NR 603 ADVANCED CLINICAL DIAGNOSIS WEEK 7 DISCUSSION

NR 603 ADVANCED CLINICAL DIAGNOSIS WEEK 7 DISCUSSION 1. The patient is a 58-year-old woman with chronic pain due to inflammatory arthritis. She presents for her first appointment with you in a primary care office. She states that she is aware that she is asking for an early refill of her Oxycontin however she is traveling out of state and she is concerned that she may have a flare up on her trip. • Apply the steps in SBIRT to this scenario Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a tool used by primary care providers to identify those at risk for substance use disorder and mental health problems and provide interventions and services to help reduce the complications arising from dependence and other severe symptoms (Hargraves et al., 2017). The primary care provider is the first point of contact for the patients and the primary care provider can identify those at risk and intervene early for better health outcomes and provide additional referral services (Hargraves et al., 2017). It is important as primary care provider to determine if the patient has taken opioid in the past and has developed tolerance or addiction as this can help develop a trusting relationship between patient and provider (Torres et al., 2017) The patient should be screened using the DAST drug screening questionnaire to help in developing a plan that would benefit the patient by reducing the use of opioid, providing education on the effects of opioid addiction, and referring the patient to specialized services who specialize in substance abuse (opioid addiction) (CMS, 2021). • Identify additional questions for this patient When were you diagnosed with inflammatory arthritis? When did you start taking pain medications for your pain? What medications have you taken and are taking for pain? How long have you been taking oxycontin? Who prescribes the oxycontin for you? Have you followed up with your prescriber? How frequently are you taking oxycontin? What is the dosage of the oxycontin you are taking? Have you tried any other pain medication? Do you see pain specialist for pain management? When was your last refill for oxycontin? How often are you having “flare-ups”? • Develop a treatment plan for this patient In the given case, the patient could be referring to rheumatoid arthritis as inflammatory arthritis and the first line treatment therapy for inflammatory pain management is non- steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (Bullock et al, 2018). The patient needs to be educated on the effects of long-term use of opioids such as dependence, constipation, nausea, headache, insomnia, and anxiety. The patient should be educated on regular exercise (Poudel et al., 2021). The patients need to be educated on multiple providers involved in the care and management of her arthritis. The patient needs referral to rheumatologist for further evaluation of arthritis and management, and better health outcomes (Bullock et al. 2018). The patient would benefit from physical and occupational therapy to help improve joint movement and strength (Bullock et al, 2018). The patient needs to follow up with the original provider and the rheumatologist for evaluation and management of arthritis and need for pain management. 2. The patient is a 24-year-old man brought to your clinic by his family for an evaluation. The patient states that he is struggling with prescription pain pills and wants help. He appears to be in opioid withdrawal; he describes anorexia and diarrhea, he is yawning and sweating upon examination. He scores 15 on the Clinical Opioid Withdrawal Scale (COWS), indicating moderate withdrawal. • Initiate office-based buprenorphine/naloxone (Sub Oxone) with a plan for observation. • Include your rationale for each treatment decision • Develop a treatment plan for this patient that includes ongoing MAT and psychosocial treatment interventions. The patient in the case is has admitted to addiction to pain medications, is showing signs of withdrawal and possibly