Question

As a FNP, you are working in an urgent care setting. TC comes to the clinic with a work-related injury to the right shoulder. The patient rates the pain 8 on a scale of 0–10. The patient is unable to perform any ROM to the shoulder. There is no neck pain.

What pieces of the holistic assessment are missing from this scenario?

1. As a healthcare provider, what else do you need to understand about this patient related to pain management?
2. Describe the process of rational drug choice for this case study. In your process, discuss your thought processing of anti-inflammatory agents, topical agents, and narcotics.
3. Include in your response the teaching you would provide to TC.
4. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.

Answer 1

For holistic assessment, we need to know vitals of the patient, injury to other parts especially head, and we need to obtain scans of the injured parts. We also need to evaluate neuro-deficit in distal right arm and forearm including hand.

Related to pain management, I would like to elicit tenderness on any specific point.

Drugs to be prescribed in this scenario are NSAIDs like aceclofenac, paracetamol; along with serratiopeptidase to reduce inflammation. In case of fracture, the patient will need surgical intervention and immobilization. Trypsin is also helpful in healing the fracture once it is reduced.

Topical agents like diclofenac nanogel, transdermal patches like buprenorphine and fentanyl, or narcotics like morphine can assist in pain management.