- 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?
- 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?
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Expert Solution Preview
The treatment and management of patients with complex medical conditions require a comprehensive approach that encompasses short term and long term goals. This essay will address three different scenarios involving patients with different medical conditions and discuss the appropriate goals and strategies for their treatment. The first scenario involves a 24-year-old male who is addicted to prescription drugs due to a prior injury and has recently suffered a neck injury in a car accident. The second scenario focuses on a 70-year-old female patient with chronic back pain who is requesting a higher dosage of narcotic medication. The final scenario involves a patient with heart failure who has been mismanaging his medication regimen. Each scenario will be analyzed individually, considering the concerns, questions, and strategies for providing comprehensive care to these patients.
Treating a 24-year-old male addicted to prescription drugs:
Short term and long term goals for treatment:
The primary goal in treating this patient is to manage his neck injury pain effectively while addressing his addiction to prescription drugs. In the short term, the immediate goal is to ensure pain relief through a combination of non-opioid analgesics and non-pharmacological interventions such as physical therapy. The long term goal is to gradually taper the patient off narcotic pain medication while providing alternative pain management strategies.
Safely meeting treatment goals:
Safety is a crucial factor when treating a patient with a history of drug addiction. To safely meet the treatment goals, a multidisciplinary approach involving a pain specialist, addiction specialist, and physical therapist should be implemented. Collaboration and regular communication between the healthcare providers involved will help ensure that the patient’s pain is managed effectively while minimizing the risk of relapse.
Treating Mrs. Z, a 70-year-old female with chronic back pain:
Concerns and questions:
The primary concern in this scenario is the potential misuse of narcotic pain medication by Mrs. Z’s granddaughter. The patient’s increasing pain and the request for a higher dosage of pills raise questions about whether the pills are being shared or diverted. Additionally, the impact of Mrs. Z’s granddaughter’s substance abuse history on her own condition needs to be assessed.
Approach and assistance:
A compassionate and non-judgmental approach should be taken when addressing Mrs. Z’s situation. It is essential to establish open communication with Mrs. Z and express concern for her well-being and that of her granddaughter. The patient should be encouraged to have a frank conversation with her granddaughter about the risks associated with prescription drug misuse. Additionally, providing education on non-pharmacological pain management techniques and involving a pain specialist can help Mrs. Z explore alternative options for managing her chronic back pain.
Assisting the family:
To assist the family, a collaborative approach involving social services and addiction specialists may be necessary. The granddaughter should be connected with appropriate support services to address her substance abuse issues. Additionally, family therapy or counseling could be beneficial to address any underlying family dynamics that may contribute to the present situation.
Coordinating a multidisciplinary approach for Mr. G, a heart failure patient:
The first step in managing Mr. G’s condition is to assess and address the immediate issue of fluid retention causing pitting edema in his lower extremities. This may involve adjusting his Lasix dosage or adding additional medications such as spironolactone. However, it is crucial to address the broader issue of medication mismanagement to prevent further complications.
A multidisciplinary approach is essential for coordinating Mr. G’s care effectively. This may involve involving a cardiologist, pharmacist, and nutritionist to evaluate and optimize his medication regimen. Regular communication and collaboration between healthcare providers can ensure that his medications are appropriately prescribed and monitored.
Patient education plays a significant role in helping Mr. G keep his medications straight. A comprehensive education plan should be developed to ensure he understands the purpose, dosage, and timing of each medication. The importance of adhering to the prescribed regimen and the potential risks of taking medications sporadically should be emphasized. Additionally, clear instructions on how to organize and manage his medications should be provided.
The treatment of complex medical conditions requires a comprehensive approach that addresses both the short term and long term goals of the patients. In the scenarios discussed, the focus was on providing effective pain management while addressing addiction, preventing medication misuse, and coordinating a multidisciplinary approach to optimize patient outcomes. By implementing these strategies, healthcare providers can ensure the safety and well-being of their patients while assisting them in achieving their treatment goals.