Case week 2.
You are a new FNP in a restricted state and you have your DEA license and state
furnishing for schedule II-V controlled substances. You are working at a busy family
practice group and you have a patient, ML, that is establishing care for the first time
with your practice, and comes to you with the following scenario:
· ML is a 54 y.o. Hispanic female with hx of chronic shoulder and back pain that
began 10 years ago when she was in a boating accident
· She lives in both US and Mexico, making regular visits across the border; lately, she
has stayed in US due to Covid border crossing constraints, living with her daughter's
family
· She had rotator cuff surgery in 2011 and reports to you that due to a long operation
and poor positioning, she has suffered from not only pain, but also chronic
numbness and tingling in her R shoulder
· As "la abuela" (grandma) she is the primary caregiver of the children and
homemaker for her family and her pain is exacerbated with housework, and
especially with the prolonged carrying of her grandchildren; one of which is 10 m.o.
· Currently, her med list is as follows
· Losartan 50 mg BID for HTN
· Gabapentin 300 mg po BID for pain
· Atorvastatin 40 mg daily for cholesterol
· Diazepam 5 mg po up to TID prn pain
· Norco 5/325 mg - takes up to two, sometimes up to 4-5x a day, prn pain
· She is a smoker, only smokes outside the house, and drinks 2-3 cans of beer on the
weekends, but more on family celebrations
· Denies recreational drugs and denies past overdoses
· Recently moved to CA more permanently to stay to take care of children during
Covid/school closures
· She asks you to refill all her meds for 6 months like her doctor in Mexico did so she
doesn't have to make another co-pay and come back and see you so often; it's hard
for her to get an appointment, and with Covid her daughter has to take off of work to
watch the kids just so she can come to you by bus since there is only one family car
You are a new FNP in a restricted state and you have your DEA license and state
furnishing for schedule II-V controlled substances. You are working at a busy family
practice group and you have a patient, ML, that is establishing care for the first time
with your practice, and comes to you with the following scenario:
· ML is a 54 y.o. Hispanic female with hx of chronic shoulder and back pain that
began 10 years ago when she was in a boating accident
· She lives in both US and Mexico, making regular visits across the border; lately, she
has stayed in US due to Covid border crossing constraints, living with her daughter's
family
· She had rotator cuff surgery in 2011 and reports to you that due to a long operation
and poor positioning, she has suffered from not only pain, but also chronic
numbness and tingling in her R shoulder
· As "la abuela" (grandma) she is the primary caregiver of the children and
homemaker for her family and her pain is exacerbated with housework, and
especially with the prolonged carrying of her grandchildren; one of which is 10 m.o.
· Currently, her med list is as follows
· Losartan 50 mg BID for HTN
· Gabapentin 300 mg po BID for pain
· Atorvastatin 40 mg daily for cholesterol
· Diazepam 5 mg po up to TID prn pain
· Norco 5/325 mg - takes up to two, sometimes up to 4-5x a day, prn pain
· She is a smoker, only smokes outside the house, and drinks 2-3 cans of beer on the
weekends, but more on family celebrations
· Denies recreational drugs and denies past overdoses
· Recently moved to CA more permanently to stay to take care of children during
Covid/school closures
· She asks you to refill all her meds for 6 months like her doctor in Mexico did so she
doesn't have to make another co-pay and come back and see you so often; it's hard
for her to get an appointment, and with Covid her daughter has to take off of work to
watch the kids just so she can come to you by bus since there is only one family car
