Pain Relief with Morphine

Morphine is the drug that is given to the patients as pain relief. The World Health Organisation [WHO] has approved the Morphine as one of the most potent analgesic drugs for treating severe pain. This essay is going to discuss the management and pharmacological process of morphine. Here the effect of Morphine in managing pain in the patient in the given case study will be critically analysed. The essay will also discuss the drug calculation and the prescription errors that nurses in the case study need to identify to provide safe health care to the patient. For those exploring similar topics, seeking healthcare dissertation help can provide valuable insights into effective management practices and error prevention strategies.

Morphine is a potential pain medication of opiate family that is generally found in the number of animals and plants (Baek et al. 2020). This medicine is used in managing the severe pain in the patient such as pain due to the accidents, post-surgery pain, trauma-related pain, cancer-related pain and intolerable pain due to the inflammation. Although this is one of the most essential pain relief medicine, it needs to be noted that this drug is the potential narcotic and is a controlled drug by the law (NICE, 2015]. There are important guidelines as well as instruction that health professionals and nurses must follow in terms of providing the right dose of morphine to the patient. The law enforcing agency sets the standard under which nurses and doctors can provide the dose of morphine within the given range that ensure safe care to the patient.

There are several ways of Morphine administration in patients’ body such as intravenously, orally, epidural, subcutaneous and infusion (Cracowski et al. 2020). The overall effect of morphine is same while administering in patients in these ways. As mentioned by NCBI although the overall effect of morphine in a patient is same despite administering the medicine in different ways, the differences in the dosage in the different patient will affect them differently (NHS, 2015]. In the case of Mr Winston, the intramuscular administration of 10 mg Morphine has been carried out to manage his pain. Under the guidelines of the Medicines and Healthcare Products Regulatory Agency (MHRA), the process of administration and dosage selectin of Morphine is based on the severity of the pain and the tolerance ability of the patient. Evidence suggests that subcutaneous process of administration of morphine is not generally relevant in case of patients with the oedematous condition. The intramuscular administration morphine is generally used in case of patients with moderate to severe pain. In the given case study, the patient, Mr Winston met an accident and suffers from severe pain, therefore, in case of him the intramuscular administration of Morphine is justified.

While administering Morphine doctors and nurses must check the age, health condition, the history and current health condition of the patient (De Witt Jansen et al. 2017). Under MHRA morphine generally cannot be administered in patients less than 14 years and also in case of the patients with asthma, heart disease and acute chest syndrome (ACS). Here in the case study, the intramuscular administration of morphine in case of Mr Winston is justified as his overall health assessment shows that he does not have any of this above-mentioned signs and he is 20 years old, therefore in his case the intramuscular administration of morphine is highly suitable.

Pharmacology is referred to as the study that deals with the interaction of the chemical substances of a drug with a different system of the body. Pharmacology discusses that how a drug impact on different body systems after administration (Fang et al. 2017). It also determines the means of ways in which human bodies also impact on the overall work process of the drug inside the body. In the pharmacological study the usage, side effects, commercial use, clinical use and the social use of different drugs are discussed comprehensively. In the given case study, the pharmacology of morphine is going to discuss how this drug will react on the ibuprofen 300 after administrating intravenously into Mr Winston. Here the medical history, weight, age, current health complication, history and regular lifestyles of Mr Winston need to be analysed as well as evaluated by the nurses and doctors in terms of determining the right dose of morphine for this patient.

Morphine is the analgesic drug which when administered into the patient’s body it reacts with the receptors such as mu-opioid (as morphine belongs to the opinion family), kappa and delta receptors that are located in the peripheral and central nervous system (Hong et al. 2017). Morphine predominantly interacts and bind to the μ-opioid receptors that are generally present in the CNS and PNS such as the human brain, spinal cord and gut. It is noted that there are factors that are associated with the stimulation of the above-mentioned three types of receptors into PNS and CNS, such as analgesia, respiratory depression, severe pain, sedation, euphoria, psychotic pain and trauma (Hunnicutt et al. 2017.). In the case of Mr Winston, the μ-opioid gets activated because of post-accident trauma and pain. Morphine is also considered as the potential δ-opioid and κ-opioid receptor agonist. The activation of these two receptors that are also present in the CNS and the PNS are associated with trauma, analgesia, healing severe pain and manage psychotomimetic behaviour of the patients.

