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Promoting Safety, Independence, and Least Restrictive Environments

When surgical patients are just one hour out of their surgeries, they are still in pain, which prompts medical practitioners to prescribe pain relief medicine such as Demerol. However, in the case of Max, a 70-year-old patient, the type of medication defined can be different to avoid exacerbating safety issues caused by hip replacement surgery. Nonetheless, the doctor ordered that the patient receive Demerol 50 mg IM, which has led to confusion and other side effects.

Safety Concerns for Max

One of the safety concerns that exists for Max is gastrointestinal implications such as constipation and stomach pains. Research has shown that most surgical patients experience the abovementioned complications after the operation (Harris et al., 2020). Harris and colleagues assert that although surgical patients receive information regarding the safety concerns they will encounter after the surgery, most will still be worried about them post-operation. At the same time, meperidine or Demerol have been found to control only mild pain after surgery. With Max having a pain of 8 on a scale of 1-10, it is evident that he will be forced to combine these opioids with other pain relief medication, which can affect their recovery. The fact that Demerol can only control mild pain means that Max can also misuse or use too much of the drug as he attempts to relieve his pain. Such actions are likely to result in physical dependence and addiction to the drug (Wong et al., 2020). Like most opioids, Demerol has been considered to be addictive, and too much dependence on it can affect the patients. Since tolerance to the drug builds quickly, its pain-relieving properties can diminish, leading to frequent doses.

Interventions to Ensure Max’s Safety

One intervention that can be taken to ensure Max’s safety is changing the prescribed medicine. Solhi et al. (2016) compared morphine and Demerol in the treatment of severe pain. The authors found that morphine is a more effective and potent drug in the treatment of severe pain. The patients prescribed morphine reported higher pain control than the ones using Demerol. This means that, although both drugs have the potential to cause addiction, morphine can relieve the pain faster, hence reducing the chances of drug tolerance and physical dependence. Another intervention technique would be to monitor signs of addiction and other adverse effects of the drug while Max continues using Demerol. This will help to understand the patient’s usage of the drug and whether the doctor should prescribe alternative medication. The pain level should also be assessed to determine if it reduces during the medication and post-operation phase.

Is Demerol a Good Choice for Max

Research shows that the age-associated side effects make Demerol not the best pain relief medication for elderly patients like Max (Harrison et al., 2022). According to Harrison and colleagues, meperidine is considered a poor choice for controlling pain among the elderly because it will unlikely offer the appropriate pain control. Also, the medication can result in seizures or delirium among elderly patients, which has made medical boards and practitioners in the United States discourage its use with these clients. Any healthcare facility that uses the drug in patients older than 65 years is likely to risk the elderly instead of helping them relieve the post-operation pain.

Services to Help Max Return Home Safely

Delayed discharge from the hospital to another setting can result in poor outcomes for the patients and cause distress to them and their family members (Gonçalves-Bradley et al., 2022). Therefore, one of the services that can help Max return home safely is making transport services available to the patient. Some hospitals have transportation services, which include wheelchair vans, ambulances, and others. If Max is eligible for this service, the hospital will safely transport them to their residence. Besides, offering to take the patient home or requesting another carer to accompany Max and his wife home will ensure they can safely return home. The physical therapy will ensure the patient is in good shape before leaving the facility, while the pharmacist ensures they have all the necessary medication. On the other hand, the registered nurse will give Max’s wife comprehensive instructions on how she can help the patient while at home, including how and when to communicate to clinicians for any medical advice.

References

Gonçalves-Bradley, D. C., Lannin, N. A., Clemson, L., Cameron, I. D., & Shepperd, S. (2022). Discharge planning from the hospital. Cochrane Database of Systematic Reviews, (2), pp. 1–113.

Harris, K., Søfteland, E., Moi, A. L., Harthug, S., Storesund, A., Jesuthasan, S., … & Haugen, A. S. (2020). Patients and healthcare workers’ recommendations for a surgical patient safety checklist–a qualitative study. BMC Health Services Research20, 1-10.

Harrison, L. R., Arnet, R. E., Ramos, A. S., Chinga, P. A., Anthony, T. R., Boyle, J. M., … & Piper, B. J. (2022). Pronounced declines in meperidine in the US: Is the end imminent? Pharmacy10(6), 1–9.

Solhi, H., Sanaei-Zadeh, H., Solhi, S., Nadian, M. A. A., Gharibi, M., & Sedeh, B. S. (2016). Meperidine (pethidine) versus morphine in acute pain management of opioid-dependent patients. Open Access Emergency Medicine, 57-59.

Wong, S. S. C., & Cheung, C. W. (2020). Analgesic efficacy and adverse effects of meperidine in managing postoperative or labor pain: a narrative review of randomized controlled trials. Pain Physician23(2), 175-201.

 

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