Running Head: GASTROINTESTINAL TRACT 1 GASTROINTESTINAL TRACT 3 GastroIntestinal Tract Name Institution Course Date GastroIntestinal Disorders Introduction Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996). Gastroesophageal Reflex Disease (GERD) There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD. Peptic Ulcer Disease (PUD) PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD Gastritis Disorders Gastritis disorders basically results from mucous injury that may have been caused by ...

1. Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the
body can break down consumed foods and digest them easily.
The major component of gastric juice is hydrochloric acid,
which is produced by oxyntic cells. The secretion of these acids
takes place in three phases namely: the cephalic phase, the
gastric phase and the intestinal phase. The cephalic phase starts
when someone has an urge to eat or smells food. The brain
signals the parietal cells to secrete gastric acids and the ECL to
secrete histamine. The gastric phase is when someone has eaten

2. and the amino acids present in the food stimulates the
production of these acids. The last phase is stimulated by the
distention in the small intestines and the amino acids too and
the secretion takes place when chime enters the small intestines
(Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as
Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease
(PUD) and Gastritis disorders. Patients suffering from GERD
have a complex gastric acid secretion caused by frequent acid
reflux. There are cases where HCL frequently flows back to the
esophagus and when this happens, the lining of the esophagus
becomes irritated. The age factor is visible in this disorder.
Older people are more likely to experience this disease than
young. However, symptoms are less visible in the elderly. The
fact that there is no serious warning symptom of GERD among
the elderly makes the disorder more complicated in them. GERD
can be diagnosed by a probe test, upper endoscopy or x-ray of
the upper digestive system. For the elderly, adequate doses of
medication that do not harm the digestive system are effective.
Medical therapeautic agents, including PPIs such as
pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric
acid and duodenal mucous defence. When the balance between
the two is disrupted, there is a consequence of mucousal injury
and hence peptic ulcers. PUD among the elderly is associated by
complications and when administering medication, special
attention should be given to the elderly since they respond
negatively to medications and surgery. PUD can be diagnosed
by carrying out both physical and diagnostic tests (Okello, et.
al, 2016) . Once it has been diagnosed, laboratory tests can then
be undertaken such as breath tests, stool and blood tests. There
are two main factors that contribute to the high rate of PUD
among the elderly are the high rates of H. Pylori and
prescription of drugs that increase damage in the

3. gastroduodenal drugs. Elderly patients receive medical
treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that
may have been caused by many factors (Azer,& Akhondi, H.
2019).. These factors include infection, too much consumption
of alcohol, excessive use of pain killers and injuries. These
factors cause stomach inflammation. Symptoms of gastric
disorder include pain in both lower and upper abdomen,
vomiting, nausea, loss of appetite, heartburn and belching.
These disorders can be diagnosed by any of the following tests:
acid and reflux tests, imaging, endoscopy and nuclear scans.
Antacids and antibiotics can help treat gastritis disorders, but
the treatment entirely depends on the course of the disorder. For
the elderly, the doctor should consider prescribing medication
that cure H. Pylori.
References
Azer, S. A., & Akhondi, H. (2019). Gastritis. In StatPearls
[Internet]. StatPearls Publishing.
Okello, T. R., Ogwang, D. M., & Pecorella, I. (2016). A 10
years trend of peptic ulcer disease and other gastrointestinal
disorders in northern Uganda. East and Central African Journal
of Surgery, 21(2), 11-16.
Testoni, P. A., Bagnolo, F., & Tittobello, A. (1992).
Interdigestive antro-duodenal motor disorders in functional
dyspepsia. Associated chronic gastritis correlates with further
motor impairment. The Italian journal of
gastroenterology, 24(8), 440-445.
Running head: COMPLEX REGIONAL PAIN DISORDER

4. 1
COMPLEX REGIONAL PAIN DISORDER
5
Complex Regional Pain Disorder Case Study
Colleen Lemmer
Walden University
Oct.13, th 2018
Complex Regional Pain Disorder
Pain and sleep/ wake disorders have become prevalent in the
recent years. Previous research done indicates that sleep/wake
disorders are more common, underdiagnosed and mostly affects
elderly people who suffer serious consequences (Miguel, &
Albuquerque, 2011). Patients suffer from insomnia and
prevalence of the disorders increases with the elderly in the
population being affected most. Clinicians and therapists make
common misconceptions by assuming that the condition is an

