5pd1

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Explain at least two types of cellular damage that are largely responsible for progression from reversible to irreversible cellular injury.

Peer Response 1:

 

Lauren Koscal posted

Two types of cellular damage responsible for progression from reversible to irreversible cellular injury are hypoxic injury and chemical injury.. Hypoxia is the single most common cause of cellular injury (McCance et al., 2019) Hypoxia is the result of insufficient oxygen supply and is primarily caused by a decrease in red blood cell production, loss of hemoglobin function, poisoning of cytochromes, as well as respiratory and cardiovascular system diseases. Ischemia, which the most common cause of hypoxia, is the result of reduction in blood supply. Reduction in oxygen supply to tissues ultimately leads to tissue death if not treated within a timely manner.  “Time is muscle” is a well known phrase for severity and extent of myocardial ischemic injury resulting from coronary occlusion could be altered with adequate, timely intervention (Abreu, 2019)

Another form of cellular injury is the result of chemical injury. Chemical injury occurs when cellular response pathways are disturbed caused by oxidative stress, heat shock response, DNA damage response, ER stress, mental stress, and inflammation. Examples of chemicals are arsenic and cyanide which cause rapid cell death. Abuse of some over-the-counter medications, abuse of heroin, morphine, opioids and other substances can cause cellular injury, and can potentially lead to death (McCance et al., 2019)

References

Abreu L. M. (2019). Time is Muscle. Arquivos brasileiros de cardiologia, 112(4), 408–409.

doi:10.5935/abc.20190059

McCance, K.L. (2019). Pathophysiology: The biologic basis for disease in adults and children.

(8th ed.). St. Louis, MO: Elsevier.

 

 

Peer Response 2:

 

Tiffany Spitzner posted

Hyperplasia is an increase/overgrowth of cells in tissues and organs,second to increased cellular division. This occurs from an increased production of cells because it experienced an abnormal exposure of stressors/injury that occurred for a prolonged period. (Brashers, Rote, McCance, & Huether, 2019) Hyperplasia is responsible for permanent cellular damage because when the stressor is not amended or controlled, the cells continue to grow and change simultaneously. (Brashers et al., 2019) The cells begin to undergo malignant transformation. Dysplasia is an abnormal development of a cell in shape, size, and body. (Brashers et al., 2019) This type of cellular change is related to a disordered growth of the cells of the epithelium, which is the tissue that lines the surface of organs and vessels throughout the body. (Brand, Ylvisaker, Gelfand, & Pope II, 1980) The occurrence of these abnormal cells signal change has occurred. Cellular changes that involve the surface of the epithelium may be reversed/corrected. This corrected change can occur if the stressors/injury is removed. If the full epithelium is involved, it is considered a pre-invasive neoplasm. (Brashers et al., 2019) Hyperplasia and Dysplasia are both cellular changes that occur for any number of causes. Chronic inflammation, hormonal changes, and exposure from injury, such as toxins or hypoxia. These examples of chronic stressors that cause cellular injury, are responsible for irreversible damage if prolonged exposure occurs to the cells. (Brashers et al., 2019) REFERNCES

Barrett Esophagus; Treatment of Barrett’s esophagus may lower risk of esophageal cancer. (2011). Retrieved from  www.proquest.com/snhu.edu Brand, D., Ylvisaker, T., Gelfand, M., & Pope II, C. (1980, April 10). Regression of Columnar Esophageal (Barrett’s) Epithelium after Anti-Reflux Surgery. The New England

Brashers, V. L., Rote, N. S., McCance, K. L., & Huether, S. E. (2019). Pathophysiology. The Biologic Basis for Disease in Adults and Children (8th ed.). St. Louis, Missouri: ELSEVIER, INC.

 

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Epidemiology and public health week 4 dis 2

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 you will discuss about other issues associated to randomized trials such as sample size, Type I and Type II errors, and the validity of the study design. Additionally you will post a brief description of the four phases for testing a new drug in the United States. Your post must be written in APA format.