After administered inro the body through different processes such as orally or intravenously, morphine binds to any of the above-mentioned receptors (based on the type of pain and the process of administration) thereby changing the way nervous system and brain work as well as respond to different types of feeling such as pain (Malick et al. 2020). The clinical intervention has proved that morphine administration overtimes in case of patients with the severe to moderate pain reduces the feeling of pain and makes the body tolerable to the pain. The pharmacological study of morphine shows that after binding to the μ-opioid receptor, morphine stimulates the receptor which causes pain relief and excitement (Miotto et al, 2017). There are several controversies regarding the use of morphine, in which many clinical studies have maintained that excess use of morphine in case of severe pain can pose adverse impacts on the respiratory system as well as on the cardiovascular functioning. In this context, the overall health tests of Mr Winston shows that he does not have any respiratory illness (he has a normal breathing rate and oxygen saturation) or any issue with his cardiovascular system. Therefore, in his case, the intramuscular administration of morphine is a justified decision that can reduce his pain.

Morphine also activates the κ-opioid receptors that are generally present in the brain system, diencephalon and limbic system (Müller et al. 2017). While binding to the receptors, morphine causes excitement, breathlessness and pain relief. Delta receptor generally present on the spinal cord, digestive system and the brain that is associated with triggering the breathlessness, analgesics and antidepression while get stimulated after binding to the Morphine. Evidence suggests that the use of Morphine overtimes can cause several side effects such as constipation even after the dose is stopped. Therefore, in the case study nurses and doctors must ensure that they guide Mr Winston in such a way that will assist him to manage any effect of Morphine after his discharge.

As per the instruction set by MHRA while administering morphine into patients’ body, the health professional must ensure that the dose of the drug is appropriate to the severity of pain in patients (MHRA, 2015). The wrong dose of morphine is considered as the contra-indicative that cause several serious health complications in patients’ body such as breathlessness, pulmonary dysfunction and cardiac failure. While administering morphine, health professionals must ensure that patient does not has the history of alcoholism, hypotension, hypovolaemia, urethra stenosis and hypertrophy (Persell et al. 2018). Therefore, before administering morphine, health professionals must check the overall medical history, current health condition, additional health complications along with the pain and the lifestyles of the patient. Here in the case study, Mr Winston’s lifestyles, medical history and the current medical health status are evaluated which shows that there is no such above-mentioned factors in this case study which can pose bars on the administration of morphine into his body, The medical history and the lifestyles analysis of Mr Winston have shown that he has no history of alcoholism, he has normal breathing rate, normal oxygen saturation level, there is no case of cardiac illness and his age is more than 14 years ( morphine cannot be used in patients’ below14 years age). Therefore, in the case of Mr Winston, the decision of morphine administration is highly appropriate that assist Me. Winston to manage his overall physical pain.

Pharmacology of morphine shows that this drug can cause severe toxicity when using with the inappropriate combination of the other drugs (Samarkandi, 2018). Some drugs can develop severe toxicity while administered in association with morphine which thereby impacting on the body system adversely and even can cause the death of the patient. For examples, benzodiazepines, while administered with morphine, can cause severe toxicity inside the body that pose adverse impacts on the respiratory system and the cardiac system of the body. Others agents that can also cause toxicity insides the body after administration of Morphine are alcohol, additional opioids, analgesics and barbiturates. Therefore, in the given case study, nurses must look out these aspects while administering the morphine to ensure that the overall administration process of morphine is safe and appropriate for Mr Winston. From the patients’ case study and the prescription, it’s clear that in case of Mr Winston morphine is administered in associated with paracetamol and ibuprofen that are not categorised under the above-mentioned age, therefore are safe while using with Morphine.

While administering the morphine, nurses must consider the pharmacological parameter of this drug, the pharmacological parameters of any drug are its rate and the amount of dose in which it is circulated and absorbed into the patient’s body system till it is excreted from the body (Persell et al. 2018). After administration or Morphine, it is transported into different body system through the gastrointestinal mucosa. Before reaching the destination, the morphine under the metabolic biotransformation, which is the hepatic first-pass process. In the case of oral administration, the bioavailability of this drug is low, therefore it takes at least 30-90 minutes to produce the appropriate effect. On the other hand, while administered intramuscularly or subcutaneously, it takes only 15-20 minutes to work on the body system. This is why in case of the severe and acute pain the intramuscular or subcutaneous administration is used. In the given case study Mr Winston suffers from severe pain due to the accident, therefore in his case, the intramuscular administration of morphine is highly relevant.

