| Course | NR 293 Pharmacology for Nursing Practice |
|---|---|
| Week | 6 |
| Paper type | Patient case response |
| Length | About 1,150 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 293 Week 6
Patient Case Response: Oxycodone 5 mg for an 84-Year-Old Woman With a Spine Fracture, Weak Kidneys, a Fall Last Winter and a Daughter Who Fills the Pillbox
Student Name
College of Nursing, Chamberlain University
NR 293: Pharmacology for Nursing Practice
Instructor Name
Month Day, Year
Patient Case Response: Oxycodone 5 mg for an 84-Year-Old Woman With a Spine Fracture, Weak Kidneys, a Fall Last Winter and a Daughter Who Fills the Pillbox
The Facts That Are Working
Mrs. V. is 84 and was admitted with a painful compression fracture of a lumbar vertebra after lifting a laundry basket. The order is oxycodone 5 mg by mouth every 4 hours as needed for pain. Several facts in the case change how that order should be given, and each is used below. Details are composite.
Her kidney function is reduced, with an estimated filtration rate of 35, which slows the clearance of oxycodone and its active products, so each dose lasts longer and builds up more. She fell last winter at home and broke her wrist. She wears hearing aids and takes them out at night. She takes five other medicines, including gabapentin, 300 mg taken morning, afternoon and bedtime for burning feet and sertraline 50 mg daily. Her daughter fills a weekly pillbox for her every Sunday. And she lives by herself, with her only bedroom up a flight of stairs.
Same Order, Different Checking
The order itself is reasonable: pain from a spine fracture is severe, and uncontrolled pain in an older woman causes immobility, pneumonia and delirium. The response is not a different plan but the same plan with tighter checks. Before each dose, the nurse assesses her pain on a scale she can hear, speaking into her better ear or with her hearing aids in; her sedation level on the unit's opioid sedation scale; her breathing rate counted for a full minute; and when she last had a bowel movement. The first dose is given when her daughter is present or a nurse can check her again in 30 to 60 minutes, because the first dose tells the team how she responds.
Two facts sharpen the sedation checks. Her kidney function means the drug lasts longer than in a younger adult. And she already takes gabapentin, which also sedates and can slow breathing. The 2023 American Geriatrics Society Beers Criteria advise avoiding the combination of opioids with gabapentinoids in older adults except when one is being used to reduce the dose of the other, and advise avoiding three or more drugs acting on the central nervous system together (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023). With oxycodone, gabapentin and sertraline, she now takes three.
The Call, Actually Worded
The combination is the provider's decision, but the nurse raises it rather than assuming it has been considered. The call, made before the first dose: "I'm calling about Mrs. V. in 12, 84, with an eGFR of 35. She has oxycodone 5 every 4 hours as needed, and she's also on gabapentin 300 three times a day and sertraline. I'm concerned about sedation with the kidney function and the gabapentin. Would you like to reduce the gabapentin, start the oxycodone at 2.5, or space the doses? Also, can we add scheduled acetaminophen and a bowel regimen?" The call names her, states the concern with the numbers behind it, offers options, and asks for the two orders that make an opioid safer in an older adult: a non-opioid for baseline pain and a laxative, since opioids almost always cause constipation.
What the First Two Doses Show
The response treats the first two doses as information, not routine. After the first dose, the nurse checks her at 30 and 60 minutes: pain score, sedation level, breathing rate and whether she can move in bed and sit up with less pain. If her pain has come down from 8 to 4 and she is awake and chatting, the dose is working without excess sedation. If her pain is still 8 but she is drowsy, the drug is sedating her without relieving pain, and the next step is a phone call, not an early second dose. If she is drowsy and her breathing has slowed below 12, the next dose is held, she is kept awake with conversation and position changes, and the provider is called; naloxone is on the unit if her breathing falls further.
The second dose is compared with the first. Because her kidneys clear the drug slowly, the effects of the second dose stack on the remains of the first. A second dose that produces more sedation than the first, at the same pain level, is an early sign of accumulation and a reason to lengthen the interval. The nurse records each check with its time, so the pattern is visible to the next shift rather than living in one nurse's memory.
Falls, Hearing and the Night
Her fall last winter makes the night the most dangerous time. An older woman given an opioid, with her hearing aids out, who wakes needing the bathroom, is at high risk of falling. The plan: bed alarm on, bed low, call light in her hand, a bedside commode for the first night, and a nurse or assistant checking on her after each night dose. Before she settles, the nurse confirms, with her hearing aids still in, that she knows to call before getting up, and checks that she can hear the call system's reply.
Home Is Part of the Assessment
Mrs. V. will go home with oxycodone, and the pillbox her daughter fills changes how the prescription should be written and taught. As-needed pills do not fit a weekly pillbox, and a daughter filling it on Sunday cannot know which days her mother will need more. The team should decide whether she goes home with a small number of as-needed doses kept in the original bottle, separate from the pillbox, with a written record for her daughter to check. The daughter should be taught the signs of too much opioid, such as unusual sleepiness, confusion and slow breathing, and the hospital's standard offer of naloxone for patients going home on opioids should be made. The two-story house matters too: the first week, she may need to sleep downstairs.
