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

Announcements (Due Oct. 19, 2019) • Week 6 Endocrine and Musculoskeletal System Posted on: Sunday, September 29, 2019 9:46:51 PM EDT Class, Enclosed is the case for Week 6. 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.” 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.” 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:  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.  Nuerontin 300 mg PO bedtime with weekly increases of 300 mg per day to a max of 2400 mg if needed. 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. Photo Credit: Getty Images/Science Photo Library RF 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. You will submit this Assignment in Week 8. Rubric Detail Select Grid View or List View to change the rubric's layout. Name: NURS_6521_Week8_Assignment_Rubric •  Grid View •  List View Show Descriptions Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific. -Excellent 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. Good 16 (16%) - 17 (17%) The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented. Fair 14 (14%) - 15 (15%) The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented. Poor 0 (0%) - 13 (13%) The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing. 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. - Excellent 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. Good 20 (20%) - 22 (22%) The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes relevant outside reference examples that lend support for the explanation provided that are accurate. Fair 18 (18%) - 19 (19%) The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided. Poor 0 (0%) - 17 (17%) The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing. The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing. 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. - Excellent 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. Good 16 (16%) - 17 (17%) The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. The response includes relevant outside reference examples that lend support for the explanation provided that are accurate. Fair 14 (14%) - 15 (15%) The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided. Poor 0 (0%) - 13 (13%) The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing. The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing. 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. - Excellent 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. Good 16 (16%) - 17 (17%) The response accurately explains 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 accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise. Fair 14 (14%) - 15 (15%) The response inaccurately or vaguely explains 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 inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise. Poor 0 (0%) - 13 (13%) vaguely 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, or is missing. The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing. Written Expression and Formatting - Paragraph Development and Organization: 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. - Excellent 5 (5%) - 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. Good 4 (4%) - 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Fair 3.5 (3.5%) - 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Poor 0 (0%) - 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. Written Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation-- Excellent 5 (5%) - 5 (5%) Uses correct grammar, spelling, and punctuation with no errors Good 4 (4%) - 4 (4%) Contains a few (1–2) grammar, spelling, and punctuation errors Fair 3.5 (3.5%) - 3.5 (3.5%) Contains several (3–4) grammar, spelling, and punctuation errors Poor 0 (0%) - 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding 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.-- Excellent 5 (5%) - 5 (5%) Uses correct APA format with no errors Good 4 (4%) - 4 (4%) Contains a few (1–2) APA format errors Fair 3.5 (3.5%) - 3.5 (3.5%) Contains several (3–4) APA format errors Poor 0 (0%) - 3 (3%) Contains many (≥ 5) APA format errors Total Points: 100 Name: NURS_6521_Week8_Assignment_Rubric Learning Resources Required Readings (click to expand/reduce) Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier. •  Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77) •  Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90) •  Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107) •  Chapter 13, “Adrenergic Agonists” (pp. 109–119) •  Chapter 14, “Adrenergic Antagonists” (pp. 121–132) •  Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137) •  Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141) •  Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158) •  Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166) •  Chapter 19, “Drugs for Epilepsy” (pp. 167–189) •  Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201) •  Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641) •  Chapter 58, “Drug Therapy of Gout” (pp. 643–651) •  Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672) American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5 This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia. Document: Mid-Term Summary & Study Guide (PDF) Required Media (click to expand/reduce) Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author. In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease. Laureate Education (Producer). (2019e). Complex regional pain disorder [Interactive media file]. Baltimore, MD: Author. In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders. Disorders of The Nervous System Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m) Accessible player --Downloads--Download Video w/CCDownload AudioDownload Transcript

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Assignment
Number of Pages	3 Page(s)/825 words
Sources	6
Format	APA
Spacing	Double Spaced

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