Although morphine has a high volume of distribution it's 30% attaches to the plasma protein and 30% of its overall clearance is carried out by the extrahepatic metabolism (Sawan et al. 2017). This is why morphine has a very short half-life (2 years). The entire metabolism process of morphine is done into the liver in which it undergoes the glucuronidation. Throughout this process, the morphine 3 glucuronide is discharged from the body through urine, on the other hand, the morphine 6 glucuronide remains within the body and performs its function thereby maintaining its half-life. After the 2 hours, this morphine 6 glucuronides is also eliminated from the body through the urine. In the case of the patient, Mr Winston, morphine is produced through mixing the 10 mg of morphine with the 9 ml of saline and then administered through the intramuscular process. As Mr Winston does not has any liver problems, there are no chances of any disturbance to the function of the morphine in the digestives system. Medication and prescription errors are the major concerns in modern health care context (Shorofi and Arbon, 2017). These errors not only have the economic implications as it enhances the overall annual spending of NHS in each year but also misleading to the entire treatment process that can even cause death. Majority of the medication and prescription occurs during the patient’s journey from one ward to the another during their inpatient stage in the hospital. Recent WHO report has stated that in each year NHS has to spend more than 98.5 million to fix the errors made by the doctors and nurses in the medication process and prescription. The report also shows that there are more than 700-1000 deaths each year in the UK due to medication and prescription errors. It is evaluated by 4.9% of all the prescriptions that transferred from the hospital to the general practitioners generally have the errors. Under MHRA health professionals follow the 7rs in terms of eliminating the chances of medication and prescription errors (Silva, 2021). These 7 rs are right patients, right medication, right route, right dosage, right time, right record and right signature by the right person. The prescription made by the doctors must be easily read and understood by the nurses. If there is any confusion or uncertainty for the nurse to understand any medication and instruction on the prescription, they must then and then consult with the concerned doctor to solve the confusion [NMC, 2015]. In the case of the treatment of Mr Winston, there are several medications and restriction errors. The information that is on the drug chart (DG) of Mr Winston is different from that in the Medication Administration Record (MAR). For example, the administration process for morphine is mentioned as intramuscular on the MAR, while it is described as the intravenous in DC. On the other hand, there is also a difference in mentioned times of morphine usage on the MAR and on the DC. On the MAR it is mentioned that Morphine is administered at regular interval of every four hours, while on the DG it is mentioned that morphine is given irregularly to Mr Winston. There is also different information about the dosage of morphine, in which On the MAR it is mentioned that 1 gm of morphine is administered in the body of Mr Winston, while in the DG only 500 mg of morphine administration is mentioned. On MAR it is mentioned that 300 mg of ibuprofen is administered four times regularly, while in the DC it is claimed that 800 mg of Ibuprofen is administered on irregularly. Therefore, these are lots of errors in the information used in the MAR and DC of Mr Winston, which need proper clarification from the concerned doctors and nurses.

On the DC of Mr Winston, there is no signature of Dr Glow in the section where the administration of ibuprofen is mentioned. Under the BNF guideline for the prescription, signature on the prescription in each section of the mentioned drug is the legal responsibility of the doctor (Sluggett et al. 2017). The signature is the important aspect that eliminates the chances of any types of denying from the prescriber. On the other hand, the signature of the prescriber on the prescription is a must which eliminates the chances of forging of signature. Therefore, in the case of Mr Winston, nurses need to check the section in which Dr Glow does not sign and inform him to sign it accordingly. On the other hand, nurses also need to check the errors regarding the time duration and quantity of the morphine and ibuprofen that are mentioned on the MAR and DC of Mr Winston.

