Module 6 Pharm Assignment: Special Populations

Special Populations: You are the primary care provider for a 24-year-old male who has recently been in a car accident. Your patient has been addicted to prescription drugs since a college…

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Module 6 Pharm Assignment: Special Populations

Paper details

Write a 1200-1500 word APA formatted essay with three sources of support, addressing all of the following topics:

You are the primary care provider for a 24-year-old male who has recently been in a car accident. Your patient has been addicted to prescription drugs since a college football injury at the age of 20, when he was prescribed narcotics. He has suffered a neck injury in the car accident and was given narcotic pain medication upon discharge from the hospital. What are your short term and long term goals for the treatment of this patient? How will you safely meet these treatment goals?

You are the primary care provider for Mrs. Z, a 70-year-old female patient who has suffered from chronic back pain for a number of years. You are well acquainted with this patient, and due to recent changes in prescription regulations you now see her once a month to renew her narcotic prescription. Three months ago Mrs. Z’s 17-year-old granddaughter moved in with her, after a fight with her mother.

Z’s granddaughter was a straight-A student prior to a car accident at the age of 15. She dropped out of high school last year and spent two weeks in rehab for substance abuse. Mrs. Z states her back pain has been worse recently, and she seems to be running out of pills before the end of the month. She is requesting a greater number of pills be prescribed. What concerns do you have? What questions would you ask Mrs. Z? What approach would you take with her? How would you help this family? 

You are a primary care nurse in a heart failure clinic. Mr. G presents in the clinic with a three-pound weight gain in the past two days. Upon assessment, he has +2 pitting edema in bilateral lower extremities. When you ask him about his regular Lasix regimen, he shows you a plastic bag full of pills and states that he has so many pills prescribed, he just takes what he thinks he needs when he feels like he needs it.

Included in the bag are Cardizem, Toprol XL, glipizide, gabapentin, Lasix, multiple vitamins, ginseng supplements, fish oil supplements, and cinnamon supplements. Where do you start? How can you coordinate a multidisciplinary approach in caring for this patient? What patient education is necessary? How can you assist Mr. G in keeping his medications straight? 

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Required Reading

Adams, M., Holland, N., & Urban, C. (2014). Pharmacology for nurses: A pathophysiologic approach (4th ed.). Upper Saddle River, NJ: Pearson Education Inc. (Chapters 8 & 42)

Solution

Case Study 1- The Case of 24-year-old Male recently involved in a Car Accident and has been on Narcotics Prescription since the age of 20

What are your short term and long term goals for the treatment of this patient?

For the treatment of addiction patients to be successful, the primary care provider should involve the patient in formulating a treatment plan and setting out both short term and long term goals for treatment. As the clinician offering primary care to this male patient aged 24 years, it is essential to remind the patient that like diabetes or heart disease, addiction is a chronic condition, which means there is no cure. At the same time, the patient should be aware that with proper and effective management, addicts can and do recover if they follow and adhere to the prescribed treatment plan (Leach, 2018).

The treatment plan will include the detoxification process using medications. These medications are like methadone, buprenorphine, and naltrexone, which, along with non-pharmacological interventions like counseling and other psychotherapy interventions. Creating the goals will be preceded by the identification of problem statements, and once the goals are formulated, each will be accompanied by SMART objectives. 

The short term goals are;

To have the patient stop using prescription narcotics in managing acute pain like neck injury pain after the recent car accident. The two specific objectives that will help in achieving this goal write a comprehensive narcotic medication history and describe treatment attempts in the last four years, the patient has been on pain medication since the football injury. The next specific objective for treatment goal # 1 is to develop a written relapse prevention plan now that the patient has been discharged from the hospital and given narcotic pain medication.

To have the patient resolve to use non-narcotic management medication as well as non-medication interventions to help manage the neck injury. The specific objectives short term goal # 2is identify three non- narcotic drugs that relieve the neck pain. The next aim of this goal is identifying triggers that can exacerbate neck pain like twisting, among others, can lead to increased use of narcotic pain killers.

