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.
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.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
- Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 8 Assignment You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Submit Your Assignment by Day 7 of Week 8
Sample Paper Week 8 Assignment
Walden NURS 6521 – Decision Tree for Neurological and Musculoskeletal Disorders
Student’s Name:
Institutional Affiliation:
Case Summary
A 43-year-old white male presents with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. The patient presents for a psychiatric evaluation after a referral by his family doctor, who felt that the pain was imaginary. The patient reports that his physician believes he is faking the pain to get narcotics to get high. He reports that the pain began7 years ago after sustaining a fall at work, landing on his right hip. He notes that the pain has led to the loss of his job and relationship, and he occasionally goes down in the dumps when he sees how the pain has impacted his life. However, he emphatically denies depression. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS).
Decision 1
Start 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
Reasons for Selecting this Decision
In patients with CRPS, changes in the nervous system caused by injuries or trauma cause malfunctioning of peripheral sensory neurons, responsible for transmitting pain signals from the brain and spinal cord to all other parts of the body. As a result, patients with CRPS have a low pain threshold, thus more sensitive to pain. Savella is a selective norepinephrine and serotonin reuptake inhibitor (SNRI) and an NMDA antagonist. Therefore, it inhibits the reuptake of norepinephrine and serotonin neurotransmitters, restoring brain chemical balance and allows more of these neurotransmitters to travel from neuron to neuron. This produces analgesic effects (Stanton-Hicks, 2018).
Although Amitriptyline, a tricyclic anti-depressant, has been established to be effective off-label neuropathic pain management, it could not be prescribed (Benzon, Liu & Buvanendran, 2016). Some of the drug’s significant side effects are drowsiness and dizziness that the client initially stated he didn’t like. Therefore, prescribing this medication for a start might only trigger non-compliance. It is the role of a care provider to prescribe drugs that promote compliance and have fewer side effects. Neurontin, an anticonvulsant, has also been established to be effective in nerve pain relief (Finnerup et al., 2015). However, it also has the side effects of drowsiness and drowsiness; therefore, it wasn’t a viable choice.
Expected Outcome
The expected outcomes of treatment with Savella were significant pain reduction to three on a scale 10 point pain scale, and the ability to walk without support. Additionally, it was expected the patient would resume normal work routine and perform activities of daily life with minimal support and regain a happy mood (Stanton-Hicks, 2018).
Difference between Expected Outcome and Actual Outcome
After four weeks, the patient returned to the facility looking joyous and hopeful. He reports the ability to walk without support, but minimal limping was noticeable. He noted the pain had decreased to four on a ten point pain scale, but it is worse in the morning and gets better as the day progressed. The patient reported occasional sweating, sleep disturbance, and palpations. His physical assessment indicated blood pressure of 147/92mmhg and pulse rate to be 110 beats/ min. He denied depression and suicidal thoughts. The palpitations, sweating, sleep disturbance, and elevated BP and pulse rate are determined to be Savella side effects, which can be addressed by reducing the dosage (Finnerup, et al., 2015).
Decision 2
Reduce the Savella 50 mg oral once-daily dosage to 25 mg twice daily.
Reasons for Selecting this Decision
Although the Savella prescription yielded significant progress, the patient reported unexplained sweats, sleep disturbance, and elevated blood pressure, which were established to be Savella’s side effects. A study has demonstrated that reducing the dosage of Savella can help manage its side effects (Stanton-Hicks, 2018).
Expected Outcome
It was expected that the patient’s pain level would progressively decrease, his limping would disappear, he would increasingly perform more and more daily life activities with minimal support, and that his social, professional, and physical functioning would also improve (Benzon, Liu & Buvanendran, 2016). The Savella side effects were expected to disappear as well, and he was expected to live a near-normal life.
Difference between Expected Outcome and Actual Outcome
The patient returned after four weeks walking with crutches and looking sad and discouraged by his pain management slip. He reported an inability to walk without support and a 7 out of 10 pain level. He also reported frequently waking up at night due to pain in his right leg and foot. Savella side effects are reported to have disappeared. He denied depression and suicidal ideation. His assessment results indicate his blood pressure was 124/85, and his pulse rate was 87 beats/ min. The deterioration was attributed to the previous decision to lower the Savella dosage (Murnion, 2018).
Decision 3
Change Savella to 50 mg orally in the morning and 25 mg at bedtime.
Reasons for Selecting this Decision
A higher dose of Savella prescribed during the patient’s initial visit was effective. Besides, the patient had reported the pain worsened early morning and improved as the day progressed. Study shows that reducing the dosage during parts of the day when pain is mostly under control is a good idea that can still contribute to achieving therapeutic goals (Finnerup et al., 2015).
Expected Outcome
The pain was expected to decrease to a three on a 10 point pain scale. The patient was expected to walk without support and perform daily life activities with minimal or no support. Stanton-Hicks (2018) supported that the patient would no longer experience sleep disturbance, and his mood would gradually stabilize. It was expected the drug side effect would normalize progressively.
Difference between Expected Outcome and Actual Outcome
After four weeks, the patient returned walking without the support and reported a pain level of 4 on a10 point pain scale. He seemed joyous, hopeful, and willing to continue with the treatment to attain further pain reduction. Assessment results indicated BP to be 120/84mmhg and pulse rate to be 86 beats/min. He denied depression and suicidal ideation and was future-oriented. The patient was aware that the pain might never completely disappear with neuropathic pain syndrome but can be managed at tolerable levels (Benzon, Liu & Buvanendran, 2016). He was advised to supplement the pharmacologic therapy with exercise, physical therapy, massage, and heat therapy for better outcomes (Murnion, 2018).
References
Benzon, H. T., Liu, S. S., & Buvanendran, A. (2016). Evolving definitions and pharmacologic management of complex regional pain syndrome.
Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., … & Kamerman, P. R. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), 162-173.
Murnion, B. P. (2018). Neuropathic pain: current definition and review of drug treatment. Australian prescriber, 41(3), 60.
Stanton-Hicks, M. (2018). Complex regional pain syndrome. In Fundamentals of Pain Medicine (pp. 211-220). Springer, Cham.
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