceptive slow pain by articulating that he is experiencing generalised, continuous and intensifying, lower back pain. Visceral slow impulse pain is transmitted by thin C-fibres through the paleospinothalamic tract and is dispersed diffusely within the brain by the neurotransmitter substance P (Craft, Gordon, Tiziani, Huether, et al., 2010, pp. 477- 483). This diffuse transmission is attributed with a poor determination of pain localisation as opposed to nociceptive fast pain which travels along the neospinothalamic tract and has a neurotransmitter that transmits to specific areas of the outer brain cortex, allowing for acute origin of pain to be identified (Craft, et al., 2010, pp. 477-483). David was prescribed non-steroidal anti-inflammatory drugs (NSAIDS) for pain management. Being over the age of sixty-five, David has an altered ability to metabolise drugs (Park, Qin, & Bavry, 2012, p. 167). This change in pharmacodynamics may alter the potency of drug effectiveness and increase patient risk of experiencing associated detrimental side effects caused by a potentially prolonged exposure to the harmful end products of the COX pathway (Park, Qin, & Bavry, 2012, p. 170). The MRI conducted on David displayed tissue destruction of thoracic and lumber vertebrae due to bone metastases. The disease progression of metastatic bone lesions will cause increasing pain and debilitation for the patient (Mabry, Ross, & Tonarelli, 2014). While the exact mechanism of action is unclear, visceral nociceptive pain responds well to opioids (Bryant, Knights, Rowland, & Darroch, 2018, p. 273). As such, David’s pain management plan should be individually tailored to include a low oral dose opioid such as codeine, with a rapid release oral opioid for breakthrough pain relief (Bryant et al, 2018, p.269). Stepping up to a stronger slow release oral opioid, such as morphine, is likely to be required as the disease advances (Bryant et al, 2018, p. 269). Due to the degenerative nature of the metastatic disease, the dose required, opiate being prescribed, and route of delivery will need to be reviewed regularly and amended accordingly to treat changing pain circumstances (Bryant et al, 2018, p. 270). NUR231 For instance, Fentanyl, delivered by a patch, may become desirable (Canadian Virtual Hospice, 2017). A dosage increase due to a build-up in opioid tolerance is unlikely given the underlying patient pathophysiology (Bryant et al, 2018, p. 270). As opioids affect the gastro-intestinal tract, constipation should be pre-empted and David should be advised on establishing a high fibre diet and consider taking a prophylactic laxative (Bryant et al, 2018, p. 279). Including a oral bisphosphonate in the patient’s drug regime may aid in delaying the disease progression by slowing down the breakdown of bone related and thus reduce associated pain.

This Nursing Assessment has been solved by our Nursing experts at My Uni Paper. Our Assignment Writing Experts are efficient to provide a fresh solution to this question. We are serving more than 10000+ Students in Australia, UK & US by helping them to score HD in their academics. Our Experts are well trained to follow all marking rubrics & referencing style.