Patient rounds involve various disciplines coming together to discuss the patient’s condition and coordinate care. They are used as an educational tool and also help keep everyone on the same page when it comes to the treatment plan. The following case is found in the textbook (Pharmacotherapy: Principles and Practices. Chisholm-Burns et al, eds. 5th edition. McGraw-Hill. New York 2019. ISBN-978-1-260-01944-5; Chapter 34. “Patient encounter”).
After reading the assigned chapters in the textbook, resources identified in Dynamed and Evidence based practice guidelines, please present the case to your peers in the form of a discussion. This will be your initial post. Please be sure to address all parts of the case and ensure your responses are well researched [including supporting, evidence based guidelines such those of the WHO, CDC, APS, etc.].
HPI: A 78-year-old man who is to undergo a left above the knee amputation due to a limb abscess
PMH: Peripheral artery disease for 18 years; cardiomyopathy, benign prostatic hypertrophy for 13 years
FH: Mother had osteoporosis; father had diabetes
SH: Lives with wife; has two grown children
Meds: Aspirin 81mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; pantoprazole 40 mg daily; tamsulosin 0.4 mg daily
Pain Assessment: Patient rates pain as 8 on a scale of 0 to 10.
Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine.
Current Meds: Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.
You would like to convert him to a combination preparation of hydrocodone and APAP for as-needed pain relief.
The patient was discharged to a skilled nursing facility and is receiving physical therapy and occupational therapy 6 days each week.
Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home, hydrocodone/acetaminophen 5/325 mg every 6 hours as needed for pain.
Pain Assessment: Patient reports pain of 7 out of 10; worse with movement.
Physical therapy notes indicate the patient is unable to complete therapy goals due to complaints of pain.
The patient has been at the skilled nursing facility for 4 weeks and is making progress toward rehabilitation goals; however, he complains that his leg is throbbing and feels like pins and needles. As a result, he requests to rest several times during her therapy sessions. During unit rounds, his therapist inquires whether her previous pain medication should be reordered.
Pain Assessment: 4 out of 10
Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home,