In the case study, the time duration of infusion of the intravenous fluid is mentioned on the DC as irregular. Under NICE guidelines, the infusion of the intravenous fluid must be at regular interval of 4 hrs to 6hrs, in which the dosage can be decreased or increased based on the current health condition of the patient [NICE, 2015]. Therefore, in the case of Mr Winston, nurses must check the time errors on the DC and correct it accordingly to maintain the validity of the prescription. On the other hand, nurses will also clarify that why different quantity of dose has been mentioned about the paracetamol as because on the MAR the dosage of paracetamol is mentioned as the 1 gram, on the other hand the dose on the DG is mentioned as the 500 milligrams. Under NICE, prescribers must mention the start date of each drug on the MAR and DG. In case of Mr. Winston there is no start date for Ibuprofen on the DG, which can be considered as the breach to the prescription roles.

Drug calculation 1 litre on 0.9%nortmal saline over the eight hours 1000 ml divided by the 8 hours duration = 125 ml

Nurses play crucial roles in providing safe and effective care to patient based on their current health needs (Tarjoman et al. 2019). Nurses are considered as the last important persons to whom the entire care delivery duty is handed over. Under NMC (2015), nurses must be enough competent in terms of ordering medicines, identifying the prescription errors, documenting the overall medication process and providing safe medication to patients [NMC, 2015]. In case of Mr. Winston, nurses need to play a crucial role in terms of maintaining effective communication with the doctors, patients and the patients’ family members to maintain a transparent information delivery system. Here nurses need to identify the errors done by Dr. Glow and make effective changes in these errors to maintain a safe medication system for Mr. Winston. Here nurses must have strong professional knowledge about the dosage of particular medicine such as morphine, paracetamol and ibuprofen. Also, in the case study nurses must know the side effects of medicines, their combination with other drug and different types of drug infusion in patient’s body.

Under NMC, (2015), nurses must implement the 6Cs into their practice such as compassion, competence, care, committeemen, courage and communication [NMC, 2015]. In the case study, the implementation of these six elements is highly important as it can provide effective holistic and person-centred care to Mr. Winston. Here nurses need to check and evaluate the past history, present history, lifestyle and current medication condition of Winston and then develop the effective care pan which will provide the maximum care and psychological support to Winston.

From the above-mentioned discussion, it can be concluded that, medicine management is important in nursing to provide safe care to patient. Nurses must ensure that they have strong and clear knowledge on medicine management such as dose, quantity, duration of medicine administration. Additionally, nurses must be competent in identifying the patient’s current health needs based on which the dose of medicines are prescribed moreover, nursing professionals must have the expertise in identifying all the errors of prescription before giving these medicines to patients and inform the prescribers (doctors ) to solve these errors accordingly.

Take a deeper dive into Pain Assessment, Obesity and Smoking with our additional resources.

Reference list:

Baek, S.Y., Lee, E.H., Oh, T.W., Do, H.J., Kim, K.Y., Park, K.I. and Kim, Y.W., 2020. Network pharmacology-based approaches of rheum undulatum linne and glycyrriza uralensis fischer imply their regulation of liver failure with hepatic encephalopathy in mice. Biomolecules, 10(3), p.437.

Berry, S.D., Rothbaum, R.R., Kiel, D.P., Lee, Y. and Mitchell, S.L., 2018. Association of clinical outcomes with surgical repair of hip fracture vs nonsurgical management in nursing home residents with advanced dementia. JAMA internal medicine, 178(6), pp.774-780.

Cracowski, J.L. and Mathieu Molimard, V.R., 2020. Ultrafast response of the french society of pharmacology and therapeutics to the COVID-19 pandemic. Therapie, 75(4), p.317.

De Witt Jansen, B., Brazil, K., Passmore, P., Buchanan, H., Maxwell, D., McIlfactrick, S.J., Morgan, S.M., Watson, M. and Parsons, C., 2017. Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. Journal of clinical nursing, 26(9-10), pp.1234-1244.

Fang, J., Wang, L., Wu, T., Yang, C., Gao, L., Cai, H., Liu, J., Fang, S., Chen, Y., Tan, W. and Wang, Q., 2017. Network pharmacology-based study on the mechanism of action for herbal medicines in Alzheimer treatment. Journal of ethnopharmacology, 196, pp.281-292.

hong Sun, J., Sun, F., Yan, B., yi Li, J. and Li Xin, D., 2020. Data mining and systematic pharmacology to reveal the mechanisms of traditional Chinese medicine in Mycoplasma pneumoniae pneumonia treatment. Biomedicine & Pharmacotherapy, 125, p.109900.

