Medical Facts Relating to the Paracetamol Overdose from a Critical Perspective - Case Study Example

CASE STUDY Student Name Course Name Instructor: Date Case Scenario Introduction Cases of paracetamol overdose are becoming more and more frequent in the society. This observation may be attributed to the ease of access of the paracetamol as they are an over the counter medication. As explained by Roberts (2011) even a slight addition to the stipulated dosage is an overdose. Some over dosages may not have adverse or noticeable effects but will still have an effect on the person. This over dosage is worse in people who have chronic pain who use excessive painkillers. This report therefore looks into all medical facts relating to the overdose from a critical perspective. Critical questions that can be used to analyze the situation and come up with appropriate medical interventions are also added to ensure that the learning is through an Inquiry Based Learning method. Erikson theory of life span development is used in this case in order to understand the patient’s progress in relation to it. Critical Questions and Rational The critical questions that have to be addressed in this case scenario reports are i. What is the patient’s current health condition? For the patient to be treated a clear medical history of the patient has to be well understood. These include previous health problems, any genetic health problems as well as allergies to medications. As stated in the study, the patient is a type 1 diabetic that was diagnosed recently. The patient is under diabetic medication but forgets to take it sometimes. Jeremy is unstable health wise with withdrawal symptoms and teary eyes when brought in. (Graudins, 2009). ii. What are the factors that are causing the patient to forget his diabetic treatment dose? It is important to observe that the fact that the patient has been missing his diabetes dosage. It is important to understand these reasons so as relevant in advising the patient on relevant behavioral changes. iii. What is the cause of the persistent headache that have driven the patient to an overdose? This headache is the main reason behind the over dosage. Once the cause of the headache is clear, the patient will not have to rely on painkillers again. The headache may be due to depression (Heath et al, 2008 p. 301-308). It is therefore important that it is well understood so as to reduce cases of overdose in future. iv. What lifestyle habits or social factors have affected the patient’s health? As explained in the case study, the patient’s lifestyle seems to be that of a typical 18 year old who spends most of the time out with friends. He is also living apart from his family which denotes that he has no close family member that can remind him about his dosages or provide guidance during illness. It also states that the patient is also working long hours so as to provide for himself. Analysis of the case study using Theoretical principles The Erikson theory of Life Span and Development The Erikson theory is one of several theories that explain the development of psychology of man which is based on the inner and outer conflicts of a person as they transition through life stages. Candida (2010, p. 52), gives detail on this theory. The theory has eight psychosocial stages which present a conflict. According to the theory, this is a stage that is characterized by the search for identity and the confusion of roles for the eighteen year old Jeremy. It is a stage where one is in search of identification depending on their past and present experiences. If this stage is successful, the teen will stay true to themselves and to others. Failure of this stage will lead to an identity crisis as well as low self-esteem (McLeud, 2008). The present condition of the patient has been explained in the case scenario as a case of over dosage of paracetamol combined with missed diabetes dosages. Emotionally, the patient is unstable due to poor relationships with his family and friends. The case scenario also explains that the patient is working long hours in order to cater for his needs and is performing poorly academically. In reference to the Erikson theory of lifespan development, the patient seems to be a failure. His past relationships are bad since he has no family in Australia. His desire to fit in the society is putting his health at risk as it is causing him to forget his medications. Impact of culture, values, beliefs, norms and lifestyle on health According to the case study, the life of the patient is that of an overworked teenager who is stressed beyond his limits. Culturally, as explained by Diane et al (2007), it is the family that is provides for family members that are underage. The fact that he has to work so as to cater for himself predicts that the cultural setting he was brought up encouraged individualism. It also suggests that his family culture depends entirely on nurses and medical personnel to provide healthcare. Diabetes type 1 is, in most cases, caused by genetic factors. In a different cultural setting, the family would have been more involved (Marimoto, 2008). A major risky practice that Jeremy is involved in is forgetting his diabetes medication. As explained in the scenario, Jeremy likes to go out with friends. If he is also an alcoholic, an overdose of PanadolOsteo tablets will affect his liver. As explained by Shailesh (2011), the effects of over dosage of PanadolOsteo will be worse in alcoholics due to its health effects on the liver. In fact the paracetamol should not be used by patients that take more than three beers per day without being prescribed by a doctor. Nursing Analysis of the case study Assessment of the patients health after the over dosage This case study involves a patient who overdosed on easily accessible over the counter painkillers known as PanadolOsteo. According to Graudins et al (2009), the paracetamol is formulation that is used as a painkiller