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Post 2 Johnas An Advanced Nurse Practitioner Anp You Are Working

As an Advanced Nurse Practitioner (ANP) working in an urgent care setting, a comprehensive holistic assessment is essential for effectively managing patient care. In the scenario where TC presents with a work-related right shoulder injury accompanied by severe pain and restricted range of motion, several key pieces of the holistic assessment are missing. These include an evaluation of the patient's age, general health history, medication allergies, current medication use, substance use history such as alcohol consumption, injury mechanism, and existing comorbidities. Additionally, psychological, social, spiritual, cultural, and developmental factors, which influence pain perception and response to treatment, are not addressed. A full physical assessment, including neurovascular status of the limb, and understanding of psychosocial supports and cultural beliefs, are critical components often overlooked in such an emergency scenario. Recognizing these areas ensures a patient-centered approach that respects individual preferences and promotes optimal health outcomes.

Regarding pain management, understanding the patient's specific pain characteristics—such as type (acute, chronic, or neuropathic), duration, intensity, and response to previous treatments—is vital. Pain perception is subjective and influenced by psychological and social factors. For example, a patient’s opioid history, prior analgesic effectiveness, and presence of psychological factors such as anxiety or depression significantly affect management strategies. Proper assessment should include exploration of these dimensions to personalize treatment, reduce unnecessary medication use, and prevent opioid dependency. Additionally, evaluating potential barriers to compliance, such as cognitive impairments or cultural beliefs about medication, enhances treatment adherence. Overall, a holistic pain assessment should integrate physiological, psychological, and social elements to guide effective pain relief strategies.

The process of rational drug choice for this case study

Choosing appropriate pharmacologic agents requires careful consideration of the injury severity, pain level, and individual patient factors. Initially, imaging of the shoulder is necessary to differentiate between soft tissue injuries and fractures; this guides treatment options. For mild to moderate pain, NSAIDs such as ibuprofen are first-line treatments due to their anti-inflammatory properties; they are generally effective for acute injuries (Woo & Robinson, 2020). The typical dose of ibuprofen would be 400 mg every 6 hours, not exceeding 3200 mg daily, administered with food to minimize gastrointestinal (GI) adverse effects. Patient education emphasizes not exceeding the dose and recognizing signs of GI distress or bleeding and kidney issues as NSAID side effects.

Topical agents like lidocaine patches offer an adjunct option, especially if localized neuropathic pain is suspected. Lidoderm 5% patches can be applied once daily for up to 12 hours; awareness of skin integrity is essential as patches should not be used on inflamed or broken skin (Woo & Robinson, 2020).

However, if pain persists or worsens—particularly with an 8/10 pain score—consideration of opioid therapy becomes necessary. Oxycodone 5 mg, with a regimen of one tablet every 6 hours as needed, can be prescribed for short-term use, typically not exceeding 5 days. This approach aligns with current guidelines emphasizing cautious opioid prescribing to prevent misuse and dependence. The use of non-opioid agents like tramadol, which has partial opioid activity but a lower addiction potential, may be appropriate as an intermediate step before opioids are considered (Woo & Robinson, 2020). Careful assessment of previous opioid use, potential for dependence, and comorbidities influences drug selection, aiming for the safest effective option tailored to the patient's pain severity and functional needs.

Patient teaching for TC

Effective patient education is vital, especially when prescribing analgesics. If NSAIDs are chosen, instruct TC to take ibuprofen with food to protect the stomach, avoid exceeding the prescribed dose, and watch for signs of GI bleeding or kidney problems. When opioids are prescribed, detailed counseling on safe use is crucial. TC should be advised against alcohol consumption during opioid therapy to avoid potentiating sedation and respiratory depression. Emphasize storing medications securely out of reach of children or others who may misuse them, and disposing of unused medication properly once pain subsides. Education should cover recognizing adverse effects such as constipation, nausea, dizziness, and signs of overdose—like slow breathing or loss of consciousness—and what actions to take, including calling emergency services if necessary. Encouraging TC to take medications early to prevent pain escalation and maintaining open communication for follow-up ensures optimal management and safety.

Additionally, instruct TC on nonpharmacologic treatments such as Rest, Ice, Compression, and Elevation (RICE) for shoulder injuries, and advise wearing lidocaine patches correctly—applying them for up to 12 hours, avoiding broken skin, and removing them if irritation occurs. Highlight the importance of adhering to prescribed activity restrictions and follow-up appointments to monitor progress and adjust treatment as necessary.

Understanding the DEA Drug Classification Schedule

The Drug Enforcement Administration (DEA) classifies controlled substances into five schedules based on their medical use, potential for abuse, dependency risk, and safety profile, as outlined in the Controlled Substances Act (DEA, 2020). Schedule I drugs have the highest abuse potential, no accepted medical use, and include heroin and LSD. These drugs are illegal in the United States. Schedule II drugs possess a high potential for abuse, can lead to severe psychological or physical dependence, but have accepted medical uses—examples include oxycodone, fentanyl, and morphine. Schedule III drugs have a moderate to low abuse potential and accepted medical uses, including medications like Tylenol with codeine and anabolic steroids. Schedule IV drugs, such as tramadol and diazepam, are considered to have low abuse potential but still carry risks of dependence. Schedule V drugs contain small amounts of controlled substances and are used for purposes like cough suppression and antidiarrheal treatments, such as Lyrica and certain formulations of specialty cough medicines (DEA, 2020). Understanding these classifications aids clinicians in prescribing medications responsibly, balancing therapeutic benefits with potential risks.

References

• Aldington, D., & Eccleston, C. (2019). Evidence-Based Pain Management: Building on the Foundations of Cochrane Systematic Reviews. American Journal of Public Health, 109(1), 46–49.
• Drug Enforcement Agency (DEA). (2020). Drug scheduling. Retrieved from https://www.dea.gov
• Lexicomp. (2017). Drug information handbook for advanced practice nursing (17th ed.). Wolters Kluwer.
• Wallace, S. (2013). The importance of holistic assessment – A nursing student perspective. Nursing, 24–30.
• Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers. F. A. Davis.