5. expected phenomena that is associated with old age and
therefore is normal (Miguel, & Albuquerque, 2011). Contrary to
therapists and doctor’s misconceptions, research conducted
indicates that the increased disorders are a result of increased
psychosocial comorbidities in the population.
Recent research and publications indicate that pain and wake
related disorders should be regarded and treated as a
multifactorial geriatric syndrome and therefore should be
addressed with high attention. Many therapists and clinicians
consider enough and good sleep to be essential towards
achieving better health (Barbehenn, & Wolfe, 2010). For
purposes of this assignment, the paper involves a case study
about Caucasian man with hip pain. The paper involves
decisions concerning medication to prescribe.
From the symptoms outlined in the Caucasian man case study
and recommended prescriptions of medications, it is evident
that the patient is suffering from Complex regional pain
disorder which is also referred to as reflex sympathetic
dystrophy. The syndrome involves chronic pain that either
affects legs or arms. The syndrome occurs after an individual
goes through a surgery, heart attack, and stroke or after an
injury. Complex regional pain disease causes aren’t clearly
understood and is mostly common with the elderly. Doctors and
therapists recommend early diagnosis and treatment of the
condition to increase chances of completely eradicating it.
Symptoms of Complex regional pain syndrome include;
decreased ability to move affected body part, swelling,
sensitivity to cold and touch, changes in hair and nail growth,
tremors, muscle spasms and atrophy (Jänig, & Baron, 2003).
However, symptoms may differ from one individual to the other
where swelling, pain, hypersensitivity and changes in
temperature being most common. Several therapies and
medications are recommended and below discussion outline
various medications for complex regional pain.
Decision Point 1
Decision point 1 involved selecting between two drugs which

6. were; Savella 12.5 mg that were to be administered orally in
day one. The drug was also supposed to be administered in day
2 where 12.5 mg was to be administered twice. 7.25 mg was to
be administered two times a day and 50 mg thereafter. The
second option in making the first decision involved
Amitriptyline where 25 mg would be taken during bedtime and
300 mg of Neurontin two times a day.
Psychiatric-mental health Nurse Practitioners (PMHNP) should
recommend Savella in the Caucasian case study. From the
results and side effects outlined in the case study, they are
similar to those associated to Savella. The drug is used to treat
psychiatric and depression disorders and is referred to as
norepinephrine reuptake inhibitor with selective serotonin
(Barbehenn, & Wolfe, 2010).
Savella is administered orally without food. By taking the drugs
without food, tolerability of the drug is enhanced. According to
the case study, the patient is supposed to return after 4 weeks.
According to the patient, the pain had significantly reduced
which is an effect of savella drug that aids in relieving pain.
Savella drug is known to cause various side effects such as;
nausea, vomiting, constipation, increased sweating, headache
and the occurrence of hot flashes (Barbehenn, & Wolfe, 2010).
According to the case study, the client is reported to be
suffering from bouts of swelling with no main cause together
with nausea and suffers from insomnia too. Therefore, it is
evident that the side effects that emerged were as a result of the
savella drug.
By making the decision that a psychiatric-mental health nurse
practitioner should opt for Savella dosage, it was to achieve and
capture the side effects caused by the drug as well as its healing
capability. Administering the drug to the patient was to also act
as proof that savella is used to heal and relieve chronic pain.
According to research, savella should be taken two times a day
just like in the Caucasian case study. After four weeks of
administering the drug, dosage can be reduced based on the
patient’s medical condition and how best he is responsive to

7. treatment.
The expectations in decision one were that the client would
have homicide and suicidal thoughts as a side effect. Savella is
known to cause suicidal thoughts to clients taking the drugs
(Barbehenn, & Wolfe, 2010). However, in the Caucasian case
study, the client reports to claim that he had been suffering
from suicide and homicide thoughts. Instead, the patients report
that the future looks good. The difference was attributed to the
patient’s positive thoughts about life. For example, the client at
some time claims that one of the doctors he had met before had
suggested for a wheelchair for the patient which he did not
admit and instead said that he was okay and did not require one.
In addition, he is optimistic about life since he had been
recently engaged and was looking up to for marriage. Therefore,
the patient’s positive attitude towards life made the client not
suffer from suicidal thoughts and thus the difference between
the expectations and actual results presented after usage of the
drug.
Clinical Decision point 2
The Psychiatric-mental health nurse practitioner had an option
of continuing with current medication which was Savella but
this time lower it. The second option was to discontinue savella
and instead start to use lyrica by administering 50mg twice in a
day. The third option for the nurse was to discontinue savella
and administer 50 mg of Zoloft twice a day.
In clinical decision point 2, the psychiatric-mental health nurse
should discontinue the use of savella since the client reported
that the situation had not been cured. He is reported to claim
that he suffered pain with a range of 4 out of 10 and wanted that
to reduce to 3. Therefore, the nurse had to try a different drug
and monitor how well the patient would recover from the
condition.
For Clinical decision point 2, the psychiatric-mental health
nurse practitioner should recommend the introduction of Zoloft.
From the results of clinical decision one, the patient continued
to suffer from lack of sleep. Zoloft is therefore recommended

