Psych Mental Health Practitioner Program Week 5
Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2).
Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource!
Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add informative content regarding to their topic that is validated via citations.
– Utilize at least two scholarly references per peer post.
Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.
– Minimum of 300 words per peer reply.
– TURNITIN Assignment.
Background: I live in South Florida, I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work in a Psychiatric Hospital.
As an Advanced Nurse Practitioner (ANP), you are working in an urgent care setting. TC comes to the clinic with a work-related injury to the right shoulder. The patient rates the pain 8 on a scale of 0–10. The patient is unable to perform any ROM to the shoulder. There is no neck pain. What pieces of the holistic assessment are missing from this scenario? A holistic assessment should take in the entire patient when considering health. This approach recognizes the physiological, psychological, sociological, developmental, spiritual and cultural needs of the patient. It is a vital first step, as the information gathered during this assessment determines the initial phases of care (Wallace, 2013). According to Wallace the above we are pretty much missing everything. But specifically, I would want to know he patients age and health history. Is he opiate naïve? Does he have any drug allergies? We may have to prescribe a different opioid. Does he have Kidney/liver issues. His ETOH history. How he received the injury. Does he have a chronic issues or other comorbidities?
1. As a healthcare provider, what else do you need to understand about this patient related to pain management?
We need to understand the type of pain. Woo & Robinson in our Textbook has some fine points specifically about the types of pain and their treatment options on page 1245. There are 3 types of pain acute pain, cancer pain and chronic pain. Each with a different treatment modality (Woo & Robinson, 2020).
2. Describe the process of rational drug choice for this case study. In your process, discuss your thought processing of anti-inflammatory agents, topical agents, and narcotics.
• Anti-inflammatory agents. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are used for mild to moderate pain. Some such as ibuprofen have anti-inflammatory properties. They are often the first line of treatment for pain. Most have ADRs including Cardiac issues, GI bleeding, renal and hepatic issues. Celecoxib even has a Cardiac block box warning (Woo & Robinson, 2020). Other anti-inflammatory drugs such as Corticosteroids will not be considered at this time. In our text book on page 836 in relation to pain associated with inflammation Woo & Robinson state “Aspirin is the gold standard against which others are judged” (Woo & Robinson, 2020, page 836).
• Topical Agents These are either anesthetics such as lidocaine or capsaicin are useful for neuropathic pain at peripheral sites. A Lidoderm 5% patch could be considered. They may be applied for 12 hours at a time once a day to non-inflamed intact skin (Woo & Robinson, 2020).
• Narcotics are the last line of treatments after the others have failed. The have been overprescribed for the past 20 years and we all know about the crisis.
• Over the counter Ibuprofen 400 mg PO Q6 hours. For mild to moderate pain. Not to exceed 3200 MG per day (Lexicomp, 2017).
• 5 Lidoderm 5% patches. Apply 1 patch daily to effected site for 5 days. Do not apply to red or broken skin. Take off after 12 hours (Lexicomp, 2017).
• 20 Oxycodone 5 mg tablets. Take 1 by mouth Q6 hours as needed for breakthrough pain > 6. Not to exceed 4 doses a day for 5 days. No refills. Woo & Johnson recommend a 5-day regimen in an outpatient setting (Woo & Robinson, 2020). I stayed away from the combination opioid drugs like NORCO 5-325 or Percocet 5-325 because I want the patient to try NSAID therapy first. I also do not want the patient to take NSAIDS then take a combination drug which also contains NSAIDS. Psych Mental Health Practitioner Program Week 5
3. Include in your response the teaching you would provide to TC.
Try the Ibuprofen and patch first. Avoid the Oxycodone if possible. Call office in 5 days if pain and ROM not improving.
Nonpharmacological treatments Rest Ice Compression Elevation (RICE). For the shoulder.
Lidoderm patch to be worn for a maximum of 12 hours. If skin red or broken do not apply. Clothing may be over patch. If irritation or burning occur at site remove patch (Lexicomp, 2017).
Opioid teaching points
• Do not drink alcohol while you are taking opioids
• Do not drive a car or use dangerous machinery.
• Store your opioids in a safe place, such as a locked cabinet.
• When your pain gets better dispose of medications properly. Do not flush down toilet.
• Call office if you have constipation, nausea, dry mouth, dizziness, vision problem.
• Call 911 if patient breathing very slowly, unable to stay awake, become very confused or unable to urinate.
(Patient education: Opioids for short-term treatment of pain. 2020)
4. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.
There are 5 categories called Schedules in the DEA drug classification system.
• Schedule 1 drugs or chemicals that have no currently accepted medical use and have a high potential for abuse. Drugs include heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-ethylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.
• Schedule 2 drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. Drugs include products with less than 15 milligrams of hydrocodone per dosage unit), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.
• Schedule 3 Drugs with a moderate to low potential for physical and psychological dependence. They are less addictive than Schedule 1 or 2 but more than schedule 4. Drugs include products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone.
• Schedule 4 Drugs have a low potential for abuse and dependence. Some examples include Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol
• Schedule 5 Drugs have an even lower potential for abuse than Schedule IV. They include formulations containing small quantities of certain narcotics. These drugs are used for antidiarrheal, antitussive, and analgesic purposes. Examples include cough medications with less than 200 milligrams of codeine per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin.
(Drug Scheduling, n.d.)
Drug Scheduling (n.d.) Retrieved from https://www.dea.gov/drug-scheduling Lexicomp. (2017). Drug information handbook for advanced practice nursing (17th ed.). Hudson, OH: Wolters Kluwer Clinical Drug Information. Patient education: Opioids for short-term treatment of pain. (2020) retrieved from https://www.uptodate.com/contents/opioids-for-short-term-treatment-of-pain-the-basics? Psych Mental Health Practitioner Program Week 5
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