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Soap Note for type II diabetes mellitus

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SOAP NOTE SAMPLE FORMAT FOR MRC

Name: Date: Time:
  Age: Sex:
SUBJECTIVE
CC: 

“ .”

 
HPI: 

.

 
Current Medications:

 
PMHx:

Allergies: 

 

Medication Intolerances:

Chronic Illnesses/Major traumas

 

Hospitalizations/Surgeries

 
Family History

 
Social History

 
ROS
General

 Cardiovascular

 
Skin

 

 Respiratory

 
Eyes

 

 Gastrointestinal

 
Ears

 

 Genitourinary/Gynecological

 
Nose/Mouth/Throat

 

  
Breast

 

 Neurological

 
Heme/Lymph/Endo

 

 Psychiatric

 
OBJECTIVE
Weight   lb   Temp – BP
Height 5’1 Pulse Respiration
General Appearance

 
Skin

 
HEENT

 
Cardiovascular

 
Respiratory

 
Gastrointestinal

 
 
Genitourinary

 
Musculoskeletal

Full ROM seen in all 4 extremities as patient moved about the exam room.
Neurological

Speech clear. Good tone. Posture erect. Balance stable; gait normal.
Psychiatric

Alert and oriented. Dressed in clean clothes. Maintains eye contact. Answers questions appropriately.
Lab Tests

 
Special Tests- No ordered at this time.

 
 Diagnosis
 Differential Diagnoses

Diagnosis

 
Plan/Therapeutics
· Plan:

· Medication –

· Education –

· Follow-up –

 
 

 

References

 

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patient education tool

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Instructions

You will design a patient education tool that can be used by nurses for teaching patients using computer applications. You will then present your tool to the class and explain the purpose, how you created it, reasoning for your choice of applications, and provide current evidence of the effectiveness of this patient education. This presentation is 5-10 minutes.

Assignment File(s)

  • Patient Education Project and Presentation???? [Word Document]

Rubric

NM 208 Patient Education Project ToolNM 208 Patient Education Project ToolCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeUse of Computer Applications20.0 to >17.0 ptsHigh ProficiencyCreative, innovative, effective use of computer applications17.0 to >14.0 ptsModerately High ProficiencyEffective use of computer applications14.0 to >10.0 ptsProficient PointsIneffective use of computer use of applications10.0 to >0 ptsLow-Level Proficiency/Non-ProficientLacking use of computer applications20.0 pts This criterion is linked to a Learning OutcomeOrganization20.0 to >17.0 ptsHigh ProficiencyExtremely well organized; logical format that was easy to follow; flowed smoothly from one idea to another and cleverly conveyed; the organization enhanced the effectiveness of the project17.0 to >14.0 ptsModerately High ProficiencyWell organized; logical format that was easy to follow; flowed smoothly from one idea to another and conveyed; the organization enhanced the effectiveness of the project14.0 to >10.0 ptsProficient PointsSomewhat organized; ideas were not presented coherently and transitions were not always smooth, which at times distracted the audience10.0 to >0 ptsLow-Level Proficiency/Non-ProficientChoppy and confusing; format was difficult to follow transitions of ideas were abrupt and seriously distracted the audience20.0 pts This criterion is linked to a Learning OutcomeContent Accuracy20.0 to >17.0 ptsHigh Proficiency100 % of the facts are accurate17.0 to >14.0 ptsModerately High Proficiency99-90% of the facts are accurate14.0 to >10.0 ptsProficient Points89-80% of the facts are accurate10.0 to >0 ptsLow-Level Proficiency/Non-ProficientFewer than 80% of facts are accurate20.0 pts This criterion is linked to a Learning OutcomeResearch20.0 to >17.0 ptsHigh ProficiencyWent above and beyond to research information; solicited material in addition to what was provided; brought in personal ideas and information to enhance project; and utilized variety of resources to make project effective17.0 to >14.0 ptsModerately High ProficiencyDid a very good job of researching; utilized materials provided to their full potential; solicited adequate resources to enhance project; at time took the initiative to find information outside of school.14.0 to >10.0 ptsProficient PointsUsed the material provided in an acceptable manner, but did not consult any additional resources10.0 to >0 ptsLow-Level Proficiency/Non-ProficientDid not utilize resources effectively; did little or no fact gathering on the topic20.0 pts This criterion is linked to a Learning OutcomeCreativity20.0 to >17.0 ptsHigh ProficiencyWas extremely clever and presented with originality; a unique approach that truly enhanced the project17.0 to >14.0 ptsModerately High ProficiencyWas clever at times; thoughtfully and uniquely presented14.0 to >10.0 ptsProficient PointsAdded a few original touches to enhance the project but did not incorporate them throughout10.0 to >0 ptsLow-Level Proficiency/Non-ProficientLittle creative energy used during this project; was bland, predictable, and lacked “zip”20.0 pts Total Points: 100.0PreviousNext

