A lecture given to nurse practitioners, physician assistants and others on pain management. The aim of the talk is to review:
1- the principles of effective pain management;
2- the knowledge and/or resources to assist in indentifying patients at high risk for substance abuse, and
3- the importance of counseling patients about the side effects, addictive nature and proper storage and disposal of prescription medications.
*Disclaimer: Case presentation is made up of a combination of cases, and does not reflect the case of any one particular patient.
A lecture given to nurse practitioners, physician assistants and others on pain management. The aim of the talk is to review:
1- the principles of effective pain management;
2- the knowledge and/or resources to assist in indentifying patients at high risk for substance abuse, and
3- the importance of counseling patients about the side effects, addictive nature and proper storage and disposal of prescription medications.
*Disclaimer: Case presentation is made up of a combination of cases, and does not reflect the case of any one particular patient.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502.
Presentation by Erin E. Krebs, MD, MPH, Minneapolis VA Health Care System and University of Minnesota Medical School
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502.
Presentation by Erin E. Krebs, MD, MPH, Minneapolis VA Health Care System and University of Minnesota Medical School
Wsam Presentation For Opiate GuidelinesJKRotchford
CME presentation at WSMA annual meeting. Problematic opioid use, questioning the concept of "pseudo-addiction", seeing chemical dependency as somewhere well along the continuum of problematic opioid use.
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients”Fred Jorgensen
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients”Fred Jorgensen
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.
For this Discussion, review the case Learning Resources and the DustiBuckner14
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 1 En
Three questions to ask the patient and a rationale for asking these questions.
How may I be of assistance today? This question creates a rapport between you and the patients, and it makes her know that the doctor is ready to listen and help her.
What are you doing to cope with grief after losing your husband? This question will help the care ...
FIRST DRAFT1FIRST DRAFT9First DraftErica K.docxAKHIL969626
FIRST DRAFT 1
FIRST DRAFT 9
First Draft
Erica K. Fernandez
Argosy University
Pain Management for Patients with Addiction Problems
Thesis Statement
The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem.
Background
The treatment modalities for chronic pain using COT in active drug users or those who are in remission present a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug-seeking behaviours that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment (Ballantyne & Mao, 2003). Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory (Chou et al., 2009). Additionally, most physicians have developed a phobia of over prescribing narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about the use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice.
Objective
The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter-argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the research intends to highlight the complex interconnection that exists between pain management and addiction to opioids.
Supporting Points
For clinicians, the hardest challenge is perhaps knowing the right way to handle patients who require pain medication, ...
1Respond to 2 people. Heidi and Pearl, by suggesting additiona.docxherminaprocter
1
Respond to 2 people. Heidi and Pearl, by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
Heidi
Week 1 Discussion
Top of Form
It is important when prescribing medication to consider a patient’s medical history and current medication regimen. The way that a patient responds depends on numerous factors that all need considered to provide safe care.
Patient Case
At a previous job I worked in the surgical department of a rural, critical access hospital. We had an orthopedic surgeon who performed numerous joint replacements each week. As with almost any surgery, patients need to stop anticoagulation therapy at least five days prior to the procedure unless otherwise indicated by the cardiologist. We had a female patient with a history of atrial fibrillation and pulmonary embolism, taking coumadin, scheduled for a knee replacement. Our protocol in surgery was to have patients hold anticoagulants five days prior to surgery after consulting the cardiologist, getting cardiac clearance, and orders for holding anticoagulants if permitted to do so.
Pharmacokinetic/Pharmacodynamic Processes
Coumadin is quick to be absorbed and has a half life of 1.5-2 days (Rosenthal & Burchum, 2018, p. 460). The way that coumadin works in the body is by blocking the vitamin k dependent clotting factors (RxList, n.d.). The patient described needed to be on anticoagulant therapy for prevention of blood clots, but for surgical purposes could be dangerous to continue. The patient was relatively healthy with no comorbidities other than the atrial fibrillation and history of a prior pulmonary embolism. The patient’s kidney function was good, her PT/INR were in therapeutic range, and she was in her mid 50’s. This patient did have decreased mobility, which is why she was undergoing a total knee replacement, which put her at risk postoperatively for a DVT or embolism.
Personalized Plan of Care
The first plan of care that I would address is to obtain cardiac consultation and clearance by the patient’s cardiologist. I would plan care based on their recommendations on how long to hold anticoagulant therapy. One option would be to dose the patient with a Lovebox bridge, that is short acting, so that they can still have some type of anticoagulant in their system and it won’t affect the surgical procedure. Atrial fibrillation is a major factor that increases the risk for a blood clot (Douketis & Lip, 2019). Interruption of anticoagulant therapy could be dangerous for a person with atrial fibrillation. Collaboration with anesthesiologist, cardiologists, and surgeons is needed for best practice consideration for holding anticoagulant.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Objectives
The post-surgical nursing staff will be able to analyze
how complementary pain management measures for
post-surgical patients could be used in conjunction
with pharmaceutical measures to manage pain on the
unit.
The post-surgical nursing staff will be able to compare
and contrast three current (with in the last five years)
evidence based best practices for complementary
pain management measures for post-surgical
patients.
