Neurological and Musculoskeletal Disorders Essay Example
Neurological and Musculoskeletal Disorders Essay Example
Complex regional pain syndrome
Complex regional pain syndrome is a type of pain where a person experiences severe pain mainly caused by injury, resulting in long-lasting, normal, and primarily affects the arms or legs (Birklein & Dimova, 2017). The injury results from damage to the soft tissues, making it more severe than expected. Some of the causes of complex regional pain disorder can include amputation or surgery (Urits et al., 2018)Neurological and Musculoskeletal Disorders Essay Example. This paper aims to discuss a case study of a patient suffering from complex regional pain disorder and provide appropriate therapy.
ORDER A PLAGIARISM-FREE PAPER HERE
Summary of the Case Study and Decisions Selected
The case study involves a 43-year-old white man who presents with the chief complaint of pain, which started seven years ago after a fall at work. The fall incident led to an injury on his right hip, and the client further reported cooling of the extremity and was diagnosed with complex regional pain syndrome. The decisions selected for the particular case are as follows; the first decision was Savella 12.5 mg once daily on day 1; followed by 12.5 mg BID on days 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID after that. The second decision was to continue with the current medication but lower the dose to 25 mg twice daily. The third decision was to change Savella to 25 mg orally in the morning and 50 mg at bedtime.
Evidence-Based Literature to Support the Decisions Selected
Milnacipran (Savella) is one of the three main drugs the FDA has approved for treating complex regional pain syndrome (Ellingrod, 2017). Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat chronic neuropathic pain and fibromyalgia (Keks et al., 2018). Milnacipran effectively treats pain due to fibromyalgia with a dose of at least 100 mg to 200 mg. Sudden withdrawal of Milnacipran is associated with withdrawal symptoms; hence, withdrawal should be gradual (Henssler et al., 2019)Neurological and Musculoskeletal Disorders Essay Example.
Expectations for the Decisions Chosen
With the point one decision, I expected that the pain experienced by the patient would decrease, which means that the patient would walk with minimal difficulty and improve in daily activities. For decision two, the patient has improved in terms of symptoms because he reports to the facility without crutches and states that his pain is at 4. Besides, the patient has improved sleep. However, discontinuing Milnacipran will lead to withdrawal symptoms, reducing the dose. Reducing Milnacipran to 25 mg is because the drug is only part of the treatment regime and should not be taken as the only option; the dose should be reduced while introducing other non-pharmacological interventions.
Actual Results from the Decisions
The results of the first decision were very close to my expectations because the patient returned in four weeks without using crutches and stated that his pain was at 4 out of 10, which was very impressive. Besides, the patient reported having improved sleep. Also, the patient is oriented to the future, a good sign of progress. At decision two, the patient reports worsening his symptoms to 7 out of 10 and frequently waking up at night. The last decision to reduce the dosage helped the patient manage his activities and overcome withdrawal symptoms Neurological and Musculoskeletal Disorders Essay Example
ORDER HERE
References
Birklein, F., & Dimova, V. (2017). Complex regional pain syndrome–up-to-date. Pain reports, 2(6).
Ellingrod, V. L. (2017). When to prescribe antidepressants to treat comorbid depression and pain disorders. Current Psychiatry, 16(1)Neurological and Musculoskeletal Disorders Essay Example.
Henssler, J., Heinz, A., Brandt, L., & Bschor, T. (2019). Antidepressant withdrawal and rebound phenomena. Deutsches Ärzteblatt International, 116(20), 355.
Keks, N. A., Hope, J., Keogh, S., & Copolov, D. L. (2018). Milnacipran: serotonin-noradrenaline reuptake inhibitor approved for fibromyalgia may be a useful antidepressant. Australasian Psychiatry, 26(5), 537-540.
Urits, I., Shen, A. H., Jones, M. R., Viswanath, O., & Kaye, A. D. (2018). Complex regional pain syndrome, current concepts and treatment options. Current pain and headache reports, 22(2), 1-9.
Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
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’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders. Neurological and Musculoskeletal Disorders Essay Example
Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images
To Prepare
• Review the interactive media piece assigned by your Instructor.
• 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.
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. Neurological and Musculoskeletal Disorders Essay Example
You will submit this Assignment in Week 8.
I have already made the 3 Decisions it asks you to make see next pages after the rubric. Case study will be after rubric
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_6521_Week8_Assignment_Rubric
• Grid View
• List View
Excellent
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific. 18 (18%) – 20 (20%)
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made 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. 23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.
The response includes specific and relevant outside reference examples that fully support the explanation provided.
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. 18 (18%) – 20 (20%)
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.
The response includes specific and relevant outside reference examples that fully support the explanation provided.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples. 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.
The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.
Written Expression and Formatting – Paragraph Development and Organization: Neurological and Musculoskeletal Disorders Essay Example
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors
Name: NURS_6521_Week8_Assignment_Rubric
Complex Regional Pain Disorder
White Male With Hip Pain
BACKGROUND
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 “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.” Neurological and Musculoskeletal Disorders Essay Example
SUBJECTIVE
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. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”
The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”
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. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.” Neurological and Musculoskeletal Disorders Essay Example
During the client interview, the client states “oh! It’s happening, let me show you!” 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. “It will last about a minute or two, then it will let up” 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 “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.
MENTAL STATUS EXAM
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.
Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)
Decision Point One
Select what you should do: Neurological and Musculoskeletal Disorders Essay Example
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
Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day
Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed
Decision Point One Picked the first one Savella
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
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Client comes into the office to without crutches but is limping a bit. The client states that the pain is “more manageable since I started taking that drug. I have been able to get around more on my own. The pain is bad in the morning though and gets better throughout the day”. On a pain scale of 1-10; the client states that his pain is currently a 4. When asked what pain level would be tolerable on a daily basis, the client states, “I would rather have no pain but don’t think that is possible. I could live with a pain level of 3.”. When questioned further, you ask what makes the pain on a scale of 1-10 different when comparing a level of 9 to his current level of 4?”. The client states that since using this drug, I can get to a point on most days where I do not need the crutches. ” The client is also asked what would need to happen to get his pain from a current level of 4 to an acceptable level of 3. He states, “If I could get to the point everyday where I do not need the crutches for most of my day, I would be happy.”
• Client states that he has noticed that he frequently (over the past 2 weeks) gets bouts of sweating for no apparent reason. He also states that his sleep has “not been so good as of lately.” He does complain of nausea today
• Client’s blood pressure and pulse are recorded as 147/92 and 110 respectively. He also admits to experiencing butterflies in his chest. The client denies suicidal/homicidal ideation and is still future oriented
Decision Point Two Picked the first one to continue Savella but lower dose to 25mg twice a day
Select what you should do next: Neurological and Musculoskeletal Disorders Essay Example
Continue with current medication but lower dose to 25 mg twice a day
Discontinue Savella and start Lyrica (pregabalin) 50 mg orally BID
Discontinue Savella and start Zoloft (sertraline) 50 mg daily
Decision Point Two
Continue with current medication but lower dose to 25 mg twice a day
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Client comes to office today with use of crutches. He states that his current pain is a 7 out of 10. “I do not feel as good as I did last month.”
• Client states that he is sleeping at night but woken frequently from pain down his right leg and into his foot
• Client’s blood pressure and heart rate recorded today are 124/85 and 87 respectively. He denies any heart palpitations today
• Client denies suicidal/homicidal ideation but he is discouraged about the recent slip in his pain management and looks sad
Decision Point Three Picked the first one
Select what you should do next:
Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME
Discontinue Savella and start tramadol 50 mg orally every 6 hours. Client may increase to 100 mg orally every 6 hours if pain is not adequately controlled
Reduce Savella to 12.5 mg orally BID and start Celexa (citalopram) 10 mg orally daily Neurological and Musculoskeletal Disorders Essay Example
Decision Point Three
Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME
ORDER TODAY
Guidance to Student
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 Neurological and Musculoskeletal Disorders Essay Example