Question

Ms. Graham is a 74-year-old female (ex-military veteran) with a history of PTSD, COPD, chronic pain, and a non-healing wound of the left philtrum, who presents to your office for evaluation. She has had multiple sunburns to the face during her time as an active military as well as exposure to agent orange. She has a history of smoking 1ppd X 45 years. She complains of pain 5/10 in the affected area and the pain she describes extends the full thickness of her upper lip.

Surgical history: hysterectomy, trigger finger release. See the picture associated.

• Discuss your expected physical assessment findings? Discuss your thoughts about psychological findings?
• Provide rationale(s) for the medication(s) you would start today.
• Discuss the pharmacologic side effects, contraindications, or safety issues to be considered.
• Discuss the education that would be provided to the patient today and why.
• When would you follow up with this patient to determine the therapeutic response and what would you expect at that visit?

Answer 1

1. Being in military has provided Ms. Graham with multiple physical and emotional or psychological impact and trauma. While examination for her physical and psychological aspects it is identified that she has several physical aspects and disorders including- Chronic Obstructive Pulmonary Disease, Chronic pain and a non-healing wound including left philtrum area that affects her upper lip. She also has several face burns due to history of exposure to sun and agent orange. It is indicative that she smokes a lot per day and the duration is great for last 45 years that enhances her wound healing and delays it making it more challenging. The psychological examination reveals that she is undergoing Post-traumatic Stress Disorder that is a frequently common disorder among ex-military population. It is seen that the trauma of seeing injured and severely physically injured people and animals in war region and military area pose a great impact on the mental well being of the individual present in the field. Similarly, she is having a traumatic experience that has led her to develop PTSD, moreover her habits and lifestyle has led to increment in these findings and also impacted her mental ability to a several extent.

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