The post-surgical nursing staff will be able to compare
and contrast current measures being used on unit to
deter opiate abuse with current (within the past five
year) evidence based best practices.
3. Perceptions
Pain is a unique disliked experience and is perceived by
each patient in a different way.
What effects perceptions of pain?
As T. Jackson Et AL, states “ the interpersonal context of
taking medication, expectations, or other verbal and
nonverbal factors” can all play an important role in how the
patient perceives their pain and relief of pain.
One study showed that the environment, healthcare
professionals presence, and medical equipment played a
role in how a patient perceived pain. This study goes on to
discuss the use of pharmaceuticals in patients
expectations for pain relief. In the study patients are given
a strong pain reliever there after they are given a placebo
to reduce their pain. In the study it was found that patients
expected the medication to work as it did initially and thus
it did and the placebo reduced the patients pain just as the
initial dose did.
4. What does this mean?
Evidence suggests that during the initial pain
assessment it is important to determine what the
patients expectations for pain relief are. This
would include inquiring about;
What the patient would do to relieve pain at
home, what percent of pain relief the patient
expects to experience, and what measures the
patient expects to receive to reduce their pain.
Two proven pain relieving interventions include
pharmaceutical measures as discussed and
complementary therapies.
5. Complementary therapies
aka CAM therapies
Background
Complementary therapies are “health care
approaches with a history of use or origins outside of
mainstream medicine.”
In the United States complementary therapies are
often used in addition to conventional medical
treatment, but can also be used alone.
There have been a reported 1800 CAM therapies!
This makes it vital for healthcare professionals to
have a basic understanding of what CAM therapies
are.
Opioids or pharmaceutical measures should be used
when non opioid therapy is not effective alone.
6. Categories of CAM therapies
Whole medical systems- Some practices do not fit
into other categories and would include things such
as homeopathy and naturopathy which take a more
holistic approach to care.
Mind-body medicine- These are the most widely used
CAM therapies today. They use the mind to effects
the bodies function.
Biologically based practices-substances generally
found in nature such as herbs.
Manipulative and body-based practices- Apply
Pressure to manipulate or move one or more body
parts.
Energy medicine-These therapies use
electromagnetic fields or biofield energies thought to
7. Risks
Kramlich confirms these therapies do not come with out risk.
“Concerns with some of the energy therapies include inaccurate
diagnoses of conditions by practitioners and safety issues
associated with the manipulative therapies
Biologics-Such products may be disruptive to normal
physiological processes, such as coagulation and glucose
regulation, and interactions with conventional medications may
produce devastating effects.
Some concerns about manipulative therapies include delay or
avoidance in seeking conventional care and aggravation of
existing conditions
8. What are They?
Within these categories there are different therapies that
can be utilized such as;
Aromatherapy
Acupuncture
Herbal medicine
Massage therapy
Visualization (guided Imagery)
Yoga
Music therapy
Reflexology
Spinal manipulation
9. Some misconceptions
Many people believe that complementary
therapies are a joke and that people don’t want to
use them.>>>>This is not true in fact according to
the National institutes of health 40% of adults and
12% of adolescents reported using CAM
therapies. For a reported spending of 34 billion
dollars!
All CAM therapies are all safe and anyone can
use them because they aren’t medical
treatments. False there are several CAM
therapies that require a licensed professional to
perform them, for example chiropractic services.
10. Benefits of Using Cam Therapy
Although there are risks involved with CAM
therapy careful considerations and accurate
patient history can eliminate many of these risks.
One benefit of CAM therapies for your unit is the
evidence that CAM therapies can reduce pain
perceptions and or eliminate pain.
11. Lets Discuss how to use CAM therapies
in Conjunction with pharmaceutical
measures.
12. Potential Problems with Pain
management
It’s no secret that opiate abuse is a serious and
potential risk when treating patients for acute and
chronic pain.
Opiate abuse is on the rise and according to the
Centers for disease control they have“ identified
prescription drug abuse and overdose as one of the
top five health threats for 2014”.
Opiate addictions are becoming one of the top leading
reasons that many people are seeking drug
rehabilitation.
The institute for clinical systems improvement
performed a retrospective cohort study showing that
patients who received a prescription for opioids within
seven days of surgery were 44% more likely to result
13. Minnesota DHS
I would now like to discuss a video I watched
produced by the Minnesota Department of Health
about opiate addiction called Heroin at home.
What does the Heroin Epidemic have to do with
the Opiate epidemic?
https://www.youtube.com/watch?v=nXAu_pWg0s
s
According to the Minnesota Department of Health
the united states has 5% of worlds population but
consumes 80% of the worlds opiates.
14. Signs of an addiction
Larger than expected amounts of opiates to control
pain.
Patient may report allergies or unwanted side effects
to many other opiates in order to gain access to the
desired drug of choice. For example a patient may
report GI upset with oral oxycodone, but reports that
they do not have the same issue with IV dilaudid.
Patient requests specific pain medications possibly
stating that others do not work for them.
