Week 8 Nurse 676 A Matt is a 15-year-old male who presents with complaints of ankle pain x 4 hours after “twisting” his foot while playing soccer. His x-ray is negative and examination is consistent with a moderate ankle sprain. He rates his pain 8/10 (1-10 pain scale). What pain medication options can you offer Matt? What side effects of your prescribed regimen does he need to be educated on? Should his parents be involved in your discussion?

Week 8 Nurse 676 A Matt is a 15-year-old male who presents with complaints of ankle pain x 4 hours after “twisting” his foot while playing soccer. His x-ray is negative and examination is consistent with a moderate ankle sprain. He rates his pain 8/10 (1-10 pain scale). What pain medication options can you offer Matt? What side effects of your prescribed regimen does he need to be educated on? Should his parents be involved in your discussion?

Ankle Sprain

An ankle sprain happens when the ankle is displaced from its regular position. This injury is more common in sports-related activities. It refers to tearing or stretching of the ankle ligaments (Melanson & Shuman, 2021). This paper will focus on the pain management of Matt, a 15-year-old male who presents with complaints of ankle pain consistent with a moderate ankle sprain. Subsequently, the paper will explore analgesic options available for him, their side effects, and whether or not to involve his guardian in the treatment plan.

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Pain Medications

Management of acute ankle sprain majorly involves conservative approaches complemented by pain medications. However, it is essential to pinpoint that those severe injuries such as third-degree injuries and associated complications such as chronic ankle instability and sprains may require surgical interventions (Doherty et al., 2017).Doherty et al. (2017) further describe the conservative management summarized by the acronym PRICES, corresponding to protection, relative rest, ice, compression elevation, and support.

On the other hand, pharmacologic agents used in managing acute ankle sprain include analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. According to Doherty et al. (2017), limited evidence is inexistent to support the use of opioids in controlling pain linked to an ankle sprain. Paracetamol is a non-steroidal anti-inflammatory drug that exhibits both analgesic and antipyretic properties. This agent acts by inhibiting the synthesis of prostaglandins that ordinarily serve as pain and fever mediators in the central nervous system (Hung et al., 2018).The agent can be given orally, rectally, or intravenously. Its use is associated with better control of pain and fever associated with an ankle sprain.

Meanwhile, he will also benefit from ibuprofen, a non-steroidal anti-inflammatory agent. Similar to paracetamol, the agent elicits analgesic, antipyretic and anti-inflammatory effects by inhibiting prostaglandin synthesis (Hung et al., 2018). Additionally, utilization of this pharmacologic agent improves pain control and reduces the swelling and fever caused by a sprained ankle. Matt’s severe pain can be controlled effectively by a combination of PRICES and the aforementioned analgesics.

Side Effects and Patient Education

Children taking paracetamol have an increased risk of agitation, anxiety, fatigue, headache, hepatotoxicity, nausea and vomiting, renal failure, and hypotension (Hung et al., 2018). Nevertheless, these effects occur with high doses or chronic use. Thus, the patient should be advised to take the medications as per the prescriptions and avoid alcohol. It is also important to always confirm the labels of this over-the-counter agent and seek health professional advice to avoid prolonged usage. Likewise, high doses and prolonged use of ibuprofen have been associated with headache, dizziness, gastrointestinal bleeding, constipation, dyspepsia, nausea and vomiting, renal failure, edema as well as psychic disturbances(Hung et al., 2018). Consequently, it is imperative to educate the patient to take medications as directed by the physician, take medications with a full glass of water and stay upright for 15-30 mins, not take OTC preparations for more than ten days, and to consult the healthcare provider in case of the effects mentioned above.

Finally, Matt’s parents should be involved in discussing his treatment plan. Although literature outlines that at age 14, adolescents have the necessary cognitive ability to understand the components of informed consent (Al-Sheyab et al., 2019), it is elemental to incorporate the parents in decision making for proper care and resultant prosperity of the treatment plan.

Conclusion

An ankle sprain is a common sports-related injury that is managed by integrating both conservative and pharmacologic options. It is critical to encompass the parents in formulating a treatment plan for the adolescents to ensure maximum prosperity of the plan.

References

Al-Sheyab, N. A., Alomari, M. A., Khabour, O. F., Shattnawi, K. K., & Alzoubi, K. H. (2019). Assent and consent in pediatric and adolescent research: school children’s perspectives. Adolescent Health, Medicine and Therapeutics, 10, 7–14. https://doi.org/10.2147/AHMT.S185553

Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 51(2), 113–125. https://doi.org/10.1136/bjsports-2016-096178

Hung, K. K. C., Graham, C. A., Lo, R. S. L., Leung, Y. K., Leung, L. Y., Man, S. Y., Woo, W. K., Cattermole, G. N., & Rainer, T. H. (2018). Oral paracetamol and ibuprofen for treating pain after soft tissue injuries: Single-center double-blind, randomized controlled clinical trial. PloS One, 13(2), e0192043. https://doi.org/10.1371/journal.pone.0192043

Melanson, S. W., & Shuman, V. L. (2021). Acute ankle sprain. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459212/

Matt is a 15-year-old male who presents with complaints of ankle pain x 4 hours after “twisting” his foot while playing soccer. His x-ray is negative and examination is consistent with a moderate ankle sprain. He rates his pain 8/10 (1-10 pain scale). What pain medication options can you offer Matt? What side effects of your prescribed regimen does he need to be educated on? Should his parents be involved in your discussion?