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Child and Adolescent Health

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Read chapter 16 of the class textbook and review the attached PowerPoint presentation.  Once done, answer the following questions;

1.  Identify and discuss the major indicators of child and adolescent health status.

2.  Describe and discuss the social determinants of child and adolescent health.

3.  Mention and discuss at least 2 public programs and prevention strategies targeted to children’s health.

4.  Mention and discuss the individual and societal costs of poor child health status.

INSTRUCTIONS:

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 12 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard.   It is mandatory to post your assignment in the SafeAssign exercise.  If the assignment is not posted there, I will grade the assignment as 0.  A minimum of 2 evidence-based references besides the class textbook no older than 5 years must be used and quoted.  You must post two replies to any of your peers sustained with the proper references no older than 5 years in two different days to verify attendance and as well make sure the references are properly quoted and mention to whom you are replying to.  The reply is a comment to your peer not an extension of your assignment.  What I mean is that you can’t post in your replies the same that you posted in your assignment.   A minimum of 800 words is required.  Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.  I will also pay close attention to spelling and/or grammar.  Please review the rubric attached to the lecture.  You must present the assignment according to how it is posted, answering the questions by number, essay-style assignments will not be accepted unless otherwise specified.  I’ve been grading a lot of assignments with quite a few spelling/grammar errors.  As a BSN student, you should be able to present an assignment according to APA and without errors.  This reflects our University

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Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

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BACKGROUND INFORMATION:

An African American Child Suffering from Depression

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

  • Client complained of feeling “sad”
  • Mother reports that teacher said child is withdrawn from peers in class
  • Mother notes decreased appetite and occasional periods of irritation
  • Client reached all developmental landmarks at appropriate ages
  • Physical exam unremarkable
  • Laboratory studies WNL
  • Child referred to psychiatry for evaluation
  • Client seen by Psychiatric Nurse Practitioner

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what the PMHNP should do:

Begin Zoloft 25 mg orally dailyBegin Paxil 10 mg orally dailyBegin Wellbutrin 75 mg orally BID

 

The Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

  • At each decision point stop to complete the following:
    • Decision #1
      • Which decision did you select?
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
    • Decision #2
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
    • Decision #3
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources no more than give years old. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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Nursing homework help

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Respond to two colleagues in one of the following ways:

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why.

Include additional insights you gained.If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them.

Include resources to support your perspective.

