Your 70-year-old client, Max, is 1 hour post-op following a total hip replacement. On arrival to his room, Max tells you that his hip pain is an 8 on a scale of 1-10. As per the doctor's order, you administer Demerol 50 mg IM. Max is usually up ad lib, and alert and oriented. However, he is a little sleepy and confused following the pain medication.

In a Word document, answer the following:

1. What safety concerns exist for Max?
2. What interventions would we take to insure Max's safety?
3. Is Demerol a good choice for 70-year-old Max? Why or why not?
4. You are in a discharge meeting for Max which is also attended by Max's wife, the RN leading the team today, physical therapy, and a pharmacist. Max's wife would like him to return home, but isn't sure how she will manage. What type of services could help Max safely return home?

 

Post operative patient after a total hip replacement on day one will definitely experience pain which has to be controlled by administrating the ordered analgesics .Demerol belongs to the opioid analgesics. This has to be administered in great caution and the patient should be closely monitored for any adverse reactions and take appropriate preventative measures especially in elderly clients.

Step-by-step explanation

1.The safety concerns which exists for this patient are

• Risk for addiction and abuse
• Respiratory depression can occur with this medication
• Gastrointestinal disturbances like nausea, vomiting, constipation ,paralytic ileus
• Central nervous system alterations Luke lightheadedness ,confusion, dizziness or drowsiness ,delirium
• Cardiovascular system can be affected by arrhythmia, low blood pressure
• Risk of androgen or adrenal insufficiency
• Renal impairment by decreased urine output in volume and frequency or urinary retention

2.The interventions which had to be taken to insure Max's safety are

• Monitor vital signs especially the respiratory rate and oxygen saturation to prevent respiratory depression by administrating oxygen as per order
• Assess the patient's neurological status, in order to check the level of consciousness
• Monitor the intake and output. Especially the output because patient can have adverse effects of decreased micturation
• Assess for signs of addiction, overdose in the patient
• Assess the pain level to know the effectiveness of pain medication and the response of the patient
• Administer medication as per order following the rights of medication administration to avoid medication error
• Document the medication administration in order to avoid double dosing
• Administer intravenous fluid as per order in order to reduce the incidence of decreased urine output and prevent constipation later

3.Demerol is an opioid analgesic which is not a safe drug for a geriatric or elderly patients. This is because in old-age patient the metabolism is decreased so there is high chance for the medication not to be distributed and excreted appropriately. In this case it will risk the older patient to have respiratory depression, coma and even death. This will be the second choice of medications in older patient when the other analgesics fails to relieve pain.

4.Elderly patient who has undergone THR need an appropriate and effective continuity of care in the home too.

The type of service which could help Max return home safely are

• Skilled nursing service in case patient has to be administered any intravenous injections after discharge
• Nursing assistant or a personal support worker to help in doing the daily activities
• Physical therapy service in order to help the patient to regain his strength and enable him to walk with walking aide.