for chronic and delays in treatment will lead to an increase on paracetamol levels in the body. Jeremy is brought approximately three and a half hours after ingestion of an unknown amount of PanadolOsteo. Physical symptoms that are noticed are withdrawal signs and teary eyes. One of the adverse effects of the overdose is the effect on the liver and if not treated well may cause a fulminant hepatic failure. Additional symptoms that may be observed include nausea, vomiting, stomach pain and sweating. Symptoms that are observed later include dark urine, pain in the lower stomach and yellowing of the skin. This is due to the effect of high paracetamol levels on the liver. Nursing interventions Since Jeremy is presented within four hours of ingestion, the first step is to measure the levels of paracetamol and the base acid status as the amount ingested is unknown. According to Tan (2006) the test on the paracetamol levels may be very helpful in risk assessment and more tests should be done after four hours. This is due to the fact that this over dosage leads to delays in reaching maximum plasma concentration levels and paracetamol absorption may be prolonged. This happens because there is continued absorption of the paracetamol. In addition to that, the sugar levels of the patient must be tested and stabilized before starting the treatment. The first treatment is continual treatment with N-acetyl cysteine if the overdose is greater than 10 grams. This treatment involves a 21 hour intravenous protocol that should continue for 5 days which is a dosage of 700mg/kg that will neutralize the paracetamol levels. Activated charcoal is another nursing intervention that can be used to reduce levels of the paracetamol. As stated by Watson et al (1997, p. 31) the activated charcoal works by reducing the quantity of paracetamol absorbed and hence reduces the peak levels. This intervention is however not used in this case as it is most effective when the post ingestion period is 1 to 2 hours (Graudins, 2009). Discharge Planning Discharge planning is conducted for patients that are leaving a healthcare setting that was providing them with care. This may involve hospices, home health agencies, inpatient rehabilitation facilities and inpatient psychiatric facilities. According to Heath et al (1998, p. 307) depression is a cause of headaches. Jeremy is depressed because of his recent breakup and is far away from his family. As part of discharge planning Jeremy should also be educated on the effects of using paracetamol in overdosed levels. In addition to that the patient is in need of counselling sessions which can be done during his recovery sessions at the hospital or after his discharge. He should also be trained on coping skills after negative situations in his life and be educated on the importance of taking his diabetes medication. This is because of the emotional factors that are distressing the patient and the fact that he seems to have lost his self-worth as seen by his poor performance in school and poor relationships (Medicare Learning Network, 2013). Safety of the patient as said by Krause et al (2009), covers the safety of the patient and quality of the care that the patient will receive. The patient’s safety must be the most paramount thing when treating Jeremy. Core factors that cover the safety of the patient include professional practice, provision and coordination of care, therapeutic and collaborative practice and critical thinking and analysis. There should be no errors in analysis of the patient’s condition and treatment Conclusion This case study has been an analysis of the patient’s condition. It is noted that the patient has lost his sense of self due to the poor relationships has had. The patient is also negligent of the fact that he has diabetes type 1 due to the fact that he forgoes his medication. It essential that he attends counseling sessions. This will help him regain focus both in school and in his entire life. This will help prevent more cases of over dosage. In addition to that, over the counter medicines should be used with caution. List of references Candida, CP 2013, looking forward through the lifespan: developmental psychology, French’s Forest, N.S.W. Pearson Australia. Craven RF 1992, Fundamentals of nursing: Human health and function. Lippincott. Diane, B &Helen, E 2008, Lewis’ medical-surgical nursing: assessment and management of clinical problems, Marrickville, N.S.W.: Elsevier Australia, 2008. Monica, EM 2005, Management and Leadership in Nursing and Health Care: An Experiential Approach, Springer publishing company, New York. Graudins A, Chiew A & Chan BS 2009, Overdose with modified-release paracetamol results in delayed and prolonged absorption of paracetamol: A case series. Internal Medicine Journal: In press. Krause, RT & Hidley, JH 2009, Taking the Lead in Patient Safety: How Healthcare Leaders Influence Behavior, John Wiley & Sons. Inc., Hoboken, New Jersey. Morimoto K 2008, "Lifestyle and health." journal-Japanese association of physical medicine balneology and climatology. Medicare Learning Network 2013, Discharge planning. Viewed 12th August 2014, McLeud, S. 2008 Erik Erikson. Viewed 12th August 2014, < http://www.simplypsychology.org/Erik-Erikson.html>. Roberts, M. 2011,Paracetamol warning: 'slightly too much can cause overdose', Viewed 12th August 2014, Sherman, R.O. 2006, Leading a Multigenerational Nursing Workforce: Issues, Challenges and Strategies. Viewed 12th August 2014, Shailesh, B, Santosh, V & Bersten D. Delayed and prolonged elevated serum paracetamol level after an overdose - possible causes and implications. [Online]. Viewed 12th August 2014, Tan, C & Graudins, A 2006 Comparative pharmacokinetics of Panadol Extend and immediate-release paracetamol in a simulated overdose model. Viewed 15th August 2014, Watson WA. Vraa EP. Neau SH. 1997, Dissolution of acetaminophen tablets under overdose Conditions. Ann Pharmacother. Read More