Examine A Caucasian Man With Hip Pain Case Study Paper Examine A Caucasian Man With Hip Pain Case Study Paper 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 clients pharmacokinetic and pharmacodynamic processes. ORDER Examine A Caucasian Man With Hip Pain Case Study Paper Examine A Caucasian Man With Hip Pain Case Study Paper 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? ? Examine A Caucasian Man With Hip Pain Case Study Paper 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? ? Examine A Caucasian Man With Hip Pain Case Study Paper Decision #3 ? 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 #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. Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen). ? ? ? 2. Write paper addressing all section listed based on the decision tree. ? Case Study: A Caucasian Man 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) ORDER INSTRUCTIONS-COMPLIANT NURSING PAPERS Decisions Made and Outcomes (Needed to formulate the paper) ? Choices for Decision 1: 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. My decision:?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 Outcome: RESULTS OF DECISION POINT ONE: Client returns to clinic in four weeks Client comes into the office to without crutches but is limping a bit. The client states that the pain is ?more manageable since I started taking that drug. I have been able to get around more on my own. The pain is bad in the morning though and gets better throughout the day?. On a pain scale of 1-10; the client states that his pain is currently a 4. When asked what pain level would be tolerable on a daily basis, the client states, ?I would rather have no pain but dont think that is possible. I could live with a pain level of 3.?. When questioned further, the PMHNP asks what makes the pain on a scale of 1-10 different when comparing a level of 9 to his current level of 4??. The client states that since using this drug, I can get to a point on most days where I do not need the crutches. ? The client is also asked what would need to happen to get his pain from a current level of 4 to an acceptable level of 3. He states, ?If I could get to the point everyday where I do not need the crutches for most of my day, I would be happy.? ?Client states that he has noticed that he frequently (over the past 2 weeks) gets bouts of sweating for no apparent reason. He also states that his sleep has ?not been so good as of lately.? He complains of nausea today. ?Clients blood pressure and pulse are recorded as 147/92 and 110 respectively. He also admits to experiencing butterflies in his chest. The client denies suicidal/homicidal ideation and is still future oriented ? Choices for Decision 2: Select what the PMHNP should do: Continue with current medication (Savella) but lower dose to 25 mg twice a day ?Discontinue Savella and start Lyrica (pregabalin) 50 mg orally BID ?Discontinue Savella and start Zoloft (sertraline) 50 mg My decision:?Continue with current medication (Savella) but lower dose to 25 mg twice a day. Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeks ?Client comes to office today with use of crutches. He states that his current pain is a 7 out of 10. ?I do not feel as good as I did last month.? ?Client states that he is sleeping at night but woken frequently from pain down his right leg and into his foot ?Clients blood pressure and heart rate recorded today are 124/85 and 87 respectively. He denies any heart palpitations today ?Client denies suicidal/homicidal ideation but he is discouraged about the recent slip in his pain management and looks sad. Choices for Decision 3: Decision Point Three Select what the PMHNP should do next: ?Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME ?Discontinue Savella and start tramadol 50 mg orally every 6 hours. Client may increase to 100 mg orally every 6 hours if pain is not adequately controlled ?Reduce Savella to 12.5 mg orally BID and start Celexa (citalopram) 10 mg orally Examine A Caucasian Man With Hip Pain Case Study Paper Outcome: Guidance to Student RESULT FROM CHOOSING TO CHANGE SAVELLA TO 25 MG ORALLY IN THE MORNING AND 50 MG ORALLY AT BEDTIME: Guidance to Student The client has a complex neuropathic pain syndrome that may never respond to pain medication. Once that is understood, the next task is to explain to the client that pain level expectations need to realistic in nature and understand that he will always have some level of pain on a daily basis. The key is to manage it in a manner that allows him to continue his activities of daily living with as little discomfort as possible. Next, it is important to explain that medications are never the final answer but a part of a complex regimen that includes physical therapy, possible chiropractic care, heat and massage therapy, and medications. Savella is a SNRI that also possesses NMDA antagonist activity which helps in producing analgesia at the site of nerve endings. It is specifically marketed for fibromyalgia and has a place in therapy for this gentleman. Tramadol is never a good option along with other opioid-similar analgesics. Agonists at the Mu receptors does not provide adequate pain control in these types of neuropathic pain syndromes and therefore is never a good idea. It also has addictive properties which can lead to secondary drug abuse. Reductions in Savella can help control side effects but at a cost of uncontrolled pain. It is always a good idea to start with dose reductions during parts of the day that pain is most under control. The addition of Celexa with Savella needs to be done cautiously. Both medications inhibit the reuptake of serotonin and can, therefore, lead to serotonin toxicity or serotonin syndrome ***Write on each decision. Make sure that in each decision choice that you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least?7 References.?Please use in-text citations for each section of each decision.?Dont forget the ethical considerations for this assignment. Make it a section by itself.*** ***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.*** ? Please use the following format when formulating the paragraphs for each section. Dont forget the intext citations. Remember to use at least 7 references. ? Introduction Decision #1 Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices) Anticipated Results (of Chosen Decision) Difference in Results (Anticipated VS Actual) Decision #2 Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices) Anticipated Results (of Chosen Decision) Difference in Results (Anticipated VS Actual) ORDER INSTRUCTIONS-COMPLIANT NURSING PAPERS Decision #3 Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices) Anticipated Results (of Chosen Decision) Difference in Results (Anticipated VS Actual) Ethical Considerations Conclusion References Examine A Caucasian Man With Hip Pain Case Study Paper Order Now