These two goals are for short term withdrawal management, also known as detoxification.

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The long term goals are;

Patient to participate in medication-assisted maintenance therapy using methadone, buprenorphine, and oral naltrexone. The specific objectives for treatment goal # 3 are for the patient to adhere to the prescribed alternatives to reduce narcotics dependency. The next specific objective is to have the patient discuss any barriers that crop up as the patient continues to take these medications.

The fourth and last goal for the patient’s treatment plan is for the patient and his family to understand the patient’s options for non- pharmacological interventions like counseling, peer support programs, and social support services, which may assist the patient in recovery. The specific objectives are that the patient will identify local clinicians currently offering group therapy and set up an appointment. Additionally, the patient wil use practical communication skills to discuss his narcotics addiction, as evidenced by prescription history.

How will you safely meet these treatment goals?

As the patient’s primary care provider, the intervention measures will include having the patient write a prescription narcotic use history detailing their attempts to recover. I will also avail education on high-risk situations to help the patient identify the triggers and effectively help the patient to complete a relapse prevention plan.

As the case manager, I will closely monitor the patient’s attendance in the recovery event. The identified peer recovery and other support networks will provide health information resources. Furthermore, I will also assist the patient in developing a daily calendar for medical appoints. These interventions will be slated to last between 45 and 60 minutes every week, and the duration will be anywhere between three and four months.

Case Study 2- The Case of Mrs. Z. a 70-year-old elderly patient on narcotic prescription who is living with her granddaughter, A 17 year who has been spent 14 days in rehab for substance abuse

What concerns do you have? 

That Mrs. Z is currently placing a request to have the number of pills prescribed to her increased. This request is because it could be that she wants to divert the increased medicine to her granddaughter, who is a school dropout, has had a fight with her mother, and once spent a fortnight in a rehab facility.

What questions would you ask Mrs. Z? 

Some of the questions would be crafted in such a way that they establish if the increased pain severity is a result of the older woman taking an under dose as a result of missing tablets/ pills. If so, does it mean the granddaughter could have made the missing pills? If she has not been forced to take less than prescribed dosage every day, then could it be that she is taking an overdose as a result of increased pain. If so, can the increase be attributed to the not so smooth relationship she could be having with her granddaughter? Stress is a factor that can increase pain severity, amongst others.

What approach would you take with her?

The first strategy is first to establish the real cause of why she has been running out of the prescribed pills, yet the prescription is calculated to last her through the next physician appointment. If it is the case of under dose, the best approach is to have the granddaughter be counseled and treated for substance narcotic abuse disorder where detoxification would be in order. If it is because the severity of pain has increased, forcing the older woman to take an overdose, then I would assess the woman and establish the causative factors.

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Some of which could be stress or engaging in strenuous physical activities as she goes out of her way to accommodate and tolerate the granddaughter. If the granddaughter is in any way linked to either missing prescription tablets or stress or forcing the older woman in physical activities, then Mrs. Z is taught how best to relate with the granddaughter.

Be that as it may, it should not be lost to the physician that the increase in pain could be an indication that the medication given is not valid and therefore requires having the dosage increased or substitutes with another drug. It could also be that combination therapy where more than one pain killer is used and alternative, complementary medicine therapy used.

How would you help this family?

The granddaughter’s treatment should take cognitive-based psychotherapy, where the cause of disagreement with the mother is established. Motivational interviewing for adolescents could also help in fostering the way she relates to her mother and grandmother. All the three women, namely Mrs. Z, her daughter, and granddaughter, would require individual counseling and group counseling so that they improve the way they relate with each other (Stoicea et al., 2019). The requirement is because a conflict in any dyad is bound to spill over to the triad and adversely, the health of all involved.

