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NR-293 Week 3 Discussion: Unfolding Case Study Lillian fell when she was returning from the bathroom after the suppository. The nurse found her sitting on the floor complaining of pain on the left side of her rib cage. The nurse called for help and assisted Lillian back to bed. She notified the physician and completed the necessary reports. The physician ordered a follow-up chest X-ray that came back within normal limits. Lillian had a small bruise on her rib cage but no fracture. The physician gave the nurse the following orders over the phone. • Acetaminophen (Tylenol): 325 mg po every 4 hours as needed for pain • Zolpidem (Ambien): 5 mg po at bedtime for sleep • Alprazolam (Xanax): 0.5 mg po as needed for anxiety 1. How would the nurse assess Lillian’s pain, and when would the nurse assess for pain when giving the acetaminophen? 2. How does zolpidem work? Be sure to include the drug category, mechanism of action, onset and duration of action, and safety considerations. 3. What are the factors that contributed to Lillian’s fall? Hello class and professor, When assessing Lillian's pain, the nurse should use the medical pain scale. The pain scale measures the patient's pain intensity with a rate of 0-10 (0 Being no pain and 10 being the worst pain) and is the common communication tool used to assess pain. I would have the patient use verbal descriptors for pain such as "mild, moderate, severe, aching, agonizing, or discomfort (Collins, Lilley, Snyder, 2019). The self-report remains the gold standard for measurement because pain is an internal, private experience (Fillingim, Loeser, Baron, & Edwards, 2017). The only onset we know of the pain is from Lillian falling on the floor after she was returning from the bathroom after the suppository. She complains of pain on the left side of her rib cage so I would assess pain before administering the acetaminophen. After one hour of administering the medications, I would assess again. The nurse should wait an hour before assessing again because PO drugs take a while to start working. Zolpidem is the most widely prescribed sedative-hypnotic in the United States and is initially approved by the Food and Drug Administration (FDA) in 1992 (Norman, Fixen, Saseen, Saba, & Linnebur, 2017). Zolpidem is used to treat insomnia and is used to help fall asleep. Zolpidem depresses CNS by binding to gamma-aminobutyric acid receptors. Its onset is. rapid with a peak of 30 minutes to 2 hours and have a duration of 6 to 8 hours. Some safety considerations when taking Zolpidem is that it may cause drowsiness, decreased mental alertness, prolonged reaction time, problems with coordination the day after you take it. One factor could be a lack of sleep because Zolpidem is a sedative and it decreases balance. Another factor could be that the suppository is activated and cannot be stopped. This causes patients to quickly go. Lillian might have gotten up too fast, causing her to be light-headed. Another factor could involve anxiety because she has prescribed Alprazolam (Xanax). References: Fillingim, R., Loeser, J., Baron, R., & Edwards, R. (2017). Assessment of Chronic Pain: Domains, Methods, and Mechanisms. J Pain. 17(7). doi: 10.1016/j.jpain.2015.08.010 Lilley, L. L., Collins, S. R., & Snyder, J. S. (2019). Pharmacology and the nursing process (9th ed.). Mosby. Norman, J., Fixen, D., Saseen, J., Saba, L., & Linnebur, S. (2017). Zolpidem prescribing practices before and after Food and Drug Administration required product labeling changes. SAGE Open Med.

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