- 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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