Case Study 3- The Case of Mr. G who presents in the clinic (for heart failure clinic) with a +2 pitting edema in bilateral lower extremities 

How can you coordinate a multidisciplinary approach in caring for this patient?

Caring for heart failure patient calls for a multidisciplinary team approach because of the complexity involved in making a heart failure diagnosis. General practitioners, (GPs) cardiologists, interns and geriatricians, and specialist nurses all must cooperate to establish the HF diagnosis and its underlying etiology. Once a determination is made, the complexity of heart failure treatment since there is a need for medication that prolongs life, to alleviate the symptoms and decrease the number of hospital readmissions.

Additionally, the presence of comorbidities, which include but are not limited to ischemia, diabetes mellitus, hypertension call, and depression require the primary care nurse to coordinate the nurse-led multidisciplinary team in an effective way (Glogowska et al., 2015). As the primary care nurse, I would organize the multidisciplinary team, ensuring there is effective communication not just with the patient but all the clinicians involved in offering care for this patient.

The team of specialist nurses, cardiologists, respiratory care, and medical specialists to mention, but a few need to liaise with each other and work closely across the diverse healthcare settings the HF patient receives care from. The optimal model to deliver the nurse-led multidisciplinary care will include the HF outpatient clinic program, the home-based management program, home telemonitoring, and a combination of models of integrated care models for both primary and secondary programs.

What patient education is necessary? 

Heart failure (HF) is the terminal stage of heart disease, with clinical indicators being exceptional dyspnea, orthopnea as well as edema, amongst other signs and symptoms. Besides medications to treat the HF and implementation of lifestyle changes that have proven effective in reducing morbidity and mortality, there is a need for self-care on HF patient education intervention. Insufficient knowledge of HF misconceptions held by the patient can lead to incorrectly administered self –care by the HF patients.

How can you assist Mr. G in keeping his medications straight?

An essential component of the self- care for HF patient’s education is knowledge of the prescribed medication. Non- adherence to prescribed medication is inversely connected to positive clinical outcomes. Using a series of questions, I would first establish Mr. G’s patient-reported medication knowledge. Some of the questions include; how many types of medicines do you take? How many heart-specific drugs do you take? Can you identify them by their names (generic or brand name? Do you know when to take the medication? 

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Armed with this knowledge, I will then classify the Mr. G’s medication regimen into ACE inhibitors (which block stress hormones and thus relieve pressure on the heart’s pumping action). Also included in this categorization are antiarrhythmic (meant to regulate irregular heartbeats), anticoagulants (the blood thinners) anti-hypertensive (to treat high blood pressure), and digitalis glycosides (to strengthen heart muscle).

Other likely groups of these medications are diuretics or water pills, Potassium supplements, and stool softeners if any. Once Mr. G can categorize each of the prescribed medications, knowledge of the side effects and other important notes on the drugs would enhance the patient’s adherence to taking the medication.

References

• Custodis, F., Rohlehr, F., Wachter, A., Böhm, M., Schulz, M., & Laufs, U. (2016). Medication knowledge of patients hospitalized for heart failure at admission and after discharge. Patient preference and adherence, 10, 2333.
• Glogowska, M., Simmonds, R., McLachlan, S., Cramer, H., Sanders, T., Johnson, R., & Purdy, S. (2015). Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses. The Annals of Family Medicine, 13(5), 466-471.
• Leach, J. M. (2018). Managing addiction to prescribed opioids: the job of general practice? The British Journal of General Practice, 68(674), 426.
• Liou, H. L., Chen, H. I., Hsu, S. C., Lee, S. C., Chang, C. J., & Wu, M. J. (2015). The effects of a self-care program on patients with heart failure. Journal of the Chinese Medical Association, 78(11), 648-656.
• Stoicea, N., Costa, A., Periel, L., Uribe, A., Weaver, T., & Bergese, S. D. (2019). Current perspectives on the opioid crisis in the US healthcare system: a comprehensive literature review. Medicine, 98(20).

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