Acute Pain Nursing Diagnosis & Care Plans Essay

Acute Pain Nursing Diagnosis & Care Plans Essay

Acute Pain Nursing Diagnosis & Care Plans Essay

Opioid Addiction

The Initial Orders to Help Control the Acute Pain

The initial step in controlling the pain should entail exploring the cause of the patient’s acute pain, implying that there is a need to get a detailed history. In addition, the plan for pain control, in this case, should be flexible since the extent of pain and the additional opioid requirement can be unpredictable among individuals chronically using opioids; thus, the level of pain may depend on the activity. Maximization of the non-opioid treatment approaches should be explored before additional opioid therapy. Methadone can be offered to the patient to manage acute pain (10-15 mg) and not exceed 20 mg per day (Jin et al.,2020). In case the patient presents with substantial opioid withdrawal symptoms within three hours, then the additional dosage should be offered, while if sedation occurs, then the next dosage has to be reduced

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The Diagnosis For GI symptoms

The patient has not used medication for the last two days, and combined with the symptoms. The patient could be experiencing opioid withdrawal. Initial withdrawal symptoms may include insomnia, runny nose, anxiety, restlessness, and muscle aches (Kosten & Baxter, 2019). Other symptoms that can appear later include diaphoresis, high blood pressure, fast heart rate, vomiting/nausea, abdominal cramping, and diarrhea.

Response for Methadone and Whether I can Prescribe Methadone As an AGACNP

            In our state, ARNPs operate and restrictive authority but can prescribe schedule II, III, and IV medication. Therefore, I can prescribe methadone but maintain a written collaborative agreement for prescriptive authority. In case the patient needs the medication, I can prescribe it; only that, I will have to monitor the patient’s overall condition, mental status, and vitals since the patient has a history of opioid use.

Concerns For The Patient and ACNP Practice, Resources Available, and Anticipated Referrals

            Various concerns exist. From the professional and ethical perspective, the main concern is that the patient has polysubstance abuse, which can put the license at risk. The patient’s wellness is also at risk due to the influence of several medications. Indeed, it has been shown that RNs have fifty percent higher rates of substance abuse in comparison to the general public since they have drug access (Fradkin, 2022). Various resources can be used. For instance, a prescription drug monitoring program can be used to electronically track the prescription of controlled substances. They can be vital in helping practitioners to identify individuals who misuse opioids and other prescribed medication. Referrals are also anticipated in this case. For example, I anticipate referring the patient to orthopedics for the assessment of pain and chronic back pain for better management. Another referral is to the psychiatric unit for mental health assessment.

Populations At Risk of Addiction, Pain Medication Diversion, and Psychological Conditions That May Cause Hyperalgesia or Adverse Reactions to Pain Regimens

            Individuals from any belief or background can be at risk of addiction. However, age, medical history, environment, and genetics all have a critical role to play. Certain medications and how patients use them can also lead to addiction. Heredity also plays a big role in addiction. For example, the risk of nicotine and alcohol addiction has been shown to be based on genetics. Living in an environment where drugs are available can increase the risk of addiction. One of the conditions that may cause adverse reactions to pain regimens is opioid-induced hyperalgesia (Higgins et al.,2019).

Resources Available to A Provider of Medical Care Who Suffers From Addiction

Various resources exist in every state. One of the resources is a Physician Health Program which can be used as an intervention (DuPont, 2018). They are confidential resources used by physicians and other professionals who could be experiencing behavioral, medical, psychiatric, or addictive conditions. Depending on what is impacting a healthcare professional, the individual chooses what to use as appropriate.

References

DuPont, R. L. (2018). The opioid epidemic is an historic opportunity to improve both prevention and treatment. Brain Research Bulletin, 138, 112-114. https://doi.org/10.1016/j.brainresbull.2017.06.008

Fradkin, D. (2022). Psilocybin: A brief overview for psychiatric mental health nurse practitioners. Perspectives in Psychiatric Care, 58(3), 1200-1203. https://doi.org/10.1111/ppc.12888

Higgins, C., Smith, B. H., & Matthews, K. (2019). Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis. British Journal of Anaesthesia, 122(6), e114-e126. https://doi.org/10.1016/j.bja.2018.09.019

Jin, H., Marshall, B. D., Degenhardt, L., Strang, J., Hickman, M., Fiellin, D. A., … & Larney, S. (2020). Global opioid agonist treatment: a review of clinical practices by country. Addiction, 115(12), 2243-2254. https://doi.org/10.1111/add.15087

Kosten, T. R., & Baxter, L. E. (2019). Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American Journal on Addictions, 28(2), 55-62. https://doi.org/10.1111/ajad.12862

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You are a new AGACNP at an urban, tertiary referral center working in the emergency department (ED). You are presented with the following case:

• Patient is a 45-year-old, Caucasian male, acute care nurse practitioner (ACNP) who comes in with the chief complaint of back pain, acute on chronic. He describes severely compromising, debilitating lumbar spine pain due to a fall from a 20-foot scaffolding several years ago. There is MRI evidence of multilevel degenerative spine disease and bulging discs, with a dx of “failed back surgery.”
• In addition to the above, he is nauseated with emesis episodes that are too numerous to count this morning. He also has intractable diffuse abdominal pain, intermittent piloerection, and diaphoresis.
• He tells you he is prescribed the following by a local pain clinic: OxyContin 20 mg BID, with oxycodone 5 mg q. 3 hours breakthrough pain, Lyrica 100 mg at HS, Lexapro 10 mg daily, and Xanax 0.5 mg BID prn anxiety. He reports that he received #60 OxyContin 20 mg and #60 oxycodone 5 mg 2 weeks ago but is saying that he has been out of medication x 2 days. When you inquired about how quickly he has used his pills, he admits to using more pills than prescribed due to increased pain following a recent fall at home. He wants help, admits to opioid addiction, and is accepting of inpatient admission.
• He is also requesting methadone to assist with addiction/pain management.
• He is receiving outpatient physical therapy as well as intermittent epidural blocks (last one was 2 weeks ago).

Answer all the following questions, in detail. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.

1. What are your initial orders to help control his acute pain?
2. What is your diagnosis for his GI symptoms?
3. What is your response to his request for methadone? Can you prescribe methadone for acute/chronic pain or addiction as an AGACNP?
4. Ethically and professionally, what are your concerns for this patient and his own ACNP practice? What resources are available to you as a prescriber to track this patient’s opioid use/abuse? What referrals do you anticipate making for him while he is in the ED?
5. What populations of people are at risk for addiction, pain medication diversion, and psychological conditions that may cause hyperalgesia or adverse reactions to pain regimens?
6. What resources are available to a provider of medical care who suffers from addiction?