Instructions: Go to this website:
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html
Decision Point One: select \”Amitriptyline\” option
Decision Point Two: select \”Continue current medication\” option.
Decision Point Three: \”Continue current dose Elavil & refer life coach\” option.
Use this as the case study to discuss for the assignment.
Assignment:
-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.
Decision Tree for Neurological and Musculoskeletal Disorders
Student’s Name
Institutional Affiliation
Date
Decision Tree for Neurological and Musculoskeletal Disorders
Background
This case study is about a 43-year-old white male patient who presents to the physician’s office with pain. He reported at the beginning of the interview that he sent him for psychiatric assessment because the doctor felt that the pain was a result of mindset. The patient sustained a fall injury 7 years ago. after careful examination, the patient was diagnosed with complex regional pain syndrome (CRPS).
Decision Point One
The selected choice for decision one was Amitriptyline 25 mg PO QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day. This decision was selected because it is supported by evidence-based practice. Su et al. (2015) state that Amitriptyline is used to treat pain and discomfort. The medication was initially developed to treat anxiety and depression but is often taken in low doses to reduce pain.
What is expected of this decision is that it would improve the pain level to below 5. It would allow the patient to perform daily activities such as walking without assistance, and other activities of daily living (ADL). It is expected that all the symptoms associated with the disease are eliminated (Casale et al., 2017). There was a slight difference between the expected and the actual results. The patient returned to the clinic after four weeks while still using crutches. He states that his pain persists although there is a significant improvement. The further assessment shows that his pain level is at 6 out of 10.
Decision Point Two
Decision point two is to continue current medication and increase the dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. And instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning. This decision was selected because the efficacy of Amitriptyline increases as the doses increase (Su et al., 2015). Pain will tremendously reduce when the doses are increased.
The expected outcomes related to decision point two include reducing pain levels to below four and improve healthy body weight. The patient is expected to improve his behavior regarding exercise and diet (Casale et al., 2017). The patient can have moderate physical activity. His diet should contain a lot of vegetables and fruits. Most of these expected outcomes were met except the patient reports a weight gain of 5 pounds.
Decision Point Three
Decision three was to continue the current dose of Elavil of 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise. Decision three was selected because the patient reported more positive outcomes, therefore, there was a need to maintain the dose (Su et al., 2015). The client is almost at his goal of pain control and increased functionality. Weight gain is a common side effect of amitriptyline and should be a counseling point at the initiation of therapy. The patient should improve his weight (side effect of Elavil) by remaining physically active and eating a healthy diet (Casale et al., 2017). The expected outcomes include pain levels below 4, a healthy weight, and a positive attitude towards a healthy diet and physical activity.
Conclusion
The patient was diagnosed with Complex regional pain syndrome (CRPS). It is a form of chronic pain that normally affects an arm or leg. The decisions one to three were selected to help the patient recover. The patient outcomes are promising.
References
Casale, R., Symeonidou, Z., & Bartolo, M. (2017). Topical treatments for localized neuropathic pain. Current pain and headache reports, 21(3), 15. https://link.springer.com/content/pdf/10.1007/s11916-017-0615-y.pdf
Su, M., Liang, L., & Yu, S. (2015). Amitriptyline Therapy in Chronic Pain. Int Arch Clin Pharmacol, 1(1), 1-5. https://www.researchgate.net/publication/280305228_Amitriptyline_Therapy_in_Chronic_Pain