A Caucasian Man with Hip Pain Case Study

A Caucasian Man with Hip Pain Case Study

  • Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders.
    The Assignment
    Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
    At each decision point stop to complete the following:
    • Decision #1
    o Which decision did you select?
    o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
    • Decision #2A Caucasian Man with Hip Pain Case Study.
    o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
    • Decision #3
    o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
    Also include how ethical considerations might impact your treatment plan and communication with clients.
    Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.A Caucasian Man with Hip Pain Case Study.

Decision Tree Assignment

Here is a general framework for what I am looking for on the decision tree assignments.

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 Provide an introduction to the disease state discussed in the case. I am looking for a high-level summary that briefly describes the key aspects of that disease state. I do not want several pages of information related to the diagnosis of the disease state.

Provide a high-level summary of the important pieces of information from the case-study that is presented. I do not want the entire case study presented. The goal is that you would be able to give your essay to someone that does not know anything about the assignment and for that individual to be able to understand the purpose of your essay. Again….focus on the important pieces of information that will help you make your decision.

You also want to mention the purpose of the assignment. This can be brief.

Decision Point 1, 2, and 3.

At each decision point, list the options that are presented and describe your rationale for choosing the option you chose.

do not want general answers….”I chose sertraline because sertraline is an SSRI and SSRIs are approved for depression/anxiety”. I want VERY SPECIFIC reasons you chose the option you chose. These reasons must be backed by good evidence. Feel free to include studies comparing agents, side effects, dosing, patient considerations, therapeutic practice guidelines, comorbid conditions, etc....  You will also need to explain your rationale for not choosing the other two options.  This is very important in your learning. Please remember that you will have MANY more medications to chose from than three in clinical practice. When you make your choice, you also need to describe your goals of treatment.A Caucasian Man with Hip Pain Case Study. What do you want to achieve by initiating the therapy you picked. Again….be specific. Defend your choices like you are in a courtroom.

After each decision, you will be presented with the outcome of that decision. You need to discuss how that outcome was what you expected or if it was different than what you expected and why.

You will do the above for all three decision points.

You need to use evidence to support your rationale. [Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Credible reference material only will be accepted. Sites such as WebMD and drugs.com (among others) will not be counted.A Caucasian Man with Hip Pain Case Study]

Don’t forget to include information related to the ethical considerations and how they might impact your treatment plan and communication with your clients.

In summary: What needs to be in your essay.

Introduction regarding disease state
High-level summary of patient case
Purpose of the essay statement

Decision 1
What options were listed
What option did you choose?
Why did you select that option?
Why didn’t you select the other two options?
What was your goal of treatment
Was the outcome what you expected? Why?

Decision 2
What options were listed
What option did you choose?
Why did you select that option?
Why didn’t you select the other two options?
What was your goal of treatment
Was the outcome what you expected? Why?

Decision 3
What options were listed
What option did you choose?
Why did you select that option?
Why didn’t you select the other two options?
What was your goal of treatment
Was the outcome what you expected? Why?

Conclusion with Ethical considerations

***Do not use the start over button and complete several different times. That is not the point. If you do use the START OVER button, I do not want your paper to reflect this. I have had students do it multiple times and address incorrect outcomes in their paper. I have also had students submit a paper that defends using all three options presented at decision point number one.A Caucasian Man with Hip Pain Case Study. You will need to click the option to move to the next screen which will provide you with the outcome and the options for the next decision point.  You will receive a ZERO on the assignment if you do not follow the instructions correctly. I had a handful of students last semester complete the assignment incorrectly.  Please ask questions if you do not understand.

Complex Regional Pain Disorder

White Male With Hip Pain

White ale on crutches

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.”A Caucasian Man with Hip Pain Case Study

 

 

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)A Caucasian Man with Hip Pain Case Study. 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.A Caucasian Man with Hip Pain Case Study”

 

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.A Caucasian Man with Hip Pain Case Study

 

 

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.A Caucasian Man with Hip Pain Case Study

 

Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)

 

Decision Point One

Select what the PMHNP 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

  • Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders.

The Assignment

Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.A Caucasian Man with Hip Pain Case Study

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.A Caucasian Man with Hip Pain Case Study
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.A Caucasian Man with Hip Pain Case Study