NURS 6521 Week 8 Assignment: Decision Tree for Neurological and Musculoskeletal Example Decision Tree for Neurological and Musculoskeletal Disorders

NURS 6521 Week 8 Assignment: Decision Tree for Neurological and Musculoskeletal Example Decision Tree for Neurological and Musculoskeletal Disorders

NURS 6521 Week 8 Assignment: Decision Tree for Neurological and Musculoskeletal Example

Decision Tree for Neurological and Musculoskeletal Disorders

Healthcare providers are expected to decide the diagnosis of their patients, considering the presenting symptoms and the potential comorbid and physical patient factors. The decisions should be supported by evidence from the literature (Portney, 2020). This discussion summarizes a case study on a patient with neurological and musculoskeletal symptoms and the decisions made using a decision tree. The summary will include the case study and the decisions made at each point, a discussion on whether the decision was based on evidence, the expected outcomes from the decisions, and the difference between the actual results and the expected outcomes.

The case study entails a 43-year-old white male who presents to the clinic complaining of pain. He has been referred to the clinic by his family doctor for a psychiatric assessment, citing that the pain is all in his head. He reports that the pain started seven years ago, after sustaining a fall at work, after which he developed cooling of the extremities and often experiences severe cramping in the extremities. The mental status exam reveals that the patient is oriented to place and time. His judgment and insight are intact, and he denies hallucinations and delusions. The diagnosis is Complex regional pain disorder (reflex sympathetic dystrophy). 

The first decision was to begin Savella 12.5 mg once daily on day 1; followed by 12.5 mg BID on days 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter, followed by continuing the current medication, but at a lower dose of 25mg BID. The third decision was to change Savella to 25 mg orally in the morning and 50 mg orally at bedtime.

The decisions provided are supported by the literature. According to Harden et al. (2022), Milnacipran (Savella) is an effective medication for treating complex regional pain disorders. Gurba and Haroutounian (2022) also note that Savella should be started using a low dose and increased later, based on the patient’s reaction, as recommended in the decisions.

The expected outcomes I hoped to achieve by making the abovementioned decisions include managing the patient’s chronic pain to a place where he will comfortably go with his daily activities. According to Miller et al. (2019), it is impossible to address chronic pain from RSD completely; the pharmacological interventions aim to reduce the pain to a manageable scale. In addition, reducing the dose aimed at dealing with the side effects, such as sweating and sleep disturbance.

However, some expected outcomes differed from the actual case study results. In the second visit, the client noted that the pain had reduced but was not manageable. After the dosage reduction, the client reported that the pain had increased, as opposed to the expected outcome, which was further pain reduction. However, the current dose managed to deal with the side effect of sleep disturbance.   

The decisions identified above were, to some extent, effective in reducing pain to a manageable level. However, since the patient has a complex neuropathic pain syndrome, pharmacological therapy may never be completely effective in total symptom remission. Therefore, using the intervention alongside physical therapy, possible chiropractic care, and heat and massage therapy is essential.

References

Gurba, K. N., & Haroutounian, S. (2022). Antidepressant analgesics in the management of chronic pain. Clinical Pain Management: A Practical Guide, 171-180. https://doi.org/10.1002/9781119701170.ch16

Harden, R. N., McCabe, C. S., Goebel, A., Massey, M., Suvar, T., Grieve, S., & Bruehl, S. (2022). Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. Pain Medicine (Malden, Mass.), 23(Suppl 1), S1–S53. https://doi.org/10.1093/pm/pnac046

Miller, G. F., Guy, G. P., Zhang, K., Mikosz, C. A., & Xu, L. (2019). Prevalence of Nonopioid and Opioid Prescriptions Among Commercially Insured Patients with Chronic Pain. Pain Medicine (Malden, Mass.), 20(10), 1948–1954. https://doi.org/10.1093/pm/pny247

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