Promote Fast Recovery And Pain Relief Essay

Write a 1200-1500 word APA formatted essay with three sources of support, addressing all of the following topics:

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You are the primary care provider for a 24-year-old male who has recently been in a car accident. Your patient has been addicted to prescription drugs since a college football injury at the age of 20, when he was prescribed narcotics. He has suffered a neck injury in the car accident and was given narcotic pain medication upon discharge from the hospital. What are your short term and long term goals for the treatment of this patient? How will you safely meet these treatment goals?Promote Fast Recovery And Pain Relief Essay
You are the primary care provider for Mrs. Z, a 70-year-old female patient who has suffered from chronic back pain for a number of years. You are well acquainted with this patient, and due to recent changes in prescription regulations you now see her once a month to renew her narcotic prescription. Three months ago Mrs. Z’s 17-year-old granddaughter moved in with her, after a fight with her mother. Z’s granddaughter was a straight-A student prior to a car accident at the age of 15. She dropped out of high school last year and spent two weeks in rehab for substance abuse. Mrs. Z states her back pain has been worse recently, and she seems to be running out of pills before the end of the month. She is requesting a greater number of pills be prescribed. What concerns do you have? What questions would you ask Mrs. Z? What approach would you take with her? How would you help this family?
You are a primary care nurse in a heart failure clinic. Mr. G presents in the clinic with a three-pound weight gain in the past two days. Upon assessment, he has +2 pitting edema in bilateral lower extremities. When you ask him about his regular Lasix regimen, he shows you a plastic bag full of pills and states that he has so many pills prescribed, he just takes what he thinks he needs when he feels like he needs it. Included in the bag are Cardizem, Toprol XL, glipizide, gabapentin, Lasix, multiple vitamins, ginseng supplements, fish oil supplements, and cinnamon supplements. Where do you start? How can you coordinate a multidisciplinary approach in caring for this patient? What patient education is necessary? How can you assist Mr. G in keeping his medications straight?Promote Fast Recovery And Pain Relief Essay

In the United States and across the globe, the use of narcotics for pain relief has reached epidemic levels. Narcotics have been associated with addiction, abuse and diversion consequences despite being identified as the most effective medications for pain relief and control. Managing patients who are addicted to narcotics present numerous challenges for physicians and nurse practitioners. However, early detection which requires a high index of suspicion promotes the ability to prevent medical complications linked to narcotic addiction. Promote Fast Recovery And Pain Relief Essay
Question 1
Short Term Goals of Care
Promote Fast Recovery and Pain Relief
Irrespective of the addiction history, priority should be the provision of effective pain management whose choice should be based on a medication’s ability to provide adequate pain relief. As suggested by Kolodny et al., (2015), this can only be known through conducting a pain assessment to know of its intensity and severity. The narcotic medications that were prescribed by the physician should, therefore, be assessed by the PCP on whether or not they are effective for pain relief and gradual changes made according to the patient’s recovery from pain.
Providing continuous/round the clock pain relief
Most pain medications that are strictly used on a need basis tend to escalate pain and influence the need for more medications required to control pain. However, ensuring around-the-clock dosing will not only guarantee that the pain is suppressed but also ensure that the patient gets the much-needed comfort. This outcome is however achieved by combining short-acting opioids on prn basis and long-acting opioids. Therefore, the PCP should establish if the prescribed narcotics provide round-the-clock pain relief and if not, make changes as needed. It should also be noted that round-the-clock pain relief can fail to be achieved in case of any dose adjustments (dose reductions) probably due to fear of legal action with regards to narcotic over-prescription (Davis & Carr, 2017). It should be noted that failure to achieve round-the-clock pain relief often leads to inadequate pain relief precipitating a relapse or forcing a client to self-medicate his pain.
Counsel the patient on Addiction to Prescription Drugs
After achieving adequate pain relief, it will be necessary to counsel the patient on addiction to prescription drugs. Therefore, to ensure that the patient does not succumb to the effects of addiction to prescription drugs, he will be counseled and alternatives such as chewing gum considered. Promote Fast Recovery And Pain Relief Essay
Long-term goals of care
Teach the patient on the effects of narcotic addiction and drugs
Most patients are misguided by the assumption that addiction to prescription drugs is better and safer as compared to being addicted to illicit drugs since the former are approved by the FDA. However, to prevent death and other complications, teaching the patient on some of the side-effects of addiction to drugs and narcotics is commendable. The most effective way to achieve this is by establishing a long-term patient counseling strategy using a specific and more detailed schedule. Besides, in the client’s medical records, it will be of the essence to document that he/she is addicted to narcotics (Davis & Carr, 2017). This will enable healthcare providers to prescribe alternative analgesics in the future.
Question 2
It is evident that based on Mrs. Z’s presentation, adequate pain relief is not being achieved. Therefore, it will first be essential to assess the dosing and frequency of Mrs. Z’s narcotic medications and the last prescription date. This will help to determine if the prescribed medications provide around-the-clock pain relief or not. Most clinical cases involving inadequate pain control may result from under-dosing among other issues. This assessment will help to establish the exact cause of inadequate pain relief/control before appropriately addressing it. Promote Fast Recovery And Pain Relief Essay
Mrs. Z’s history is also significant as a close relative (grand-daughter) who has a history of drug abuse that contributed to her dropping out of school and being enrolled in a rehabilitation center. There is a high likelihood that her granddaughter could be urging her to ask for additional narcotic pills. Unless determined otherwise, this likelihood cannot be done away with.
It will be necessary to conduct a comprehensive assessment of Mrs. Z to rule out potential underlying medical issues that may be aggravating her back pain. The assessment will also help to determine if the demand for more pills is as a result of influence from the granddaughter or not. If yes, Mrs. Z will undergo intensive counseling to educate her on the signs and effects of narcotic addiction and adequately address it. Mrs. Z will also undergo several blood tests to assess for dependence. A family health assessment in collaboration with a family health practitioner would also be necessary to address destructive family health patterns existing among the family members (Kolodny et al., 2015). This will help to ensure adequate social and family support for the granddaughter and Mrs. Z to achieve good health outcomes. Promote Fast Recovery And Pain Relief Essay
Question 3

