Nursing

Write a summary paper that addresses the following:

Briefly summarize the patient case study, including each of the three decisions you chose for the patient presented. Support your decisions with evidence-based literature. Be specific and provide examples.
What were you hoping to achieve with the decisions you recommended for the patient case study? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

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ANSWER

 

 

 

 

Case Study: A Caucasian Man with Hip Pain

 

Walden University

 

 

 

 

 

 

 

 

 

 

 

Introduction

This is a case study by Laureate Education on complex regional pain disorder. A 43 year old white male walks into a hospital and on seeing the doctor, says that he has hip pain. After a vigorous analysis, the doctor settles on treatment using amitriptyline. Other approved FDA medication alternatives for treatment would include anticonvulsants such as regabalin, carbamazepine, phenytoin and sodium valproate. Anticonvulsants have favorable risk/benefit ration but most of the drugs are not yet available in the drug market. Oploid analgesics (eg, NSAIDs, acetaminophen) have been highly recommended by the FDA for nonmalignant pain. However, oploids have a high risk in that failure of one opioid cannot predict the patient’s response to another opioid (Stanton-Hicks 2018). This is a deep breakdown of the treatment decisions undertaken towards the recovery of the patient including adjustments and explanations made towards the journey to his recovery.

Case Study: A Caucasian Man with Hip Pain

“The patient is a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for a psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.” The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression.” (Laureate Education, 2016a).

Decision #1

The patient receives amitriptyline 25mg PO QHS and is expected to titrate upward weekly by 25mg to a maximum dose of 200mg per day (Laureate Education, 2016a). Amitriptyline is widely used to treat depression but in low doses, it can treat pain. However, the side effects would include is dizziness and drowsiness.

The choice was decided because the patient describes episodes of pain and would limp whenever he tried walking without clutches. This medicine is norepinephrine, noradrenaline and serotonin. It is an inhibitor that treats neuropathic pain, fibromyalgia and other types of pains. While boosting neurotransmitters in the norepinephrine, noradrenaline and serotonin, the drug also the beta-adrenergic receptors and the serotonin 1A receptors. As an antidepressant, amitriptyline is applied towards neuropathic pain conditions but with moderate impact (Benzon 2016). Apart from patients with preexisting conditions such as HIV or cancer, it is expected to heal the patient.

The expectation was that the pain would reduce significantly and the patient would be able to walk without any support and his pain would reduce from 9 to 3. It was also expected that he would be able to perform regular operations without assistance and that his mood would improve greatly to a pleasant one. However, the outcome was that the client was still using support to walk and when he was not he was limping. He still experienced the pain of up to 6. He did very few activities without the support which was not enough in comparison to the expectations. His toes still curled often and the patient expressed that he experienced throbbing on his right leg. The patient was able to wane out the mental side effects by not feeling suicidal or homicidal and remaining future-oriented.

Decision #2

The second decision was to continue current medication and increase the dose to 125 mg at bedtime continuing towards the goal dose of 200 mg daily. The client was instructed to take the medication an hour earlier than normal starting that night and call the office in 3 days to report how his function is in the morning. The expectation was to again reduce the pain from 6/10 to 3/10 which was almost achieved by a record of 4/10 after four weeks.

There were major improvements in other areas, for instance, he was not groggy in the morning and was able to start his day early as was expected with the initiation of medication an hour earlier. He was able to perform more activities around the house without the support and his right leg had ultimately stopped throbbing. From consistently cramping, his toes had only cramped twice in the last one month.

During the client’s second visit the client had stated a feeling of “grogginess in the morning” which was what prompted the decision to change his administration. He also stated that the pain was declining which prompted the decision to continue his current medication that saw the pain go down from 6 to 4. It was unexpected that the client would gain so much weight in such a short time which needed to be addressed promptly in the third decision since the client expressly stated that it was a problem to him (Stanton-Hicks 2018).

Decision #3

The third decision was to continue the current dose of Elavil of 125 mg per day and refer the client to a life coach who can counsel him on good dietary habits and exercise. There was a mark of increased functionality and the pain was going down and the medicine was working and there was no need to change or adjust it.

The third decision majorly refers to the client’s gaining of weight due to the use of the amitriptyline, a known side effect but with this patient, the weight gain was too fast. Putting the patient in another drug for the management of weight proved unnecessary and instead, dietary coaching proved the better decision where he would watch what he eats and exercise and as a result manage his weight (Finnerup 2015).

Conclusion

Managing pain requires careful assessment. With amitriptyline was a good choice with very minimum side effects and achieve client’s goal as initially stated. The decisions were sound as evident from the results and with a dietary coach the patient is expected to make a full recovery.

 

 

References

Benzon, H. T., Liu, S. S., & Buvanendran, A. (2016). Evolving definitions and pharmacologic management of complex regional pain syndrome

Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., .& Kamerman, P. R. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), 162-173. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder.

Laureate Education (Producer). (2019e). Complex regional pain disorder [Interactive media file]. Baltimore, MD: Author.

Stanton-Hicks, M. (2018). Complex regional pain syndrome. In Fundamentals of Pain Medicine (pp. 211-220). Springer, Cham. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder.

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