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Examining A Patient With Hip Pain

Introduction

Hip pain is a common complaint in older adults. It can be caused by arthritis or other medical conditions, but it’s often due to osteoarthritis. Osteoarthritis occurs when the cartilage that cushions your joints wears down and becomes inflamed. In addition to pain, people with hip arthritis may experience stiffness and limited mobility as well. A physical exam can help identify any underlying conditions that may be causing symptoms such as pain or restricted movement in your hip area

The primary lesion is most likely to be in the hip.

The hip is a ball-and-socket joint that allows movement of the trunk and legs. Hip pain is common, but what causes it can be more complicated.

Doctors may find that it’s caused by arthritis, which causes damage to tendons, ligaments and cartilage in your joints. Arthritis may occur as a result of trauma or infection, or you may have it because of bone spurs (which are abnormal growths on bones). Other conditions associated with hip pain include muscle strain—which can come from overuse activities like running or weight lifting—and bursitis (inflammation caused by fluid buildup around a bony prominence).

First, you should examine the back.

The first thing you should do is examine the patient’s back. Look for tenderness, swelling and deformity. Make sure that there is not any restriction to motion of the hip joint or muscle weakness in either direction (flexion/extension). If you find any of these things, then check muscle spasms as well.

Then examine the patient’s legs.

• Examine the patient’s legs

• Check for swelling and tenderness of the hip joint area

• Check for pain, weakness and range of motion at each joint in both thighs, hips and knees (if applicable)

• Observe reflexes in each leg

Check the skin carefully for rashes and evidence of trauma.

If a patient has a rash or bruises, look for other signs of trauma that could indicate a hip problem.

Check the skin carefully for rashes, bruises, or other evidence of trauma. Check the skin around your mouth and gums to see if they look normal or swollen (redness).

If you notice any changes in your teeth that may be related to the hip problems like yellowing around their crowns (alveolar bone loss), check with your dentist first before making any assumptions about a possible infection.

Ask about recent colds or bladder infections, which can cause pain that mimics arthritis.

A patient with hip pain should be asked about recent colds or bladder infections, which can cause pain that mimics arthritis. These are common causes of musculoskeletal problems and may need to be ruled out before you diagnose the patient with arthritis.

Then have the patient stand.

• Stand up and walk. Ask the patient to stand, then walk in a straight line for about 10 steps. You should check their gait at this point, as well as ask them if they feel any pain during or after walking.

• Squat down and sit back up again without touching your toes (this is called a “chair squat”). This can help highlight any early signs of injury by causing tension in the hip muscles (when you’re sitting).

Have the patient perform several tasks to help you localize the problem.

To help you localize the problem, have the patient perform several tasks to help you assess their hip.

• Standing and walking: Have them stand on both feet with a straight back and keep their knees soft. Walk around in an office or hallway for about 15 minutes, then have them sit down for another 15 minutes and stand up again. Repeat this process three times before moving on to other exercises that may be more helpful in finding out what’s causing the pain (see below).

• Sitting and standing: This exercise can be done anywhere—the patient doesn’t necessarily need a chair or bench! Sit comfortably at their desk or table, then get up slowly while keeping their knees soft at all times throughout this movement; repeat as many times as necessary until it feels comfortable enough not only for sitting but also standing upright without any discomfort whatsoever.* Lying on one side: Lie face down with arms by side; breathe normally through nose so nothing gets caught between teeth during inhalation phase of breath cycle.* Lying face up: Same thing except start chest expansion phase first instead of starting with exhalation phase since breathing would still be affected by gravity if performed incorrectly here too 🙂

When examining a patient with hip pain, first ask about associated symptoms and then perform a careful physical examination

When examining a patient with hip pain, first ask about associated symptoms and then perform a careful physical examination.

• Ask about associated symptoms: Does the patient have any other medical conditions? Has he or she injured his or her back recently? Has he or she been active recently (e.g., jogging, playing sports)?

• Perform a careful physical examination: Check for evidence of trauma on self-report or during history taking; look for swelling and redness in the skin around each hip joint; check for warmth that can be felt at this area after palpating it gently with your finger tips along its length as well as up into your elbow crease area; examine for rashes or infections that may indicate osteoarthritis (OA) within the joint itself but which may also be found elsewhere along its course such as on the outside edges where they meet bone ends; confirm whether OA has actually occurred by looking closely at those areas using magnification instruments such as binoculars!

Conclusion

If you have any questions about the examination, ask your doctor. He or she will be able to give you more information and help you with your diagnosis.