{"id":128840,"date":"2023-02-14T00:00:00","date_gmt":"2023-02-14T00:00:00","guid":{"rendered":"https:\/\/nursingstudybay.com\/2023\/02\/14\/nursing-assessment-nursing-homework-help-2\/"},"modified":"2023-02-14T00:00:00","modified_gmt":"2023-02-14T00:00:00","slug":"nursing-assessment-nursing-homework-help-2","status":"publish","type":"post","link":"https:\/\/www.studyproessays.com\/help\/nursing-assessment-nursing-homework-help-2\/","title":{"rendered":"Nursing assessment. | Nursing homework help"},"content":{"rendered":"

<\/p>\n

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\"White<\/p>\n

BACKGROUND<\/strong><\/p>\n

This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is Helped 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 \u201call in his head.\u201d He further reports that his physician believes he is just making stuff up to get \u201cnarcotics to get high.\u201d<\/p>\n

SUBJECTIVE<\/strong><\/p>\n

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\u2019clock to 12 o\u2019clock 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 \u201cthere is no such thing as RSD, it comes from depression\u201d 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 \u201cI said \u2018no,\u2019 there is no need for a wheelchair, I can beat this!\u201d<\/p>\n

The client reports that he used to be a machinist where he made \u201cpretty good money.\u201d He was engaged to be married, but his fianc\u00e9 got \u201csick and tired of putting up with me and my pain, she thought I was just turning into a junkie.\u201d<\/p>\n

He reports that he does get \u201cdown in the dumps\u201d from time to time when he sees how his life has turned out, but emphatically denies depression. He states \u201cyou can\u2019t let yourself get depressed\u2026 you can drive yourself crazy if you do. I\u2019m not really sure what\u2019s wrong with me, but I know I can beat it.\u201d<\/p>\n

During the client interview, the client states \u201coh! It\u2019s happening, let me show you!\u201d this prompts him to stand with the Helpance 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. \u201cIt will last about a minute or two, then it will let up\u201d 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 \u201cif there is anything you can do to help me with this pain, I would really appreciate it.\u201d He does report that his family doctor has been giving him hydrocodone, but he states that he uses is \u201csparingly\u201d because he does not like the side effects of feeling \u201csleepy\u201d and constipation. He also reports that the medication makes him \u201cloopy\u201d and doesn\u2019t really do anything for the pain.<\/p>\n

MENTAL STATUS EXAM<\/strong><\/p>\n

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.<\/p>\n

Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)<\/strong><\/p>\n

Decision Point One<\/p>\n

Select what the PMHNP should do:<\/strong><\/h5>\n

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<\/a>Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day<\/a>Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed<\/u><\/a><\/p>\n

Examine Case Study: A Caucasian Man With Hip Pain.<\/em> 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\u2019s pharmacokinetic and pharmacodynamic processes.<\/p>\n

At each decision point stop to complete the following:<\/p>\n