NURS 6521 week 8 Assignment: Decision Tree for Neurological and Musculoskeletal
Review the interactive media piece assigned. http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment. NURS 6521 Advanced Pharmacology – Week 7 – Quiz
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.
You will submit this assignment by the end of NURS 6521 week 8 Assignment.
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NURS 6521 Week 8 Assignment Sample Solution
Decision Tree for Neurological and Musculoskeletal
The case study involved a 43-year-old man, who presented with the chief complaint of pain. The client reported that the pain began 7 years ago after he sustained a fall that slit the right hip joint. From then, he started experiencing symptoms such as cooling and severe cramping of the extremity. The diagnosis for this client is complex regional pain disorder (CRPS). The symptoms of CRPS that the client manifests include chronic pain, cramping on the foot, color changes from the knee, and inconsistent folding on the foot.
The first decision selected for the client with CRPS was to administer Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a maximum dose. The medication was selected because of its efficacy in relieving neuropathic pain as indicated by Moore et al (2015). The patient showed significant improvement with this decision and thus the second decision was to continue with Amitriptyline and increase the dose to 125 mg at BEDTIME. Amitriptyline has sedative properties and this is the rationale for administering the medication at bedtime. The medication is being titrated upwards to increase its efficacy and because the patient is tolerating the medication and dose well. The third decision is to have the client continue with Amitriptyline 125 mg per day and have him referred to a life coach for counseling on good dietary habits and exercise. This decision was selected because the medication is effective and the patient reported significant weight gain. Good dietary habits and exercise will help the patient lose and maintain a good weight.
The decisions provided were supported by evidence-based literature. For example, Amitriptyline was selected for this patient because studies have shown that amitriptyline is a tricyclic antidepressant that is effective in the treatment of neuropathic pain (Obata, 2017). Studies have also demonstrated that amitriptyline inhibits neuropathic pain by increasing the amount of noradrenaline in the spinal cord and also the medication acts on the locus coeruleus, and thus inhibits the pain directly (Kamble et al., 2017). Evidence has demonstrated the efficacy of noradrenaline in blocking neuropathic pain.
Kamble, S. V., Motlekar, S. A., D’Souza, L. L., Kudrigikar, V. N., & Rao, S. E. (2017). Low doses of amitriptyline, pregabalin, and gabapentin are preferred for the management of neuropathic pain in India: is there a need for revisiting dosing recommendations. The Korean journal of pain, 30(3), 183–191. https://doi.org/10.3344/kjp.2017.30.3.183.
Moore, R. A., Derry, S., Aldington, D., Cole, P., & Wiffen, P. J. (2015). Amitriptyline for neuropathic pain in adults. The Cochrane database of systematic reviews, 2015(7), CD008242. https://doi.org/10.1002/14651858.CD008242.pub3.
Obata H. (2017). Analgesic Mechanisms of Antidepressants for Neuropathic Pain. International journal of molecular sciences, 18(11), 2483. https://doi.org/10.3390/ijms18112483.