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Case Study Assignment: Caucasian Man with Hip Pain Essay
Case Study Assignment Caucasian Man with Hip Pain Essay
The case study entails a 43-year old white male suffering from hip pain that he acquired after falling at his workplace. The patient was diagnosed with complex regional pain disorder also known as reflex sympathetic dystrophy (RSD) four years after the fall. He has had the condition for 7 years now and has developed strange symptoms such as cooling and cramping of the extremity (Laureate Education, 2016a). However, his family doctor maintained that the patient was simply suffering from depression. The assessment conducted at the hospital from his subjective data and mental health status exam revealed that the patient was indeed suffering from complex regional pain disorder.
The diagnosis of the conditions paved way for the formulation of a pharmacotherapy for the client. At the first decision point, the PMNHP elected to start the client on Amitriptyline 25 mg PO, which would be titrated upwards by a dose of 25 mg up to 200 mg, which is its maximum dosage (Laureate Education, 2016a). The assessment of the client after 4 weeks of using the drug revealed that his pain level had reduced to 6/10 from initial levels of 9/10. Moreover, the client’s usage of the crutches had reduced while he denies homicidal ideation. However, the client feels groggy from the usage of the drug. The results of the assessment saw the PMNHP recommend a continuation of the Amitriptyline dosage which would be increased to 125 mg to be taken at BEDTIME during the fifth week (Stahl, 2014b). The dose would be continued towards the maximum level of 200 mg on a daily basis. Further, the client was instructed to take their medication an hour earlier and then call to report the drugs function in the morning after three days. The alteration of the dosage time was effective as the client did not feel groggy probably due to the reduction of plasma concentration of the drug. At decision point three, the PMNP decided to continue the dose of Elavil at 125 mg while referring the patient to a life coach. The decision to continue the drug at that dosage was because it was managing the symptomatology of the condition while the dietician would help to address the weight gain side effect of the drug.
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The decisions elected at various decision points were indeed supported by evidence-based practice. Amitriptyline has been used
as a first line treatment for neuropathic pain for a long period (Moore et al., 2015); hence supporting decision point one. Agarwal and Joshi (2017) revealed that amitriptyline was effective in the management of pain in a study that involved 147 individuals with neuropathic pain. The administration of the drug entailed repeated increasing doses with optima dosage of 200 mg using optional titration. This aligned with both decision point two and decision point three from the case study.
Justification for the Decisions
Choosing to use Amitriptyline would lead to the management of some of the symptoms and manifestations of the pain that the patient was experiencing. The PMHP expects that by prescribing the pharmacological agent, the patient would stop using his crutches while the pain levels would reduce. The second decision was chosen because the patient was already responding to the drug (Hayashida & Obata, 2019). The therapeutic level had already been achieved yet the patient did not have any adverse events with the drug. Thus, the decision to increase the dosage to 125 entailed further management of the symptoms as demonstrated by the reduction of the pain scale to 4/10. Regarding decision point three, maintaining the dose even with the presence of the weight gain side effect was the correct decision. The PMNHP expected that the 125 mg would continue providing the patient with relief from the condition while the diet coach would manage the weight gain (Hiroki, Suto, Saito, & Obata, 2017). Therefore, the third decision was expected to manage both the pain symptoms as well as the side effect of the drug.
Differences between Expectations and Actual Achievements
The expectations of the nurse were met with each of the decisions that were made at each decision point. Each of the decision led to the reduction of pain with noticeable improvement in the functionality of the patient. The presence of weight gain as a side effect at decision point two was expected since it is part of the adverse events of the Amitriptyline (Kessler, 2019). Thus, the results of the therapy were consistent with the expectations of the PMNHP.
Case Study Assignment: Caucasian Man with Hip Pain Essay Conclusion
The diagnosis of pain is a complex process that should be conducted with a lot of care. After several years, the 43-yeard old white male in the present case was diagnosed with reflex sympathetic dystrophy. The management of such conditions is complex but first line medications such as amitriptyline are given priority by evidence-based studies. These studies support the effectiveness of amitriptyline particularly when titrated upwards up to the optimum therapeutic dose. However, the usage of the pharmacological agent is fraught with dangers as side-effects such as weigh gain may occur, In such a case, the PMNHP should advise counseling at the beginning of the therapy.
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Important information for writing discussion questions and participation
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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource