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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.
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 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.
Use and cite at least 4 sources for the assignment.
Please discuss each medication option listed in Decision Point 1. Why did you not choose the alternative options? What is the mechanism of action for each medication? What are first line FDA approved medications for the disease state?
Case study assigned: YOU PICK
Under Required Media, 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.

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.htmlAssignment: 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.

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 3-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.

BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You nTo 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-Decision Tree for Neurological and Musculoskeletal Disorders

Write a 1- to 2-page summary paper using this case: Complex Regional Pain Disorder : White male with HIP PAIN that addresses the following:
· 1.Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
· 2.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.
· 3. 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.
· 4.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.

BACKGROUND

This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted 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 “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.”

SUBJECTIVE

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’clock to 12 o’clock 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 sRunning Head: A CAUCASIAN MAN WITH HIP PAIN 1

A CAUCASIAN MAN WITH HIP PAIN 3

A Caucasian Man with Hip Pain.
Student’s Name.
Institution.

I received a client who complained of pain on the right hip which he had sustained after falling while in his place of work seven years ago. He had numerous x-rays, CT scan and even MRIs tests done on him. None of the doctors he visited had agreed to perform hip replacement citing that he is too young for it. One neurologist suggested that he suffered from a reflex sympathetic syndrome which the family doctor citing there is nothing of such sought. The family doctor referred him to psychiatry. The patient refused the advice of using a wheelchair. He would rather use crutches to walk rather than use a wheelchair. I took the following decisions:

Decision 1

Following the evaluation, i did on the patient. I decided to go with choice 1 amongst the 3 choices. This is because Savella helps in reducing pain to the patient to a manageable level and improved physical activities (Chen, 2013). A combination of Amitriptyline and Neurontin helps to treat mental illness as the patient exhibited some level of depression which had been diagnosed by the neurologist earlier. Anticipated results included reduction of pain in the first week and improved physical activities. However, there was a variation between the expected and actual result. Though the pain had reduced, it was bad during the night. However, on the positive side, the patient sometimes needed not to use crutches to walk.

Decision 2

I prescribed the patient to take Lyrica (pregabalin) 50 mg and Zoloft 50 mg. this option has less side effect as compared choices. The expected results were Lyrica was to target the chemical neural so as to reduce the pain experienced by the patient (Schjøtt, & Bergman, 2014). Zoloft was expected to act as antidepressant so as to improve the chemical balance in the brain through improved communication between nerve cells and central nervous system. However, there was a deviation between the expected results and the observed results. After four weeks the pain had become much worse with a scale of 7-10. The patient was still using crutches to walk. The pain frequently affected the patient during the night. Though the patient denied experiencing depression, he seemed very sad. The patient body seemed not to respond to the prescribed drugs

Decision 3.

I prescribed the patient start tramadol 50 mg and Celexa with a change of Savella to 25 mg in the morning and 50 mg during the night which would later be reduced to 12.5 mg. the reason for choosing this was aided by the fact that the combination of both Savella and tramadol would help reduce pain. Expected result was reduced pain to significant level and Celexa was expected to reduce mental depression (Bar‐Yam, 2016). However, the patient did not respond to the drugs prescribed as the pain seemed to be neuropathic. The patient must be made aware that he must expect some Case Study: A Caucasian Man with Hip Pain
Amanda Briand
07/14/18
NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology
Walden University

Case Study: A Caucasian Man with Hip Pain
“The patient is a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted 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 “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.” 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. He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression.” (Laureate Education, 2016a).

Decision #1

My first decision was to start this patient on Amitriptyline 25mg po QHS and titrate upward weekly by 25g to a max dose of 200mg per day (Laureate Education, 2016a). This is a serotonin and norepinephrine/noradrenaline reuptake inhibitor that can be prescribed for neuropathic pain/chronic pain, fibromyalgia and for a wide variety of pain syndromes (Stahl, 2013). It boosts neurotransmitters serotonin and norepinephrine/noradrenaline and presumably desensitizes both serotonin 1A receptors and beta adrenergic receptors (Stahl, 2013). I did not choose Savella because it is a selective serotonin-norepinephrine reuptake inhibitor (SNRI), similar to some drugs used for the treatment of depression and other psychiatric disorders (Wolters Kluwer Clinical Drug Information, 2018b). It is also used for fibromyalgia but I did not feel it was appropriate to start this patient on a medication for psychiatric disorders when he has chronic pain in his hip. I did not choose Neurontin because it is commonly prescribed for neuropathic pain and posttherpetic neuralgia (Stahl, 2013). I did not think it would be an appropriate medication or effectively treat his pain. With this decision I was hoping to have a decrease in his pain.
When he returns in four weeks he is still using his crutches but states his pain has improved and he is groggy in the morning (Laureate Education, 2016a). He reports his pain level is 6 out of 10 and states his acceptable pain level would be a 3(Laureate Education, 2016a). He reports he is able to go the bathroom or to the kitchen without using his crutches all the time and the achiness is less and his toes to not curl as often as they did before (Laureate Education, 2016a). His level prior to starting the medication was 9 out of 10 so there was a slight decrease in his pain but he is still experiencing his toes curling (Laureate Education, 2016a).

Decision #2

My second decision was to continue the current medication and increase dose to 125mg at bedtime this week continuing towa

  
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