What the Response Does Not Do
The response does not refuse the order, change the dose or stop the gabapentin, all of which are the provider's decisions. It does not withhold pain relief from an 84-year-old because she is old, which would leave her immobile and at risk of other harms. What it does is make sure that the prescriber hears the facts that make this order riskier for her than for most patients, that each dose is given with checks matched to those facts, and that the plan extends to the pillbox and the stairs at home.
References
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
NR 293 Week 6 instructions, in plain terms
The Week 6 assignment gives you a patient case with a medication order and asks how you would give it safely. Expect the instructions to ask which patient factors matter, what to assess before and after doses, what to report to the prescriber, how to prevent harm and what to teach, written in APA and drawing on drug references or the geriatric prescribing criteria. The response should keep the nurse's role: you can raise concerns, but changing the drug or dose belongs to the prescriber. Each patient factor should change something specific. Word any call you would make. Plan for discharge, including who manages medicines at home, and state what would trigger escalation.
How this NR 293 Week 6 example is built
The response opens by listing the facts in the case that change practice: an eGFR of 35, gabapentin already prescribed, a fall last winter, hearing aids and a daughter who fills the pillbox. The order is kept as reasonable, with tighter checks before each dose. The Beers Criteria from 2023 support raising the opioid and gabapentin combination. The call is written word for word, starting with her room and eGFR. A section treats the first two doses as information, checking at 30 and 60 minutes and comparing the second dose's effect with the first. Night safety follows. The home plan addresses as-needed pills and the pillbox. A final section lists what the response does not do.
NR 293 Week 6 rubric: what full points look like
Patient case rubrics usually grade identification of relevant patient factors, safe administration and monitoring, communication with the prescriber, patient safety measures, discharge teaching and APA. Patient factors carry the most weight, so each one in this response leads to a changed check. Monitoring earns credit when timing and measures are specific. Communication scores when the call is worded with the facts the provider needs. Safety measures are graded on fit with this patient, such as night falls with hearing aids out. Discharge planning that addresses the pillbox shows realism. Keeping within the nurse's scope, while still raising the concern, matches the professional role criteria.
Common NR 293 Week 6 mistakes, and how to avoid them
Restating the vignette burns space the grader already wrote. A response that would read the same for a 40-year-old shows that age never changed a check. Naming fall risk with nothing done differently earns little. Recommending a different medicine moves into a decision this course does not give you. A call described but never worded, teaching aimed at the chart and no escalation trigger all lose points. Age alone does not change the answer; what age does to clearance and falls does. Quote only the facts that drive decisions. Forward the vignette exactly as written, and a response can be built that turns each of its facts into a bedside check.
Get a NR 293 Week 6 example written to your instructions
Send the vignette your section published, the prompt and the rubric, and we will return a worked response inside 24-48h with the first one free. If the case is one you have partly drafted, send that too and the example will be built to sit beside your reasoning rather than to replace it, which is what makes it useful while you write.
More NR 293 papers and pre-licensure samples
- NR 293 Week 1: Nurse's Medication Responsibility Post
- NR 293 Week 2: Spironolactone Drug Card
- NR 293 Week 3: Dosage Calculation Practice Set
- NR 293 Week 4: Medication Error Safety Analysis
- NR 293 Week 5: Beta-Blocker Drug Class Write-Up
- NR 293 Week 7: Patient Teaching Script
- NR 293 Week 8: Medication Care Plan
- NR 302 Week 6: Cardiovascular Assessment
- NR 283 Week 6: COPD and Heart Failure Case Analysis
- NR 304 Week 6: Documentation Exercise
- NR 228 Week 6: Low Sodium Patient Handout
NR 293 Week 6 questions, answered
Is age by itself enough to change the answer?
Not on its own, and saying so is a stronger move than the alternative. What changes the answer is the specific consequence the vignette supplies: reduced kidney clearance, a previous fall, a drug list of six, thinner skin, a memory that struggles with a new schedule. Name the mechanism you are reasoning from and the response stops sounding like a generalization about older people.
Can I say the medicine should not be given at all?
You can say the dose waits and why, which is different and is inside your remit. A parameter breached, a value out of range, an assessment finding that makes administration unsafe right now, all of those are yours, with the call that follows. What sits outside is rewriting the prescription itself. Sections generally reward the hold and the report, not the substitution.
How much of the vignette should I quote back?
Almost none of it. Pick out the details you intend to use, name them in a clause each, and let the rest go. Graders read dozens of these and a summary of a case they wrote is the fastest paragraph to skim. Where a value matters, quote the number, since the number is what your checking is built on.
Where can I find a free NR 293 Week 6 sample paper?
The full Week 6 case response for Mrs. V., with tightened checks, the worded call and the plan for the pillbox at home, is reproduced on this page.
What concern does the NR 293 Week 6 response raise with the provider?
It raises the combination of oxycodone with gabapentin in an 84-year-old with an eGFR of 35, which the 2023 Beers Criteria advise avoiding because both sedate and can slow breathing.