Symptoms of withdrawal when opiates are not given
may arise. Such as; Low energy, irritability, yawning,
teary eyes, muscle aches/pains, hot and cold sweats,
abdominal pains, and or N/V.
15. DSM-V substance use disorder
Criteria
The drug is taken in larger amounts and over
longer periods of time than intended
There is a persistent desire or unsuccessful
attempts to cut down or control use
A great deal of time is spent in activities to obtain,
use or recover from the effects.
Craving or a strong desire for the substance
Tolerance: a need for increased amounts to
achieve the desired effects
Withdrawal: A syndrome developing after
cessation characteristic to the specific substance.
16. Solutions
what can we do?
Assessing a patients opiate exposure can aide in
determining a patients risk for opiate abuse. As it
has been shown that those exposed to opiates
more so then those not have a higher risk for
developing abuse. Also if a patient has history of
street drug use they are more likely of opiate
addiction. Overall an in depth risk assessment
prior to opioid administration is beneficial in the
reduction of opioid abuse.
Use clinical judgment and effective
communication with your healthcare team to
determine whether a patient truly needs opioid
therapy and if so how much is needed.
Implementation of an algorithm to aide in opiate
administration could also be beneficial.
17. Solution cont…
Let your postoperative patients know in advance there
is and endpoint to their surgical pain.
Explain the risks of opiate use and encourage the
patient to be involved with their care.
Encourage prescribing providers to check the
prescription monitoring website prior to administration
to determine current narcotic prescriptions with in the
last year.
Remind your patients to discard any unused pain
medication and to not save for future pains as this is
considered drug abuse.
The FDA is also currently working on an opioid abuse
deterrent pain medication that if made could help
control pain while reducing the risk for opioid
addiction!
18. Case Study
Your patient rates there a pain at a 2 on a 0-10 scale where 0
is no pain and 10 is the worst pain. The patient has had a
total knee replacement and is post op day 3. This rating is
given after having an hour of physical therapy. The patient
describes the pain as dull and aching and states it gets
worse with exercise and activity. Which would be the most
appropriate action.
A. Do nothing the pain rating is not high enough
B. Give the patient 10mg of Oxycodone P.O as ordered
C. Give the patient Tylenol 650mg P.O as ordered and assist the
patient with guided imagery.
D. Give the patient 5mg of Oxycodone P.O as ordered and assist
the patient with guided imagery.
19. Case Study
You are the primary RN for a patient who has been admitted with
severe abdominal pain. X rays, ultrasounds, and other diagnostic
studies are finding no cause for the pain. You have been given
orders for 5 to 10mg of oxycodone q4hours P.O as needed. The
patient has taken 10mg of oxycodone and is still rating their pain at
a 10 on a 0-10 scale with 10 being the worst possible. You request
an order for IV dilaudid .5mg to 1mg q 1-2 hours as needed. After
receiving the order you give the patient .5mg of dilaudid. The patient
continues to rate pain at a 10 despite IV medication. You administer
the other .5mg of Dilaudid IV and the patient rates pain has
decreased and is now rating pain at a 9. You have also tried several
other complementary therapies such as guided imagery, music
therapy, and aromatherapy with no results. Despite best efforts the
patient continues to call every 10 to 15 minutes about pain. You
notify the provider that you are concerned about your patient as
nothing is helping. The provider decides to do exploratory studies
and again finds nothing. You begin to wonder if the patient has a
history of opioid abuse and share this with the provider they are
suspecting the same thing. What would be the best way to gather
further information to determine the patients history with narcotic
20. Case Study cont….
A. Next time the patient calls for pain medication notify them that
you are concerned that they have been taking way to many pain
meds and this is a classic sign of opioid abuse, also letting them
know that they need to tell you the truth.
After administering the patients pain medication you begin
talking with them about them about the current epidemic with
pain medications telling them how much you are disgusted with it
and then ask them if they have ever had any issues with opioid
abuse.
You enter the patients room letting them know that you are
concerned about there increasing needs for increased dosing of
narcotic pain medications. In a matter of fact approach you let
them know that you are concerned there might be an issue with
opioid abuse.
21. Case study
This same patient tells you that they do have a problem with
opioid abuse and have had an addiction to narcotics for 5
years now. They state they heard about tolerance with the
drugs after using for a period of time, but that their pain is
real. They state that they generally take 50mg of oxycodone
a day recreationally. What is your response to this situation
A. Let the patient know that tolerance is very likely and that you
believe their pain is real. While letting them know you will have to
notify the provider in order to determine a more effective
approach to their treatment.
B. Let the patient know that because they have an addiction to
pain medication you can not give them narcotics any longer
despite their complaints of pain.
Leave the patients room immediately and notify the provider.
23. References
Acute Pain Assessment and Opioid Prescribing Protocol. (2014).
Quality Improvement Support, 1-44.
Cobaugh, D., Gainor, C., Gaston, C., Kwong, T., Magnani, B.,
Painter, J., & Krenzelok, E. (2014). The opioid abuse and misuse
epidemic: Implications for pharmacists in hospitals and health
systems. Am J Health-Syst Pharm, 71, 1539-1551.
General Internal Medicine in Minnesota. (2015, January 1).
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