Main Post

Agonist-to-Antagonist Spectrum of Action

Molecules that bind to receptors are referred to as ligands (“Pharmacology Corner: Agonists and Antagonists”, 2015).  Ligands are capable of binding to receptor sites and producing a biological response. These ligands are called agonists (“Pharmacology Corner”, 2015).  The opposite effect can also take place. Ligands that block the responses of agonists are referred to as antagonists. An agonist binds to a receptor site, activates it, and causes a signal to be transmitted. This reaction is called a biological response (“Pharmacology Corner,” 2015).  Conversely, an antagonist also binds to a receptor site, but blocks binding from any other agonists, thus preventing any biological response (“Pharmacology Corner”, 2015).  Several types of agonists exist on a spectrum. Their place on this spectrum is measured by comparing their binding ability versus endogenous agonists already present in the body (“Pharmacology Corner”, 2015).  Endogenous agonists are present in the body. Super agonists produce a greater biological response than endogenous agonists. Next on the spectrum are full agonists, which mimic the efficacy of the endogenous agonists. Next in line are the partial agonists, which only exert a partial biological response as their name suggests (“Pharmacology Corner”, 2015).  The next group of agonists are the inverse agonists which act in two ways. They inhibit the normal receptor site activity, and exert the opposite pharmacological activity at the same time. Last on the spectrum are the irreversible agonists which permanently bind and activate the receptor site. Since this action is permanent, it only occurs once and results in the destruction of the receptor (“Pharmacology Corner”, 2015).
G-Couple Proteins and Ion-Gated Channels

Receptors called G-protein-coupled receptors (GPCRs) facilitate most physiological responses to neurotransmitters, hormones, and stimulants in the environment. As such, they have great potential to be targeted for the treatment of many diseases (Rosenbaum, Rasmussen, & Kobilka, 2009). GPCRs comprise the largest group of membrane proteins and are responsible for most cellular responses to neurotransmitters and hormones. They also contribute significantly to the human senses of vision, smell, and taste (Rosenbaum et al., 2009).  GPCRs are made up of seven alpha-helical segments separated by intracellular and extracellular looped areas (Rosenbaum et al., 2009).

The fastest and least complex of signal pathways occur with signals whose receptors are gated ion channels (Ahern & Rajagopal, 2019).  Gated ion channels consist of many transmembrane proteins that create a hole, or a channel in the cell membrane. Each ion channel will allow the passage of a certain ionic species depending on its type. They are called gated because the passage is controlled by a gate which must be opened to allow the ions to pass (Ahern & Rajagopal, 2019).  The opening of the gates is controlled by the binding of a signal to the receptor. This causes the immediate passage of millions of ions across the membrane (Ahern & Rajagopal, 2019).
Epigenetics in Pharmacologic Action

Epigenetics refers to genetic information that exists beyond the information contained solely in the individual’s genetic code (Stefanska & MacEwan, 2015). Human diseases can be caused by a single base genetic mutation. Scientists have made great strides in unraveling the genetic code, recording the first complete sequence of the human genome in 2001 (Stafanska & MacEwan, 2015). These advances have prompted scientists to think beyond treating illness through drugs activating receptors, but in a more global fashion. Epigenetic mechanisms are systems that are able to alter or cancel genetic activation, and are present in all genes (Stefanska & MacEwan, 2015). These mechanisms may affect more than one gene or group of proteins, and can even regulate large groups of genes. Cancer is one disease in which the understanding of epigenetics can be key to more effective treatment (Stefanska & MacEwan, 2015).
Specific Client Example

One example of a common client issue is the opioid epidemic. Naloxone (Narcan) is an opioid antagonist that binds to the opioid receptors in the patient’s brain, reversing or blocking the effects of the opioid (“Opioid overdose reversal with naloxone (Narcan, Evzio)”, 2018). This is essential to save the patient’s life who has accidentally or intentionally overdosed on opiate drugs. Naloxone can quickly restore a normal breathing pattern in a person whose respirations have slowed or stopped as a result of the opiate (“Opioid overdose reversal”, 2018). Naloxone (Narcan) can be administered using a pre-filled delivery device that is sprayed into the nostril while the patient lies supine. This device is simple to use and requires no assembly (“Opioid overdose reversal”, 2018).