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The three-pound weight gain in two days indicates the worsening of the patient’s current health status. Therefore, Mr. G must be thoroughly assessed for other manifestations of decompensated heart failure such as dyspnea, exertion, levels of oxygen saturation among others. A comprehensive assessment of the patient’s vital signs, hemodynamic state, electrolyte and fluid balance, levels of blood glucose, heart sounds, breath sounds, and jugular venous pressure will be mandatory. The laboratory findings will guide the immediate nursing interventions. Following a history of edema, the patient’s fluid intake and output should be recorded to ensure a fluid balance, blood glucose levels should be maintained within the required limits to prevent short term complications and oxygen should be administered depending on the levels of saturation (Azad & Lemay, 2014).
The CDC recommends the management of patients with heart failure using an interdisciplinary approach. Therefore, when managing Mr. G, the following should make part of the management team: a cardiologist, dietician, diabetic nurse, physician, renal specialist, and pharmacist. A dietary recall to ensure that the patient is maintained under low sodium, calorie-free, the fat-free and diabetic diet will also be necessary. Promote Fast Recovery And Pain Relief Essay
After the patient has been stable, he should be educated on the following: self-care management, maintaining a diet that is low in sodium, maintaining a HASH and diabetic diet, medication adherence, and follow-up, avoiding smoking and alcohol intake.
It was also evident that Mr. G had no knowledge of the indications of the drugs that he was initially prescribed. Therefore, to promote adherence, it would be necessary to educate him and close family members about all the medications. In the process, it will also be possible to determine the likelihood of having a drug that was prescribed and does not benefit Mr. G to prevent polypharmacy (Azad & Lemay, 2014). Mr. G should also be encouraged to use digital applications with reminders to remind him of the drug to take, the specific time, drug name and dosage. Promote Fast Recovery And Pain Relief Essay
Conclusion
Primary care providers assess and manage patients who present with a wide range of medical needs. As observed, pain is one of the most commonly diagnosed and managed medical problems in primary care settings. However, pain management may present numerous challenges to physicians especially among patients who are addicted to narcotics. Irrespective of the addiction or abuse history, pain should be managed as a medical emergency using the appropriate drug and dosage based on intensity and severity. Patients who are addicted to narcotics should always be educated and alternatives considered after adequate pain relief/control is achieved.Promote Fast Recovery And Pain Relief Essay

References
Azad, N., & Lemay, G. (2014). Management of chronic heart failure in the older population. Journal of geriatric cardiology: JGC, 11(4), 329.
Davis, C. S., & Carr, D. H. (2017). The Law and Policy of Opioids for Pain Management, Addiction Treatment, and Overdose Reversal. Ind. Health L. Rev., 14, 1.
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual review of public health, 36, 559-574.

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