DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
BY DAY 7 OF WEEK 8
Submit your Assignment, started in Week 6.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm Links to an external site.). All papers submitted must use this formatting.
SUBMISSION INFORMATION
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Next, click on Upload File and select Submit Assignment for review.
Rubric
NURS_6521_Week8_Assignment_Rubric
NURS_6521_Week8_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeBriefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.
20 to >17.0 pts
Excellent
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.
17 to >15.0 pts
Good
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
15 to >13.0 pts
Fair
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
13 to >0 pts
Poor
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.
20 pts
This criterion is linked to a Learning OutcomeBased on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
25 to >22.0 pts
Excellent
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature. … The response includes specific and relevant outside reference examples that fully support the explanation provided.
22 to >19.0 pts
Good
The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature. … The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
19 to >17.0 pts
Fair
The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature. … The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
17 to >0 pts
Poor
The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing. … The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
25 pts
This criterion is linked to a Learning OutcomeWhat were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
20 to >17.0 pts
Excellent
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned. … The response includes specific and relevant outside reference examples that fully support the explanation provided.
17 to >15.0 pts
Good
The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. … The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
15 to >13.0 pts
Fair
The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. … The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
13 to >0 pts
Poor
The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing. … The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
20 pts
This criterion is linked to a Learning OutcomeExplain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.
20 to >17.0 pts
Excellent
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. … The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.
17 to >15.0 pts
Good
The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. … The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.
15 to >13.0 pts
Fair
The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. … The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.
13 to >0 pts
Poor
vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing. … The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.
20 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 to >3.5 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 to >3.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
3 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors
4 to >3.5 pts
Good
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 to >3.0 pts
Fair
Contains several (3–4) grammar, spelling, and punctuation errors
3 to >0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 to >4.0 pts
Excellent
Uses correct APA format with no errors
4 to >3.5 pts
Good
Contains a few (1–2) APA format errors
3.5 to >3.0 pts
Fair
Contains several (3–4) APA format errors
3 to >0 pts
Poor
Contains many (≥ 5) APA format errors
5 pts
Integrating Evidence-Based Practices in Complex Pain Management: A Case Study Analysis
Introduction
Complex Regional Pain Syndrome (CRPS), a challenging neurological condition, demands a nuanced and evidence-based approach to alleviate suffering and enhance patients’ quality of life. This in-depth analysis delves into the intricate case of a 43-year-old white male diagnosed with CRPS in his right hip. Through a series of carefully considered decisions, this patient’s journey sheds light on the complexities of managing CRPS while balancing medication side effects and therapeutic outcomes.
Patient Summary
The patient’s ordeal commenced seven years ago, following a fall at work resulting in significant right hip injury. Despite extensive diagnostic tests, he faced skepticism from healthcare professionals, leading to delays in appropriate treatment. The decisions taken included initiating amitriptyline at 25 mg, titrating to 125 mg at bedtime, and later reducing the dosage to 100 mg daily. These decisions were geared towards mitigating pain, enhancing functionality, and minimizing side effects such as grogginess and weight gain.
Evidence-Based Support for Decisions
The initiation of amitriptyline aligns with studies demonstrating its efficacy in managing neuropathic pain, particularly CRPS (Neyama et al., 2020). Amitriptyline, a tricyclic antidepressant, modulates pain perception through multiple pathways, making it a cornerstone in neuropathic pain management (Solomon et al., 2022). The decision to maintain the dose despite minor weight gain is substantiated by research indicating that the benefits of pain control often outweigh modest side effects (Naguib et al., 2021). Additionally, the avoidance of Qsymia was prudent, considering its potential cardiac risks and the patient’s BMI falling below the recommended threshold for its use (Lei et al., 2021).
In addition to pharmaceutical interventions, exploring alternative therapies such as neuromodulation techniques has gained significant attention. A comprehensive study by Sivanesan, & Goebel (2021) delves into the effectiveness of spinal cord stimulation and peripheral nerve stimulation in managing Complex Regional Pain Syndrome, providing valuable insights into diverse treatment modalities.
Goals and Outcomes
The overarching goal was to reduce the patient’s pain levels to an acceptable threshold (around 3 on the scale) and restore his ability to perform daily activities without crutches. The outcomes were remarkably positive; the patient’s pain diminished from a debilitating 9 to a manageable 4. This reduction facilitated enhanced mobility and daily functioning, marking a significant improvement in his overall well-being. Despite minor weight gain, the patient’s improved quality of life underscored the success of the interventions.
Discrepancies Between Expectations and Results
In this case, the outcomes closely mirrored the expectations. The patient experienced a substantial reduction in pain, improved functionality, and minimal side effects, including manageable weight gain. The decisions made successfully struck a delicate balance between therapeutic benefits and potential drawbacks, ensuring the patient’s optimal quality of life. The minor weight gain, while a concern, was overshadowed by the vast improvements in pain control and functionality, aligning with the patient’s stated preferences.
Conclusion
CRPS management necessitates a holistic and individualized approach, integrating evidence-based practices, patient preferences, and vigilant monitoring of outcomes. This case study underscores the pivotal role of healthcare providers in navigating the complexities of CRPS treatment. By employing a comprehensive understanding of available therapies and their potential effects, clinicians can significantly enhance the lives of individuals afflicted with this debilitating condition.
References
Lei, X., Ruan, J., Lai, C., Sun, Z., Yang, X., Lei, X.-G., & Ruan, J.-Q. (2021). Efficacy and Safety of Phentermine/Topiramate in Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis. Obesity (19307381), 29(6), 985–994. https://doi.org/10.1002/oby.23152
Naguib, I. A., Ali, N. A., Elroby, F. A., & Elghobashy, M. R. (2021). Green HPLC-DAD and HPTLC Methods for Quantitative Determination of Binary Mixture of Pregabalin and Amitriptyline Used for Neuropathic Pain Management. Journal of Chromatographic Science, 59(6), 536–547. https://doi.org/10.1093/chromsci/bmab031
Neyama, H., Dozono, N., Uchida, H., & Ueda, H. (2020). Mirtazapine, an α 2 Antagonist-Type Antidepressant, Reverses Pain and Lack of Morphine Analgesia in Fibromyalgia-Like Mouse Models. The Journal of Pharmacology and Experimental Therapeutics, 375(1), 1–9. https://doi.org/10.1124/jpet.120.265942
Sivanesan, E., & Goebel, A. (2021). Complex regional pain syndrome: developing diagnostic tools and treatments from sympathetic nervous system, neuroimmune and neuromodulation discoveries in neuropathic pain. Regional Anesthesia & Pain Medicine, 46(3), 193–195. https://doi.org/10.1136/rapm-2020-101644
Solomon Tesfaye, Gordon Sloan, Jennifer Petrie, David White, Mike Bradburn, Tracey Young, Satyan Rajbhandari, Sanjeev Sharma, Gerry Rayman, Ravikanth Gouni, Uazman Alam, Steven A Julious, Cindy Cooper, Amanda Loban, Katie Sutherland, Rachel Glover, Simon Waterhouse, Emily Turton, Michelle Horspool, … Dinesh Selvarajah. (2022). Optimal pharmacotherapy pathway in adults with diabetic peripheral neuropathic pain: the OPTION-DM RCT. Health Technology Assessment, 26(39). https://doi.org/10.3310/RXUO6757
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