As you continue, thestudycorp.com<\/a> has the top and most qualified writers to help with any of your assignments. All you need to do is place an order <\/a>with us.<\/p>\n\n\n\n BACKGROUND<\/p>\n\n\n\n This week, 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 psychiatric assessment because the doctor felt that the pain was \u201call in his head.\u201d He further reports that his physician believes he is just making stuff up to get \u201cnarcotics to get high.\u201d<\/p>\n\n\n\n SUBJECTIVE<\/p>\n\n\n\n NURS 6521 Complex Regional Pain Disorder White Male With Hip Pain<\/p>\n\n\n\n The client reports that he used to be a machinist where he made \u201cpretty good money.\u201d He was engaged to be married, but his fianc\u00e9 got \u201csick and tired of putting up with me and my pain, she thought I was just turning into a junkie.\u201d<\/p>\n\n\n\n He reports that he does get \u201cdown in the dumps\u201d from time to time when he sees how his life has turned out, but emphatically denies depression. He states \u201cyou can\u2019t let yourself get depressed\u2026 you can drive yourself crazy if you do. I\u2019m not really sure what\u2019s wrong with me, but I know I can beat it.\u201d<\/p>\n\n\n\n During the client interview, the client states \u201coh! It\u2019s happening, let me show you!\u201d this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. \u201cIt will last about a minute or two, then it will let up\u201d he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot\/toes appears to be releasing. The client states \u201cif there is anything you can do to help me with this pain, I would really appreciate it.\u201d He does report that his family doctor has been giving him hydrocodone, but he states that he uses is \u201csparingly\u201d because he does not like the side effects of feeling \u201csleepy\u201d and constipation. He also reports that the medication makes him \u201cloopy\u201d and doesn\u2019t really do anything for the pain.<\/p>\n\n\n\n MENTAL STATUS EXAM<\/p>\n\n\n\n The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual\/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal\/homicidal ideation, and is future oriented.<\/p>\n\n\n\n Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)<\/strong><\/p>\n\n\n\n Decision Point One<\/p>\n\n\n\n Select what you should do:<\/strong><\/p>\n\n\n\n Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter<\/a><\/p>\n\n\n\n Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day<\/a><\/p>\n\n\n\n Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed<\/a><\/p>\n\n\n\n Decision Point One<\/p>\n\n\n\n Savella 12.5 mg once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter<\/p>\n\n\n\n RESULTS OF DECISION POINT ONE<\/p>\n\n\n\n Decision Point Two<\/p>\n\n\n\n Continue with current medication but lower dose to 25 mg twice a day<\/a><\/p>\n\n\n\n RESULTS OF DECISION POINT TWO<\/p>\n\n\n\n Decision Point Three<\/p>\n\n\n\n Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME<\/a><\/p>\n\n\n\n Guidance to Student<\/strong><\/p>\n\n\n\n The client has a complex neuropathic pain syndrome that may never respond to pain medication. Once that is understood, the next task is to explain to the client that pain level expectations need to be realistic in nature and understand that he will always have some level of pain on a daily basis. The key is to manage it in a manner that allows him to continue his activities of daily living with as little discomfort as possible. Next, it is important to explain that medications are never the final answer but a part of a complex regimen that includes physical therapy, possible chiropractic care, heat and massage therapy, and medications. Savella is a SNRI that also possesses NMDA antagonist activity which helps in producing analgesia at the site of nerve endings. It is specifically marketed for fibromyalgia and has a place in therapy for this gentleman. Tramadol is never a good option along with other opioid type analgesics. Agonists at the Mu receptors does not provide adequate pain control in these types of neuropathic pain syndromes and therefore is never a good idea. It also has addictive properties which can lead to secondary drug abuse. Reductions in Savella can help control side effects but at a cost of uncontrolled pain. It is always a good idea to start with dose reductions during parts of the day that pain is most under control. The addition of Celexa with Savella needs to be done cautiously. Both medications inhibit the reuptake of serotonin and can, therefore, lead to serotonin toxicity or serotonin syndrome.