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Presentation

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In week 5, you will submit a 6-10 minute audio/visual presentation of your chosen ethical issue (Patient Confidentiality), and your stance supporting this issue. You will submit this as an assignment. You will post this video to the discussion board in week 7. You may not be personally in support of this issue, however, it is your job to convince us of a supporting position. Include evidence why you you are taking an affirmative stance with this issue. Your presentation should include both audio and visual components. The visual component can be PowerPoint slides, graphics, etc. Your presentation should be no more than 10 minutes long. Only the first 10 minutes of your presentation will be graded if you go over the time limit. You must succinctly sum up your position.

Include in your 10 minute presentation:

  • A summary of your chosen ethical issue (the problem)
  • A brief description of the dilemmas or concerns involved (why is this a problem?)
  • Your rationale for a supportive stance on the issue. 
  • Your proposed resolution. 
  • The key stakeholders and factors in support of the issue resolution
  • Ethical principles involved (e.g., justice, autonomy,
  • Any policy drivers related to the issue resolution such as access, quality, and cost
  • Any ethical theories that support your position

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Nursing homework help

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When deciding to enter a Master’s program inevitably, I knew it had to be an online course. The advantage of going to school online while being able to work full time was a significant precursor in deciding to go back. The convenience and flexibility offered in online courses are un-matched, with most learners being full-time workers and parents (Kauffman, 2015). With there being so many appealing attributes, online learning is growing at a rapid rate (Kauffman, 2015). In 2010, over 6.5 million people were taking at least one online course (Kauffman, 2015).

While there are many positive aspects of online learning, there are a few negatives to take into consideration, as well. When choosing an online course, you lack face-to-face interaction with peers and instructors (Kauffman, 2015). The lack of interaction was the biggest concern I had when entering this course. Not being able to have your questions answered right away as you would in a physical classroom is an example. However, the communication between Walden staff in all of my classes so far has been excellent. My academic advisor and all of the teachers have been quick to respond and answer and questions. They always ensure I understand what is being asked of me when they submit the reply.

The second biggest concern I have is finding clinical sites for my practicum courses in the MSN program. I live in a city that is saturated with Nurse Practitioner students, and that makes finding clinical sites difficult. Working with my academic advisor this week, I have nailed down the exact dates I will need practicum to ensure I have a deadline.  According to Online Colleges (n.d.), one of the traits of a successful online learner is self-direction and self-efficiency. Taking the initiative, utilizing resources, and staying on schedule fall under this category (Online Colleges (n.d.). Previously, in my BSN program, we also had a practicum in the last quarter. During that time, I failed to utilize my resources and exercise self-direction and efficiency and didn’t meet the deadline for my practicum applications. By failing to meet the practicum deadline, I delayed one of my courses for six weeks, ultimately putting me behind. Although this was an inconvenience, it was a learning experience for me on time management and self- direction with online learning.

The third and final concern I had was writing Master’s level papers and discussions. The Writing Center was beneficial while obtaining my Bachelor’s Degree, and I will continue to utilize it as a resource to earn my MSN. With options such as help with writing, grammar and composition, APA format, and scholarly writing, you are provided an abundance of tools to ensure success (Walden University Writing Center, 2019).

In conclusion, I have many resources available to me on a professional and academic level. Whether it be my academic advisor, the writing center, a mentor, or colleague in addition to personal discipline and accountability makes me prepared to take MSN courses.

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Decision Tree for Neurological and Musculoskeletal Disorders

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For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

 

Photo Credit: Getty Images/Science Photo Library RF

To Prepare
  • Review the interactive media piece assigned by your Instructor.
  • Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
  • Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
  • You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

  • Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
  • Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
  • What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
  • Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

 

Complex Regional Pain Disorder
White Male With Hip Pain

White male on crutches

BACKGROUND

This week, 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.”

SUBJECTIVE

The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”

The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”

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. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.”

During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented.

Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)

Decision Point One

Select what you should do:

Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafterAmitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per dayNeurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg 

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