8. to improve on sleep and the mood. The drug has several other
uses such as treating; panic attacks, obsessive-compulsive
disorders, social phobia, post-traumatic stresses and severe form
of premenstrual syndrome disorder (Miguel, & Albuquerque,
2011).
According to the Caucasian case study, the patient reported to
have no suicidal and homicide thoughts. Meanwhile, the pain
increased from 4 to 3 out of 10 and that the condition did not
improve, instead, it worsened. However, the client no longer
experienced difficulties in sleeping. Moreover, his blood
pressure was reported to have increased but did not suffer
palpitations. The improvements to better sleep can be associated
with the introduction of the new drug Zoloft. The drug may be
administered with food or without. The best times to take the
drugs should be in the morning or after the evening meal. The
drug is associated with many side effects and therefore, a doctor
may recommend that a patient start on a low dosage and later
increase it to control the effects. Some of the common side
effects include; nausea, dry mouth, diarrhea, stomach upset and
drowsiness.
The expectations of using the drug included reduced pain from 4
to 3 out of 10. Though there were improvements in sleep, it was
affected by the severe pain. It was expected that the patient
would get enough sleep. Heart rate and pressure were expected
to remain at normal rates. Research conducted does not show
any side effects that cause increased heartbeat and pressure. The
drug is associated with boosting a patient’s mood and the reason
he never suffers from homicide and suicidal thoughts.
The difference between the expectations and the actual results
presented is attributed to the mix up of drugs. The body did not
adapt to the sudden changes introduced and therefore reason as
to why pain increased. The positive moods caused by the drug
are a reason as to why the client does not have suicidal
thoughts. Moreover, the patient was evaluated after four weeks.
The time was a long period since it was a new drug. The
psychiatric mental health practitioners should have

9. recommended the patient to return to the clinic after a week in
order to urgently monitor his progress. For example, if the
patient visited the clinic after a week, the nurse would have
been in a position to detect increased pain to 7 out of 10 and
thus change the dosage or medication.
Clinical Decision 3
In clinical decision 3, the nurse had the option of using Savella
but increase the dosage from 12 mg to 25 mg in the morning and
50 mg during bedtime. The psychiatric nurse practitioner had
also an option to discontinue savella and instead introduce 50
mg of tramadol. In addition, the nurse had an option of
introducing a new drug calexa with 12.5 mg.
The PMHNP nurse should prescribe Salville. The drug should at
this stage be increased to a higher amount. From the results of
clinical decision 1, the patient had recorded improvements in
her condition, especially on pain. Therefore, the client ought to
have continued with the medication to improve the condition
further.
The expectations after deciding to continue with the drug were
that pain would reduce to probably a rate below 4 out of 10 like
he experienced after decision one. Further expectations were
that the patient would now have peaceful sleep since Zoloft had
already cured insomnia. At end of stage 2, the patient reported
to only lack sleep due to pain. Therefore, since pain would be
reduced through the introduction of more dosage, the patient
would have enough sleep. At this stage, the patient was still
optimistic that he would heal and therefore pain would end and
therefore did not have homicidal and suicidal thoughts
The difference between the expectations and the results was the
increased pain. The patient reported complex neuropathic pain
syndrome which was feared not to respond to pain medication.
By the second re-introduction of the drug, the patient could
have suffered from resistance to the drugs which resulted to
increased pain (Barbehenn, & Wolfe, 2010). Tramadol and
celexa were ruled because they were not good and were feared
to cause severe side effects such as serotonin toxicity.

10. How Ethical Considerations Might Impact Treatment Plan
Confidentiality
According to APA ethics standards, psychiatrists and
psychologists are mandated to maintain the confidentiality of
their patients. However, confidentiality is sometimes breached
for example in instances where insurance companies require
details about patients in order to make hospital bill payments
(Kerridge, & Stewart, 2009).
Patient Abandonment
Psychologists are not supposed to abandon patients. However,
in a multidisciplinary setting, psychologists are faced by ethical
issues where at time patients are abandoned. According to APA
standards, psychologists should provide pre-termination
counselling (Rezai, &Zonenshayn, 2002).
Clinical Research
In most cases, psychologists are required to conduct and
participate in clinical research especially in a multidisciplinary
setting. However, ethical issues may arise for example in
choosing appropriate and adequate control groups.
Psychology’s Interface with Medicine
Patients are treated with multiple medications. However, ethical
issues may arise when too many drugs are recommended to the
patient and at times end up being ineffective. APA standards
stipulate that psychologists should provide services that are
within their boundaries (Rezai, &Zonenshayn, 2002).
Patient Autonomy and Informed Consent
Chronic pain illness sometimes requires patients to fill in
informed consents regarding hospitalization and medication.
However, ethical issues may arise in instances where a patient
is forced into medication and treatment.
References

11. Barbehenn, E., & Wolfe, S. (2010). Petition to ban fibromyalgia
drug milnacipran (Savella). Citizen.org. Public Citizen, 20.
Jänig, W., & Baron, R. (2003). Complex regional pain
syndrome: mystery explained?. The Lancet Neurology, 2(11),
687-697.
Kerridge, I., Lowe, M., & Stewart, C. (2009). Ethics and law for
the health professions (p. 225). Sydney: Federation Press.
Miguel, C., & Albuquerque, E. (2011). Drug interaction in
psycho-oncology: antidepressants and
antineoplastics. Pharmacology, 88(5-6), 333-339.
Rezai, A. R., &Zonenshayn, M. (2002). U.S. Patent No.
6,438,423. Washington, DC: U.S. Patent and Trademark Office.
Running head: COMPLEX REGIONAL PAIN DISORDER
1
COMPLEX REGIONAL PAIN DISORDER
5
Complex Regional Pain Disorder Case Study
Colleen Lemmer
Walden University
Oct.13, th 2018

12. Complex Regional Pain Disorder
Pain and sleep/ wake disorders have become prevalent in the
recent years. Previous research done indicates that sleep/wake
disorders are more common, underdiagnosed and mostly affects
elderly people who suffer serious consequences (Miguel, &
Albuquerque, 2011). Patients suffer from insomnia and
prevalence of the disorders increases with the elderly in the
population being affected most. Clinicians and therapists make
common misconceptions by assuming that the condition is an
expected phenomena that is associated with old age and
therefore is normal (Miguel, & Albuquerque, 2011). Contrary to
therapists and doctor’s misconceptions, research conducted
indicates that the increased disorders are a result of increased
psychosocial comorbidities in the population.
Recent research and publications indicate that pain and wake
related disorders should be regarded and treated as a
multifactorial geriatric syndrome and therefore should be
addressed with high attention. Many therapists and clinicians
consider enough and good sleep to be essential towards
achieving better health (Barbehenn, & Wolfe, 2010). For
purposes of this assignment, the paper involves a case study
about Caucasian man with hip pain. The paper involves
decisions concerning medication to prescribe.
From the symptoms outlined in the Caucasian man case study
and recommended prescriptions of medications, it is evident
that the patient is suffering from Complex regional pain
disorder which is also referred to as reflex sympathetic

13. dystrophy. The syndrome involves chronic pain that either
affects legs or arms. The syndrome occurs after an individual
goes through a surgery, heart attack, and stroke or after an
injury. Complex regional pain disease causes aren’t clearly
understood and is mostly common with the elderly. Doctors and
therapists recommend early diagnosis and treatment of the
condition to increase chances of completely eradicating it.
Symptoms of Complex regional pain syndrome include;
decreased ability to move affected body part, swelling,
sensitivity to cold and touch, changes in hair and nail growth,
tremors, muscle spasms and atrophy (Jänig, & Baron, 2003).
However, symptoms may differ from one individual to the other
where swelling, pain, hypersensitivity and changes in
temperature being most common. Several therapies and
medications are recommended and below discussion outline
various medications for complex regional pain.
Decision Point 1
Decision point 1 involved selecting between two drugs which
were; Savella 12.5 mg that were to be administered orally in
day one. The drug was also supposed to be administered in day
2 where 12.5 mg was to be administered twice. 7.25 mg was to
be administered two times a day and 50 mg thereafter. The
second option in making the first decision involved
Amitriptyline where 25 mg would be taken during bedtime and
300 mg of Neurontin two times a day.
Psychiatric-mental health Nurse Practitioners (PMHNP) should
recommend Savella in the Caucasian case study. From the
results and side effects outlined in the case study, they are
similar to those associated to Savella. The drug is used to treat
psychiatric and depression disorders and is referred to as
norepinephrine reuptake inhibitor with selective serotonin
(Barbehenn, & Wolfe, 2010).
Savella is administered orally without food. By taking the drugs
without food, tolerability of the drug is enhanced. According to
the case study, the patient is supposed to return after 4 weeks.
According to the patient, the pain had significantly reduced

