Decision Tree For Neurological And Musculoskeletal Disorders
Week 6 Assignment:
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:
- Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
- Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
- What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? 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.Running head: COMPLEX REGIONAL PAIN DISORDER 1
COMPLEX REGIONAL PAIN DISORDER 5
Complex Regional Pain Disorder Case Study
Colleen Lemmer
Walden University
Complex Regional Pain Disorder
Pain and sleep/ wake disorders have become prevalent in the recent years. Previous research done indicates that sleep/wake disorders are more common, underdiagnosed and mostly affects elderly people who suffer serious consequences (Miguel, & Albuquerque, 2011). Patients suffer from insomnia and prevalence of the disorders increases with the elderly in the population being affected most. Clinicians and therapists make common misconceptions by assuming that the condition is an expected phenomena that is associated with old age and therefore is normal (Miguel, & Albuquerque, 2011). Contrary to therapists and doctor’s misconceptions, research conducted indicates that the increased disorders are a result of increased psychosocial comorbidities in the population.
Recent research and publications indicate that pain and wake related disorders should be regarded and treated as a multifactorial geriatric syndrome and therefore should be addressed with high attention. Many therapists and clinicians consider enough and good sleep to be essential towards achieving better health (Barbehenn, & Wolfe, 2010). For purposes of this assignment, the paper involves a case study about Caucasian man with hip pain. The paper involves decisions concerning medication to prescribe.
From the symptoms outlined in the Caucasian man case study and recommended prescriptions of medications, it is evident that the patient is suffering from Complex regional pain disorder which is also referred to as reflex sympathetic dystrophy. The syndrome involves chronic pain that either affects legs or arms. The syndrome occurs after an individual goes through a surgery, heart attack, and stroke or after an injury. Complex regional pain disease causes aren’t clearly understood and is mostly common with the elderly. Doctors and therapists recommend early diagnosis and treatment of the condition to increase chances of completely eradicating it.
Symptoms of Complex regional pain syndrome include; decreased ability to move affected body part, swelling, sensitivity to cold and touch, changes in hair and nail growth, tremors, muscle spasms and atrophy (Jänig, & Baron, 2003). However, symptoms may differ from one individual to the other where swelling, pain, hypersensitivity and changes in temperature being most common. Several therapies and medications are recommended and below discussion outline various medications for complex regional pain.
Decision Point 1
Decision point 1 involved selecting between two drugs which were; Savella 12.5 mg that were to be administered orally in day one. The drug was also supposed to be administered in day 2 where 12.5 mg was to be administered twice. 7.25 mg was to be administered two times a day and 50 mg thereafter. The second option in making the first decision involved Amitriptyline where 25 mg would be taken during bedtime and 300 mg of Neurontin two times a day.
Psychiatric-mental health Nurse Practitioners (PMHNP) should recommend Savella in the Caucasian case study. From the results and side effects outlined in the case study, they are similar to those associated to Savella. The drug is used to treat psychiatric and depression disorders and is referred to as norepinephrine reuptake inhibitor with selective serotonin (Barbehenn, & Wolfe, 2010).
Savella is administered orally without food. By taking the drugs without food, tolerability of the drug is enhanced. According to the case study, the patient is supposed to return after 4 weeks. According to the patient, the pain had significantly reduced which is an effect of savella drug that aids in relieving pain. Savella drug is known to cause various side effects such as; nausea, vomiting, constipation, increased sweating, headache and the occurrence of hot flashes (Barbehenn, & Wolfe, 2010). According to the case study, the client is reported to be suffering from bouts of swelling with no main cause together with nausea and suffers from insomnia too. Therefore, it is evident that the side effects that emerged were as a result of the savella drug.
By making the decision that a psychiatric-mental health nurse practitioner should opt for Savella dosage, it was to achieve and capture the side effects caused by the drug as well as its healing capability. Administering the drug to the patient was to also act as proof that savella is used to heal and relieve chronic pain. According to research, savella should be taken two times a day just like in the Caucasian case study. After four weeks of administering the drug, dosage can be reduced based on the patient’s medical condition and how best he is responsive to treatment.
The expectations in decision one were that the client would have homicide and suicidal thoughts as a side effect. Savella is known to cause suicidal thoughts to clients taking the drugs (Barbehenn, & Wolfe, 2010). However, in the Caucasian case study, the client reports to claim that he had been suffering from suicide and homicide thoughts. Instead, the patients report that the future looks good. The difference was attributed to the patient’s positive thoughts about life. For example, the client at some time claims that one of the doctors he had met before had suggested for a wheelchair for the patient which he did not admit and instead said that he was okay and did not require one. In addition, he is optimistic about life since he had been recently engaged and was looking up to for marriage. Therefore, the patient’s positive attitude towards life made the client not suffer from suicidal thoughts and thus the difference between the expectations and actual results presented after usage of the drug.
Clinical Decision point 2
The Psychiatric-mental health nurse practitioner had an option of continuing with current medication which was Savella but this time lower it. The second option was to discontinue savella and instead start to use lyrica by administering 50mg twice in a day. The third option for the nurse was to discontinue savella and administer 50 mg of Zoloft twice a day.
In clinical decision point 2, the psychiatric-mental health nurse should discontinue the use of savella since the client reported that the situation had not been cured. He is reported to claim that he suffered pain with a range of 4 out of 10 and wanted that to reduce to 3. Therefore, the nurse had to try a different drug and monitor how well the patient would recover from the condition.