Hong, M., Li, S., Wang, N., Tan, H.Y., Cheung, F. and Feng, Y., 2017. A biomedical investigation of the hepatoprotective effect of radix salviae miltiorrhizae and network pharmacology-based prediction of the active compounds and molecular targets. International Journal of Molecular Sciences, 18(3), p.620.

Hunnicutt, J.N., Tjia, J. and Lapane, K.L., 2017. Hospice use and pain management in elderly nursing home residents with cancer. Journal of pain and symptom management, 53(3), pp.561-570.

Lee, A.Y., Park, W., Kang, T.W., Cha, M.H. and Chun, J.M., 2018. Network pharmacology-based prediction of active compounds and molecular targets in Yijin-Tang acting on hyperlipidaemia and atherosclerosis. Journal of Ethnopharmacology, 221, pp.151-159.

Malick, D., Baba, M.M.M.S. and Ziba, F.A., 2020. Performance of Pharmacist Pharmacologist versus Nurse Pharmacologist in teaching Nursing Pharmacology at the University for Development Studies, Tamale, Ghana: Nursing Students Perceptions.

Miotto, K., Cho, A.K., Khalil, M.A., Blanco, K., Sasaki, J.D. and Rawson, R., 2017. Trends in tramadol: pharmacology, metabolism, and misuse. Anesthesia & Analgesia, 124(1), pp.44-51.

Müller, T.D., Finan, B., Clemmensen, C., DiMarchi, R.D. and Tschöp, M.H., 2017. The new biology and pharmacology of glucagon. Physiological reviews, 97(2), pp.721-766.

Parekh, N., Page, A., Ali, K., Davies, K. and Rajkumar, C., 2017. A practical approach to the pharmacological management of hypertension in older people. Therapeutic advances in drug safety, 8(4), pp.117-132.

Persell, S.D., Karmali, K.N., Lazar, D., Friesema, E.M., Lee, J.Y., Rademaker, A., Kaiser, D., Eder, M., French, D.D., Brown, T. and Wolf, M.S., 2018. Effect of electronic health record–based medication support and nurse-led medication therapy management on hypertension and medication self-management: a randomized clinical trial. JAMA internal medicine, 178(8), pp.1069-1077.

Samarkandi, O.A., 2018. Knowledge and attitudes of nurses toward pain management. Saudi journal of anaesthesia, 12(2), p.220.

Sawan, M., Jeon, Y.H., Fois, R.A. and Chen, T.F., 2017. Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: a qualitative study. Research in Social and Administrative Pharmacy, 13(3), pp.513-523.

Shorofi, S.A. and Arbon, P., 2017. Complementary and alternative medicine (CAM) among Australian hospital-based nurses: knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users. Complementary therapies in clinical practice, 27, pp.37-45.

Silva, W., 2021. Pharmacological Management of the Diabetic Patient: A Staff Education Project.

Sluggett, J.K., Ilomäki, J., Seaman, K.L., Corlis, M. and Bell, J.S., 2017. Medication management policy, practice and research in Australian residential aged care: current and future directions. Pharmacological research, 116, pp.20-28.

Tarjoman, A., Vasigh, A., Safari, S. and Borji, M., 2019. Pain management in neonatal intensive care units: A cross sectional study of neonatal nurses in Ilam City. Journal of Neonatal Nursing, 25(3), pp.136-138. Bergomi, P., Scudeller, L., Pintaldi, S. and Dal Molin, A., 2018. Efficacy of non-pharmacological methods of pain management in children undergoing venipuncture in a pediatric outpatient clinic: a randomized controlled trial of audiovisual distraction and external cold and vibration. Journal of pediatric nursing, 42, pp.e66-e72.

Tsuji, B.T., Pogue, J.M., Zavascki, A.P., Paul, M., Daikos, G.L., Forrest, A., Giacobbe, D.R., Viscoli, C., Giamarellou, H., Karaiskos, I. and Kaye, D., 2019. International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 39(1), pp.10-39.

Wilson, E., Caswell, G., Turner, N. and Pollock, K., 2018. Managing medicines for patients dying at home: a review of family caregivers' experiences. Journal of pain and symptom management, 56(6), pp.962-974.

Zhang, N., Lian, Z., Peng, X., Li, Z. and Zhu, H., 2017. Applications of Higenamine in pharmacology and medicine. Journal of ethnopharmacology, 196, pp.242-252.