Week 8-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.

Photo Credit: Getty Images/Science Photo Library RF

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.

Write a 2+ page summary paper that addresses the following:

• Briefly summarize the patient case study, including each of the three decisions you chose for the patient presented. Support your decisions with evidence-based literature. Be specific and provide examples.
• What were you hoping to achieve with the decisions you recommended for the patient case study? 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.Week 8-Neurological and Musculoskeletal Disorders

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Please discuss each medication option listed in Decision Point 1. Why did you not chose the alternative options? What is the mechanism of action for each medication? What are first line FDA approved medications for the disease state?

Use and cite at least 4 sources for the assignment.

Case study assigned: YOU PICK

Under Required Media for Week 6

Feel free to go through both interactive scenarios as many times as you would like. Pick ONE to write your paper on and discuss the points above.

This paper presents a 43-year-old white male who present himself in the office having pain complaint. The patient arrives in the unit aided with his ambulation together with a set of crutches. The patient reports moving in as directed by his family doctor for psychiatric assessment since he experienced pain “all in his head”. More so, the client report that the physician believed it was not genuine situation in that he wanted to get some stuff to remain high. Still, according to his report the patient condition started in the last seven years when fall at working place but landed on right hip sustaining serious injury. At one point he reports that a neurologist had diagnosed him with complex regional pain syndrome. Even though persevering a lot of pain the patient denies depression. Lastly, the paper will present three clinical decisions based on medical grounds to treat the patient condition.

Decision one: start this patient on Amitriptyline 25mg po QHS and titrate upward weekly by 25g to a max dose of 200mg per day

My initial decision is starting this patient on Amitriptyline 25mg po QHS and titrate upward weekly by 25g to a max dose of 200mg per day. This decision was critically arrived since Amitriptyline acts as a serotonin as well as norepinephrine reuptake inhibitor recommended for chronic pain and fibromyalgia (Lawson, 2017). My aim of choosing this decision was primarily aimed at boosting neurotransmitters serotonin receptors. Even though there were other probable selection that might could act as a remedial for the patient condition they were not eligible for the patient condition. For instance, Savella 12.5 mg act as a selective serotonin-norepinephrine reuptake inhibitor (SNRI). Savella drug function well in treatment of patients with psychiatric disorders and depression (Freeman et al., 2018). I did feel if it was necessary to give patient with pain issue a depressive treatment. On the other hand, Neurontin 300 mg option was not taken since it is mostly prescribed for postherpetic neuralgia and neuropath.Week 8-Neurological and Musculoskeletal Disorders

After four weeks the patient turns around to the clinic but still using crutches with improvement in pain experience but with groggy in morning. The patient progress at this time is similar to the anticipated outcome since he reports decreased pain levels. The outcome opposes my expected aim that the patient will complete end pain experience in regard to his body interactions with the medication.

Decision two: continue the current medication and increase dose to 125mg at bedtime this week continuing towards the goal dose of 200mg daily

My second take is to propose to the patient to continue with the same dosage but not to take it an hour earlier contrary to normal hours starting tonight, then call the office after 3 days to report his progress. My aim of making this decision was to ensure the patient will decrease grogginess in the morning hours as well as decreasing the remaining pain levels. Even though there were other options to choose this was recommendable depending with current condition of the patient. Such options included discontinue Savella and start Lyrica (pregabalin) 50 mg orally BID was not an outstanding remedial for the condition since pregabalin drug is applicable in treating epilepsy and depression (Cain et al., 2018). On the other hand, discontinuing Savella and start Zoloft (sertraline) 50 mg daily was not an eligible option since it is administered in treating social anxiety disorder and Generalized Anxiety Disorder (GAD).

According to the expected and actual outcome seemed to have similarity since the patient grogginess declined. More so, after return the patient reports to have a decreased pain levels at a scale of 4 out of 10. In fact, the patient progress indicated a what I was hoping for the client to weight more weight than actual recording of 5lb.

Decision third: continue the current dose of Elavil of 125mg per day and refer the patient to a life coach who can counsel him on good dietary habits and exercise

My third decision for the patient is to continue with the dosage as well as getting a life counsellor for guiding his diet. At patient at this time shows significant outcome responses but have an increased weight problem that need to be addressed by a nutritionist. This decision was critically arrived due the client’s weight increase thus requiring a response in management. This was the best option as compared to the present options such as Qsymia medication that might cause cardiac arrhythmias (Chao et al, 2020). Still, reduction of Elavil could not be effective based on the patient current condition. At this point, the patient will have achieved aimed goals to elevate pain as well as controlling his weight gain.Week 8-Neurological and Musculoskeletal Disorders

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Conclusion

In conclusion, the presented case study it shows the importance for providers to counter check client’s issue rather than jumping to conclusive medications. For instance, this was crucial for the patient to get each medication before getting prescription. I recommend amitriptyline in treatment and management of such condition. Eventually, after patient following the three decisions, he will optimally achieve promising outcome.

References

Cain, S. M., Bohnet, B., LeDue, J., Yung, A. C., Garcia, E., Tyson, J. R., … & Snutch, T. P. (2017). In vivo imaging reveals that pregabalin inhibits cortical spreading depression and propagation to subcortical brain structures. Proceedings of the National Academy of Sciences, 114(9), 2401-2406.

Chao, A. M., Wadden, T. A., Berkowitz, R. I., Quigley, K., & Silvestry, F. (2020). The risk of cardiovascular complications with current obesity drugs. Expert Opinion on Drug Safety, 19(9), 1095-1104.

Freeman, M. P., Lee, H., Savella, G. M., Sosinsky, A. Z., Marfurt, S. P., Murphy, S. K., & Cohen, L. S. (2018). Predictors of depressive relapse in women undergoing infertility treatment. Journal of Women’s Health, 27(11), 1408-1414.

Lawson, K. (2017). A brief review of the pharmacology of amitriptyline and clinical outcomes in treating fibromyalgia. Biomedicines, 5(2), 24. Week 8-Neurological and Musculoskeletal Disorders