For Clinical decision point 2, the psychiatric-mental health nurse practitioner should recommend the introduction of Zoloft. From the results of clinical decision one, the patient continued to suffer from lack of sleep. Zoloft is therefore recommended to improve on sleep and the mood. The drug has several other uses such as treating; panic attacks, obsessive-compulsive disorders, social phobia, post-traumatic stresses and severe form of premenstrual syndrome disorder (Miguel, & Albuquerque, 2011).
According to the Caucasian case study, the patient reported to have no suicidal and homicide thoughts. Meanwhile, the pain increased from 4 to 3 out of 10 and that the condition did not improve, instead, it worsened. However, the client no longer experienced difficulties in sleeping. Moreover, his blood pressure was reported to have increased but did not suffer palpitations. The improvements to better sleep can be associated with the introduction of the new drug Zoloft. The drug may be administered with food or without. The best times to take the drugs should be in the morning or after the evening meal. The drug is associated with many side effects and therefore, a doctor may recommend that a patient start on a low dosage and later increase it to control the effects. Some of the common side effects include; nausea, dry mouth, diarrhea, stomach upset and drowsiness.
The expectations of using the drug included reduced pain from 4 to 3 out of 10. Though there were improvements in sleep, it was affected by the severe pain. It was expected that the patient would get enough sleep. Heart rate and pressure were expected to remain at normal rates. Research conducted does not show any side effects that cause increased heartbeat and pressure. The drug is associated with boosting a patient’s mood and the reason he never suffers from homicide and suicidal thoughts.
The difference between the expectations and the actual results presented is attributed to the mix up of drugs. The body did not adapt to the sudden changes introduced and therefore reason as to why pain increased. The positive moods caused by the drug are a reason as to why the client does not have suicidal thoughts. Moreover, the patient was evaluated after four weeks. The time was a long period since it was a new drug. The psychiatric mental health practitioners should have recommended the patient to return to the clinic after a week in order to urgently monitor his progress. For example, if the patient visited the clinic after a week, the nurse would have been in a position to detect increased pain to 7 out of 10 and thus change the dosage or medication.
Clinical Decision 3
In clinical decision 3, the nurse had the option of using Savella but increase the dosage from 12 mg to 25 mg in the morning and 50 mg during bedtime. The psychiatric nurse practitioner had also an option to discontinue savella and instead introduce 50 mg of tramadol. In addition, the nurse had an option of introducing a new drug calexa with 12.5 mg.
The PMHNP nurse should prescribe Salville. The drug should at this stage be increased to a higher amount. From the results of clinical decision 1, the patient had recorded improvements in her condition, especially on pain. Therefore, the client ought to have continued with the medication to improve the condition further.
The expectations after deciding to continue with the drug were that pain would reduce to probably a rate below 4 out of 10 like he experienced after decision one. Further expectations were that the patient would now have peaceful sleep since Zoloft had already cured insomnia. At end of stage 2, the patient reported to only lack sleep due to pain. Therefore, since pain would be reduced through the introduction of more dosage, the patient would have enough sleep. At this stage, the patient was still optimistic that he would heal and therefore pain would end and therefore did not have homicidal and suicidal thoughts
The difference between the expectations and the results was the increased pain. The patient reported complex neuropathic pain syndrome which was feared not to respond to pain medication. By the second re-introduction of the drug, the patient could have suffered from resistance to the drugs which resulted to increased pain (Barbehenn, & Wolfe, 2010). Tramadol and celexa were ruled because they were not good and were feared to cause severe side effects such as serotonin toxicity.
How Ethical Considerations Might Impact Treatment Plan
Confidentiality
According to APA ethics standards, psychiatrists and psychologists are mandated to maintain the confidentiality of their patients. However, confidentiality is sometimes breached for example in instances where insurance companies require details about patients in order to make hospital bill payments (Kerridge, & Stewart, 2009).
Patient Abandonment
Psychologists are not supposed to abandon patients. However, in a multidisciplinary setting, psychologists are faced by ethical issues where at time patients are abandoned. According to APA standards, psychologists should provide pre-termination counselling (Rezai, &Zonenshayn, 2002).
Clinical Research
In most cases, psychologists are required to conduct and participate in clinical research especially in a multidisciplinary setting. However, ethical issues may arise for example in choosing appropriate and adequate control groups.
Psychology’s Interface with Medicine
Patients are treated with multiple medications. However, ethical issues may arise when too many drugs are recommended to the patient and at times end up being ineffective. APA standards stipulate that psychologists should provide services that are within their boundaries (Rezai, &Zonenshayn, 2002).
Patient Autonomy and Informed Consent
Chronic pain illness sometimes requires patients to fill in informed consents regarding hospitalization and medication. However, ethical issues may arise in instances where a patient is forced into medication and treatment.
References
Barbehenn, E., & Wolfe, S. (2010). Petition to ban fibromyalgia drug milnacipran (Savella). Citizen.org. Public Citizen, 20.
Jänig, W., & Baron, R. (2003). Complex regional pain syndrome: mystery explained?. The Lancet Neurology, 2(11), 687-697.
Kerridge, I., Lowe, M., & Stewart, C. (2009). Ethics and law for the health professions (p. 225). Sydney: Federation Press.
Miguel, C., & Albuquerque, E. (2011). Drug interaction in psycho-oncology: antidepressants and antineoplastics. Pharmacology, 88(5-6), 333-339.
Rezai, A. R., &Zonenshayn, M. (2002). U.S. Patent No. 6,438,423. Washington, DC: U.S. Patent and Trademark Office.Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: