Complex regional pain disorder NURS 6521.docx - 1 Decision...

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1 Decision Tree for Neurological and Musculoskletal Disorder Esther Nkwanyuo Walden University NURS 6521 Advance Pharmacology Dr. Ramona Pramedass-Blom January 15, 2021
2 Decision Tree for Neurological and Musculoskletal Disorder Summary According to Laureate Education (2019e), the case study analysis is of a 43-year-old Caucasian male with main complaint of pain in the right hip which attributable to an accidental fall at his workplace seven years ago. He was sent for a psychiatric evaluation because his primary care physician thought the pain was “all in his head.” The presenting symptoms include neurological and musculoskeletal disorders. Though client eloquently stated and exhibited strange sequence of symptoms which included cooling of the extremity (measured by electromyogram). Complaint stated included excruciating pain to his extremity cramping. He confirmed the neurologist’s conclusive diagnosis was complex regional pain syndrome (CRPS), which is also termed reflex sympathetic dystrophy (RSD). No trait of overt delusion or paranoia was demonstrated by the client during the examination. Also, he stated being future oriented and claimed not experiencing mental health related issues including depression as his mode is consistent with reality (Laureate Education, 2019e). Treatment decision for this patient Initial decision would be prescription of Amitriptyline (Elavil) 25 mg PO QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day. On the fourth week, the patient is back in the office, still on crutches with improved pain. Pain is at a 6 out of 10 but appears groggy. According to the scenario, the client seems realistic and will be content to keep his pain at a level of 3. With the current dose, the client states, ability to move about independently like use the bathroom or kitchen with less dependence on crutches and confirmed a decline in the pain and toes curling (Laureate Education, 2019e). He claimed no thoughts of killing himself or hurting others.
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