<\/p>\n\n\n\n Decision Point One<\/p>\n\n\n\n Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day<\/p>\n\n\n\n RESULTS OF DECISION POINT ONE<\/p>\n\n\n\n As you continue, thestudycorp.com<\/a> has the top and most qualified writers to help with any of your assignments. All you need to do is place an order <\/a>with us. (Complex Regional Pain Disorder White Male With Hip Pain)<\/p>\n\n\n\n Decision Point Two<\/p>\n\n\n\n Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning<\/a><\/p>\n\n\n\n RESULTS OF DECISION POINT TWO<\/p>\n\n\n\n Decision Point Three<\/p>\n\n\n\n Continue with the Elavil at his current 125 mg a day dose and start Qsymia (phentermine and topiramate) 3.75 mg\/23 mg tablet once daily and titrate as required by package insert<\/a><\/p>\n\n\n\n Guidance to Student<\/strong><\/p>\n\n\n\n At this point, the client is almost at his goal pain control and increased functionality. Weight gain is a common side effect with amitriptyline and should be a counseling point at the initiation of therapy. He has a small weight gain of 5 pounds in 8 weeks. A reduction in dose may have an effect on the weight gain but at a considerable cost of pain to the client. This would not be in the best interest of the client at this point. Amitriptyline has a side effect of cardiac arrhythmias. He is not experiencing this at this point. The drug, qsymia contains a product called phentermine which has a history of causing cardiac arrhythmias at higher doses. This product is also only approved for a client with obesity defined as a BMI greater than 30 kg\/m2. Your client\u2019s BMI is currently 25.5 kg\/m2. He does not meet the definition of obesity but is considered overweight. His best course of action would be to continue the same dose of Elavil, counsel him on good dietary and exercise habits and connect him with a life coach who will help him with this problem in a more meaningful way than a 10 minute counseling session will be able to accomplish.<\/p>\n\n\n\n Decision Point One<\/p>\n\n\n\n Neurontin (gabapentin) 300 mg orally at BEDTIME with weekly increases of 300 mg per day to a max of 2,400 mg if needed<\/p>\n\n\n\n RESULTS OF DECISION POINT ONE<\/p>\n\n\n\n Decision Point Two<\/p>\n\n\n\n Discontinue Neurontin. Start Zoloft (sertraline) 50 mg orally daily and titrate at weekly intervals to a dose of 200 mg<\/a><\/p>\n\n\n\n RESULTS OF DECISION POINT TWO<\/p>\n\n\n\n Decision Point Three<\/p>\n\n\n\n Reduce Zoloft to 100 mg per day. Give the client a short course (2 weeks) of Ativan to help with his anxiety<\/a><\/p>\n\n\n\n Guidance to Student<\/strong><\/p>\n\n\n\n Anxiety is a transient effect of SSRI and SNRI therapy and should be anticipated. Counseling the client is key in continuing the therapeutic alliance you have with the client. Short course benzodiazepines will usually be sufficient to bridge this time period. Erectile dysfunction is a side effect of all SSRI\u2019s and should be a counseling point for men. It happens in roughly 10% of men using SSRI\u2019s. A dose reduction in Zoloft will certainly help with the side effects but will most likely result in increased pain. A change in therapy is always an option at this point but will normally not reduce the anxiety or erectile dysfunction experienced and will still require short course benzodiazepine therapy and appropriate counseling. It would be most prudent, in this case, to add-on Wellbutrin XL 150 mg po QAM to help with the side effect of erectile dysfunction. Although we have told you throughout this course that the addition of a medication to treat a side effect is not good therapy, this is one of those cases where it is recommended, especially when the client is experiencing relief from a regimen that took time to achieve. Wellbutrin is a DNRI and does not overlap in SSRI therapy (maybe a little in the DRI of Zoloft).<\/p>\n\n\n\n Assignment: Decision Tree for Neurological and Musculoskeletal Disorders<\/strong><\/p>\n\n\n\n For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module\u2019s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.<\/p>\n\n\n\n Photo Credit: KATERYNA KON\/SCIENCE PHOTO LIBRARY \/ Science Photo Library \/ Getty Images<\/p>\n\n\n\n To Prepare<\/strong><\/p>\n\n\n\n As you continue, thestudycorp.com<\/a> has the top and most qualified writers to help with any of your assignments. All you need to do is\u00a0place an order\u00a0<\/a>with us. (Complex Regional Pain Disorder White Male With Hip Pain)<\/p>\n\n\n\n By Day 7 of Week 8<\/strong><\/p>\n\n\n\n Write a 1- to 2-page summary paper that addresses the following:<\/p>\n\n\n\n You will submit this Assignment in Week 8.<\/strong><\/p>\n\n\n\n Submission and Grading Information<\/strong><\/p>\n\n\n\n To submit your completed Assignment for review and grading, do the following:<\/strong><\/p>\n\n\n\n Grading Criteria<\/strong><\/p>\n\n\n\n To access your rubric:<\/p>\n\n\n\n Week 8 Assignment Rubric<\/p>\n\n\n\n Check Your Assignment Draft for Authenticity<\/strong><\/p>\n\n\n\n To check your Assignment draft for authenticity:<\/p>\n\n\n\n Submit your Week 8 Assignment draft and review the originality report.<\/p>\n\n\n\n Submit Your Assignment by Day 7 of Week 8<\/strong><\/p>\n\n\n\n To participate in this Assignment:<\/p>\n\n\n\n Week 8 Assignment<\/p>\n\n\n\nNURS 6521 Complex Regional Pain Disorder White Male With Hip Pain<\/h2>\n\n\n\n
NURS 6521 Complex Regional Pain Disorder White Male With Hip Pain<\/h3>\n\n\n\n
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