DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
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This week you will be covering Psychological Disorder management. During this week, there are several media cases for you to review for your discussion assignment. Per the requirements, you will select an interactive media piece to practice decision making when treating patients with psychological 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 modules Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.
Assignment:
- In your course resources under week 6 you will find the decision tree under required media.
- Choose the case ” Complex Regional Pain Disorder”, It should be the second on the list
To Prepare:
- Review the interactive media piece assigned by your Instructor.
- Reflect on the patients 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 patients diagnosis and treatment.
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.
- https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/…
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 oclock to 12 oclock 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 cant let yourself get depressed you can drive yourself crazy if you do. Im not really sure whats wrong with me, but I know I can beat it.
During the client interview, the client states oh! Its 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 doesnt 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
Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed
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