Reference no: EM133260351
James Peter is a 54 year old male who has previously been diagnosed with anxiety and substance misuse of heroin intravenously. He had a recent episode of pneumonia and was treated with amoxicillin. James is a smoker (tobacco), and regularly drinks excessive amounts of alcohol. James has had issues with housing and is currently homeless and has no close relationships with family except with his sister Sandra. He is divorced with two children who live interstate with their mother and stepfather. James is a former carpenter who saw a close friend and colleague die after suffering a workplace injury where he was also injured and required surgery (open reduction, external fixation of left radius). Since then James has developed anxiety and began to regularly use cannabis and is now using heroin. James was dismissed from his job and then his marriage broke down leading to a divorce. After the divorce James ended up homeless, staying with his sister or in the local men's shelter He spends time with his sister who also engages in heavy drinking and cannabis use.
James initially presented to the GP with the infected right leg ulcer and was prescribed clarithromycin 500mg BD PO for seven days but was non-cooperative with this treatment. James has now presented to the Emergency Department (ED), with worsening infection in the leg ulcer, cellulitis, and increased pain. James went to theatre and had the ulcer debrided and has come into the vascular ward post-operatively.
James describes his mood as low and reports often feeling stressed and angry. He has previously been prescribed an antidepressant mirtazapine, although has stopped taking this medication, stating it doesn't work. He takes oxazepam when able to get a script. He has inconsistently been on a suboxone program, but this has not been charted on this admission yet. When James arrives on the ward he is initially haemodynamically stable and comfortable, with no complaints of pain.
As the shift progresses he reports increased pain as the local anaesthesia given in theatre is starting to wear off. James is becoming agitated and demanding pain relief and beer. He is prescribed 1g paracetamol orally, and 5mg oxycodone 6hrly PRN orally. James' sister is visiting and when you are assessing James you notice that his breath smells of alcohol. You speak with Nurse in Charge (NIC), about this and are told that James is an attention seeker, and that he can't be in that much pain as he had morphine in theatre. In the meantime James is becoming increasingly verbally aggressive and his sister is increasingly belligerent towards you. James is now attempting to pull off the wound dressing and yelling out that he is in pain.
Case Study Question:
How would you as an Registered Nurse prioritise and manage this situation?
In your answer you are required to consider the Registered nurse standards for practice, (Nursing and Midwifery Board of Australia [NMBA], 2016), relevant clinical practice guidelines and legislation.