NURS 6512 DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS PAPER

NURS 6512 DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS PAPER

NURS 6512 DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS PAPER

Decision Tree for Neurological and Musculoskeletal Disorders

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Neurological and musculoskeletal disorders are some of the conditions that psychiatric mental health practitioners often experience in their practice. The practitioners should be competent in ensuring accurate diagnosis and initiation of appropriate therapies to promote recovery. Therefore, this paper examines a case study of a patient that has been diagnosed with complex regional pain disorder (reflex sympathetic dystrophy).

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Summary of the Case Study

The case study is of a 43-year-old patient that presents at the office with a chief complain of pain. The patient is assisted in his ambulation with a set of crutches. The family doctor sent him for psychiatric assessment since he felt that the pain was all in his head. Subjective data shows that the patient started experiencing the pain seven years ago after sustaining a fall at work. Numerous diagnostic tests have been done since then. A diagnosis of a torn cartilage was made four years ago. The patient reported experiencing frequent cooling of the extremity, excessive cramping, pain, and reduced functioning. The patient has been diagnosed with complex regional pain disorder (reflex sympathetic dystrophy).

The first decision made for the patient is starting him on amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day. The second decision is continuing with the current medication and increase dose to 125 mg at bedtime this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning. The third decision is to continue the current dose of Elavil of 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise.

If Evidence-Base Literature Supports the Decisions Made

 Evidence-based literature supports the above decisions made to treat the client. Evidence-based data shows that amitriptyline is highly effective in improving the symptoms associated with complex regional pain. This includes pain, autonomic and motor symptoms, and functioning. Literature also shows the increased risk of complications such as QT prolongation with the use of amitriptyline, hence, the need to initiate patients on low doses and titrate upwards with close monitoring (Eldufani et al., 2020; Iolascon & Moretti, 2019). Amitriptyline is an antidepressant associated with the risks of suicidal ideation, plans, or attempts, weight gain, and sleep disturbances. As a result, it is appropriate to monitor the patient for these risks while anticipating the improvement in the symptoms of the disorder. Literature also supports the need for practitioners to titrate dosage upwards based on the patient’s response to amitriptyline and changes in symptoms (Caradonna et al., 2023; Limerick et al., 2023). Therefore, evidence-based literature informed the decisions made in the client’s treatment.

What I Was Hoping to Achieve

 I was hoping to achieve improvement in symptoms of complex regional pain with the decisions made in the case study. This included the reduction in the patient’s pain to the lowest rating in the pain rating scale, improved functioning as evidenced by him not being dependent on crutches, and tolerance to amitriptyline. Studies have shown that amitriptyline reduces pain in patients with complex pain syndrome. It also improves physical functioning by eliminating the motor symptoms of the disorder. Patients also benefit from improved quality of sleep and quality of life with the reduction in the distressing symptoms of the syndrome(Fallico et al., 2022; Shin et al., 2022).

Differences

Minimal differences were observed between what I expected to achieve and the results of the decisions in the exercise. First, I anticipated moderate improvement in pain in the first decision. However, the client reported mild improvement in pain, translating into the dosage being inadequate to manage symptoms. I also did not anticipate the patient to report weight gain in the second decision, which is a side effect of amitriptyline(Shin et al., 2022).

Conclusion

 This case study shows that amitriptyline is effective when used for complex regional pain. Amitriptyline was selected with the aim of reducing the symptoms of complex regional pain and improving functioning. Evidence-based literature informed the decisions made in the case study. The decisions made aligned with most of my expected outcomes.

References

Caradonna, A. J., Lee, D., & Caparó, M. (2023). Early Neuropathic Treatment May Prevent the Chronic Stage of Complex Regional Pain Syndrome Type II (CRPS II​). Cureus. https://doi.org/10.7759/cureus.36861

Eldufani, J., Elahmer, N., & Blaise, G. (2020). A medical mystery of complex regional pain syndrome. Heliyon, 6(2), e03329. https://doi.org/10.1016/j.heliyon.2020.e03329

Fallico, N., Padmanabhan, R., Rahman, S., Somma, F., & Spagnoli, A. M. (2022). A randomised placebo-controlled clinical trial on the efficacy of local lidocaine injections and oral citalopram for the treatment of complex regional pain syndrome. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75(3), 970–979. https://doi.org/10.1016/j.bjps.2021.11.022

Iolascon, G., & Moretti, A. (2019). Pharmacotherapeutic options for complex regional pain syndrome. Expert Opinion on Pharmacotherapy, 20(11), 1377–1386. https://doi.org/10.1080/14656566.2019.1612367

Limerick, G., Christo, D. K., Tram, J., Moheimani, R., Manor, J., Chakravarthy, K., Karri, J., & Christo, P. J. (2023). Complex Regional Pain Syndrome: Evidence-Based Advances in Concepts and Treatments. Current Pain and Headache Reports. https://doi.org/10.1007/s11916-023-01130-5

Shin, S. E., Haffner, Z. K., Chang, B. L., & Kleiber, G. M. (2022). A Pilot Investigation into Targeted Muscle Reinnervation for Complex Regional Pain Syndrome, Type II. Plastic and Reconstructive Surgery Global Open, 10(12), e4718. https://doi.org/10.1097/GOX.0000000000004718

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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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.

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