Case Study: A Caucasian Man with Hip Pain
Name
University
NURS 6521
Date
, Introduction
“The patient is a 43-year-old white male presents at the office with a chief complaint
of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical
interview, the client reports that his family doctor sent him for psychiatric assessment because
the doctor felt that the pain was “all in his head.” He further reports that his physician
believes he is just making stuff up to get “narcotics to get high.” The client asserts that the
pain began approximately seven years ago after sustaining a fall at work. During the fall, the
patient landed on the right hip. He reports that he does get “down in the dumps” from time to
time when he sees how his life has turned out, but emphatically denies depression.” The
mental examination shows that the client is oriented, alert and appropriately addressed for the
time and weather. He makes good eye contact with a clear speech. He denies any form of
homicidal or suicidal ideation.
Decision Step 1
During the first step, I would start this current patient on a dose of Amitriptyline 25mg
po QHS and titrate upward weekly by 25g to a max dose of 200mg per day. According to
Stahl (2013), Amitriptyline is serotonin and noradrenaline reuptake inhibitor that is effective
in the treatment of fibromyalgia, neuropathic pain, chronic pain and other pain syndromes.
The drug deactivates the beta adrenergic receptors and serotonin 1A by boosting the serotonin
neurotransmitters and norepinephrine (Stahl, 2013). Starting the current patient on Savella
was not chosen since the drug is a selective serotonin-norepinephrine reuptake inhibitor
(SNRI) which has the same compounds as those used in the management of psychiatric
disorders such as depression (Stahl, 2013). Savella may also be utilized for the treatment
fibromyalgia. However based on the chronic pain in the hip, I did not see the essence of
starting the current patient of drugs used for treatment of the psychiatric disorders (Arcangelo
Name
University
NURS 6521
Date
, Introduction
“The patient is a 43-year-old white male presents at the office with a chief complaint
of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical
interview, the client reports that his family doctor sent him for psychiatric assessment because
the doctor felt that the pain was “all in his head.” He further reports that his physician
believes he is just making stuff up to get “narcotics to get high.” The client asserts that the
pain began approximately seven years ago after sustaining a fall at work. During the fall, the
patient landed on the right hip. He reports that he does get “down in the dumps” from time to
time when he sees how his life has turned out, but emphatically denies depression.” The
mental examination shows that the client is oriented, alert and appropriately addressed for the
time and weather. He makes good eye contact with a clear speech. He denies any form of
homicidal or suicidal ideation.
Decision Step 1
During the first step, I would start this current patient on a dose of Amitriptyline 25mg
po QHS and titrate upward weekly by 25g to a max dose of 200mg per day. According to
Stahl (2013), Amitriptyline is serotonin and noradrenaline reuptake inhibitor that is effective
in the treatment of fibromyalgia, neuropathic pain, chronic pain and other pain syndromes.
The drug deactivates the beta adrenergic receptors and serotonin 1A by boosting the serotonin
neurotransmitters and norepinephrine (Stahl, 2013). Starting the current patient on Savella
was not chosen since the drug is a selective serotonin-norepinephrine reuptake inhibitor
(SNRI) which has the same compounds as those used in the management of psychiatric
disorders such as depression (Stahl, 2013). Savella may also be utilized for the treatment
fibromyalgia. However based on the chronic pain in the hip, I did not see the essence of
starting the current patient of drugs used for treatment of the psychiatric disorders (Arcangelo