14. which is an effect of savella drug that aids in relieving pain.
Savella drug is known to cause various side effects such as;
nausea, vomiting, constipation, increased sweating, headache
and the occurrence of hot flashes (Barbehenn, & Wolfe, 2010).
According to the case study, the client is reported to be
suffering from bouts of swelling with no main cause together
with nausea and suffers from insomnia too. Therefore, it is
evident that the side effects that emerged were as a result of the
savella drug.
By making the decision that a psychiatric-mental health nurse
practitioner should opt for Savella dosage, it was to achieve and
capture the side effects caused by the drug as well as its healing
capability. Administering the drug to the patient was to also act
as proof that savella is used to heal and relieve chronic pain.
According to research, savella should be taken two times a day
just like in the Caucasian case study. After four weeks of
administering the drug, dosage can be reduced based on the
patient’s medical condition and how best he is responsive to
treatment.
The expectations in decision one were that the client would
have homicide and suicidal thoughts as a side effect. Savella is
known to cause suicidal thoughts to clients taking the drugs
(Barbehenn, & Wolfe, 2010). However, in the Caucasian case
study, the client reports to claim that he had been suffering
from suicide and homicide thoughts. Instead, the patients report
that the future looks good. The difference was attributed to the
patient’s positive thoughts about life. For example, the client at
some time claims that one of the doctors he had met before had
suggested for a wheelchair for the patient which he did not
admit and instead said that he was okay and did not require one.
In addition, he is optimistic about life since he had been
recently engaged and was looking up to for marriage. Therefore,
the patient’s positive attitude towards life made the client not
suffer from suicidal thoughts and thus the difference between
the expectations and actual results presented after usage of the
drug.

15. Clinical Decision point 2
The Psychiatric-mental health nurse practitioner had an option
of continuing with current medication which was Savella but
this time lower it. The second option was to discontinue savella
and instead start to use lyrica by administering 50mg twice in a
day. The third option for the nurse was to discontinue savella
and administer 50 mg of Zoloft twice a day.
In clinical decision point 2, the psychiatric-mental health nurse
should discontinue the use of savella since the client reported
that the situation had not been cured. He is reported to claim
that he suffered pain with a range of 4 out of 10 and wanted that
to reduce to 3. Therefore, the nurse had to try a different drug
and monitor how well the patient would recover from the
condition.
For Clinical decision point 2, the psychiatric-mental health
nurse practitioner should recommend the introduction of Zoloft.
From the results of clinical decision one, the patient continued
to suffer from lack of sleep. Zoloft is therefore recommended
to improve on sleep and the mood. The drug has several other
uses such as treating; panic attacks, obsessive-compulsive
disorders, social phobia, post-traumatic stresses and severe form
of premenstrual syndrome disorder (Miguel, & Albuquerque,
2011).
According to the Caucasian case study, the patient reported to
have no suicidal and homicide thoughts. Meanwhile, the pain
increased from 4 to 3 out of 10 and that the condition did not
improve, instead, it worsened. However, the client no longer
experienced difficulties in sleeping. Moreover, his blood
pressure was reported to have increased but did not suffer
palpitations. The improvements to better sleep can be associated
with the introduction of the new drug Zoloft. The drug may be
administered with food or without. The best times to take the
drugs should be in the morning or after the evening meal. The
drug is associated with many side effects and therefore, a doctor
may recommend that a patient start on a low dosage and later
increase it to control the effects. Some of the common side

16. effects include; nausea, dry mouth, diarrhea, stomach upset and
drowsiness.
The expectations of using the drug included reduced pain from 4
to 3 out of 10. Though there were improvements in sleep, it was
affected by the severe pain. It was expected that the patient
would get enough sleep. Heart rate and pressure were expected
to remain at normal rates. Research conducted does not show
any side effects that cause increased heartbeat and pressure. The
drug is associated with boosting a patient’s mood and the reason
he never suffers from homicide and suicidal thoughts.
The difference between the expectations and the actual results
presented is attributed to the mix up of drugs. The body did not
adapt to the sudden changes introduced and therefore reason as
to why pain increased. The positive moods caused by the drug
are a reason as to why the client does not have suicidal
thoughts. Moreover, the patient was evaluated after four weeks.
The time was a long period since it was a new drug. The
psychiatric mental health practitioners should have
recommended the patient to return to the clinic after a week in
order to urgently monitor his progress. For example, if the
patient visited the clinic after a week, the nurse would have
been in a position to detect increased pain to 7 out of 10 and
thus change the dosage or medication.
Clinical Decision 3
In clinical decision 3, the nurse had the option of using Savella
but increase the dosage from 12 mg to 25 mg in the morning and
50 mg during bedtime. The psychiatric nurse practitioner had
also an option to discontinue savella and instead introduce 50
mg of tramadol. In addition, the nurse had an option of
introducing a new drug calexa with 12.5 mg.
The PMHNP nurse should prescribe Salville. The drug should at
this stage be increased to a higher amount. From the results of
clinical decision 1, the patient had recorded improvements in
her condition, especially on pain. Therefore, the client ought to
have continued with the medication to improve the condition
further.

17. The expectations after deciding to continue with the drug were
that pain would reduce to probably a rate below 4 out of 10 like
he experienced after decision one. Further expectations were
that the patient would now have peaceful sleep since Zoloft had
already cured insomnia. At end of stage 2, the patient reported
to only lack sleep due to pain. Therefore, since pain would be
reduced through the introduction of more dosage, the patient
would have enough sleep. At this stage, the patient was still
optimistic that he would heal and therefore pain would end and
therefore did not have homicidal and suicidal thoughts
The difference between the expectations and the results was the
increased pain. The patient reported complex neuropathic pain
syndrome which was feared not to respond to pain medication.
By the second re-introduction of the drug, the patient could
have suffered from resistance to the drugs which resulted to
increased pain (Barbehenn, & Wolfe, 2010). Tramadol and
celexa were ruled because they were not good and were feared
to cause severe side effects such as serotonin toxicity.
How Ethical Considerations Might Impact Treatment Plan
Confidentiality
According to APA ethics standards, psychiatrists and
psychologists are mandated to maintain the confidentiality of
their patients. However, confidentiality is sometimes breached
for example in instances where insurance companies require
details about patients in order to make hospital bill payments
(Kerridge, & Stewart, 2009).
Patient Abandonment
Psychologists are not supposed to abandon patients. However,
in a multidisciplinary setting, psychologists are faced by ethical
issues where at time patients are abandoned. According to APA
standards, psychologists should provide pre-termination
counselling (Rezai, &Zonenshayn, 2002).
Clinical Research
In most cases, psychologists are required to conduct and
participate in clinical research especially in a multidisciplinary
setting. However, ethical issues may arise for example in

18. choosing appropriate and adequate control groups.
Psychology’s Interface with Medicine
Patients are treated with multiple medications. However, ethical
issues may arise when too many drugs are recommended to the
patient and at times end up being ineffective. APA standards
stipulate that psychologists should provide services that are
within their boundaries (Rezai, &Zonenshayn, 2002).
Patient Autonomy and Informed Consent
Chronic pain illness sometimes requires patients to fill in
informed consents regarding hospitalization and medication.
However, ethical issues may arise in instances where a patient
is forced into medication and treatment.
References
Barbehenn, E., & Wolfe, S. (2010). Petition to ban fibromyalgia
drug milnacipran (Savella). Citizen.org. Public Citizen, 20.
Jänig, W., & Baron, R. (2003). Complex regional pain
syndrome: mystery explained?. The Lancet Neurology, 2(11),
687-697.
Kerridge, I., Lowe, M., & Stewart, C. (2009). Ethics and law for
the health professions (p. 225). Sydney: Federation Press.
Miguel, C., & Albuquerque, E. (2011). Drug interaction in
psycho-oncology: antidepressants and
antineoplastics. Pharmacology, 88(5-6), 333-339.
Rezai, A. R., &Zonenshayn, M. (2002). U.S. Patent No.
6,438,423. Washington, DC: U.S. Patent and Trademark Office.