Case Exemplar Patient Question & Answer Guide (With Explanation)
This question focuses on applying theory to practical scenarios.
What This Question Is About
This question relates to case exemplar patient and requires a structured academic response.
How to Approach This Question
Focus on explaining concepts clearly and supporting them with examples.
Key Explanation
This topic involves case exemplar patient. A strong answer should include explanation, application, and examples.
Original Question
CASE EXEMPLAR: Patient With Traumatic Injury MF is a 25-year-old graduate student who was involved in a motorcycle accident 2 days ago and sustained several injuries. He presented with a left femur fracture, multiple rib fractures bilaterally, and burst spine fractures at T4 and T5 levels. Upon arrival to the ED, his pain was 9/10 and marginally controlled with hydromorphone 1 mg every hour as needed. He had an episode of desaturation while in the ED; therefore, he was admitted to the ICU. Past Medical History • Significant for asthma since the age of 5 Family History • Noncontributory Social History • Social alcohol use • No tobacco use • Occasional use of marijuana (legal in his state) • Denies any other illicit drug use • Occupation: Teaching assistant in the laboratory at the local pharmacy school Physical Examination • Blood pressure: 150/95; pulse: 95; respiration rate 18; temperature: 97.7 °F • Well-developed, well-nourished male in moderate distress due to pain • Respiratory effort is reduced due to pain associated with rib fractures • Examination is benign except for decreased mobility due to injuries Labs • Within normal limits, • Blood alcohol: 0.24 mg/dL • Urine: Positive for methamphetamines and cannabinoids Assessment • A diagnosis of multiple fractures is made, and orthopedic surgery is planned to fix the injuries to the spine and left femur. • Patient is complaining of severe pain “all over”; rates pain at 9/10. He describes pain as throbbing, sharp, with significant back spasm. • Trauma surgeon started the patient on morphine by patient-controlled analgesia (PCA) with the following settings: Morphine PCA dose, 2 mg Lockout interval: 15 minutes Maximum: Four doses/hour Additional doses of morphine 4 mg were administered four times in the past 24 hours in response to the patient’s loud complaints DISCUSSION QUESTIONS 1. What are the potential factors that may have contributed to the desaturation episode in the ED? 2. MF will more than likely become a patient with chronic pain after this incident. How should his chronic pain be managed after discharge? What are some strategies to mitigate the risk of opioid misuse? 3. What drug-drug interactions should a clinician avoid while considering an opioid as a pain reliever for this patient? 4. To proactively treat potential overdose of opioids, what medication should also be prescribed when opioids are prescribed or have escalated to this level? 5. What patient communication strategies should a clinician implement to optimize outcomes?
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