...al. published data regarding the use of topical morphine in the treatment of painful ulcers, confirming the results of a pilot study. Topical morphine seems to be safe and efficacious in the treatment of ulcer-related pain.1,2 At the Medical Oncology Department of the University of L’Aquila, five patients with malignant or benign painful ulcers were observed recently. All were affected by metastatic cancer and were receiving opioids; none was receiving disease-oriented therapies. On admission, all patients reported pain localized to ulcers, which was no longer controlled by systemic treatment; pain scores were O 5 on a numerical rating scale (NRS). Morphine was topically applied to ulcers three times daily (morphine sulfate injection 10 mg in 8 g Intrasite gelÒ, Smith & Nephew, Agrate Brianza, Italy). The morphine dose was the same in all patients, regardless of the ulcer size and the scheduled systemic treatment. Ulcers were washed before treatment with a ringer lactate and metronidazole solution. Systemic treatment was not modified. Pain was assessed daily by the patients using the NRS; nurses reported local and/or systemic adverse effects related to treatment in nursing charts. Patients were observed in the hospital for seven days. Characteristics of patients and pain scores are reported in Table 1. All patients responded References 1. National Institutes of Health NIDDK/DKUHD: Excerpts from the United States renal data system 2001. Annual data report. Am J Kidney Dis 2001; 38(Suppl...
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...July 3, 2014 Card v. American National Property and Casualty Spencer E. Richards IN ARBITRATION * * * TRAVIS CARD, Plaintiff, v. AMERICAN NATIONAL PROPERTY AND CASUALTY, Defendant. ) ) ) ) ) ) ) ) ) ) Deposition of: SPENCER E. RICHARDS * * * July 3, 2014 10:00 a.m. CHRISTENSEN & HYMAS 11693 South 700 East, Suite 100 Draper, Utah * * * Wade J. Van Tassell - Certified Realtime Reporter Registered Merit Reporter DepomaxMerit Litigation 801-328-1188 Wade J. Van Tassell July 3, 2014 Card v. American National Property and Casualty Spencer E. Richards Page 2 APPEARANCES For the Plaintiff: Kenneth L. Christensen Matthew Hansen Jake Lee CHRISTENSEN & HYMAS 11693 South 700 East, Suite 100 Draper, Utah 84020 For the Defendant: Sade A. Turner STRONG & HANNI 102 South 200 East, Suite 800 Salt Lake City, Utah 84111 Also Present: (Via Telephone) Dorothy Clay Sims Oregon Hunter Page 4 *** INDEX EXAMINATION By Mr. Christensen By Ms. Turner By Mr. Christensen PAGE 3 132 157 EXHIBITS No. 1 No. 2 3-19-14 Ltr, Turner to Richards 11-14-13 Deposition Transcript Excerpt 86 86 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Page 3 Uh-huh. MS. TURNER: Mr. Christensen, these are the medical records because we didn't print them all out. MR. CHRISTENSEN: I figured. And you had sent me those, but I appreciate you bringing them. We might open them up and refer to them, actually. Q. Did you happen to have in your file your billing for your...
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...strength. 2. Describe differences between acute pain management and chronic pain management. The differences between acute pain management and chronic pain management are: acute pain can be treated right away and the patient’s pain might be relieved. The patient with chronic pain will have to be treated long term. 3. Identify common concerns related to long-term use of opiod medications. The common concerns with opioid medications are: the risk of drug tolerance, drug abuse, respiratory depression, and accidents related to the use of opioids. 4. What are the top three nursing diagnosis priorities for a patient with an acute exacerbation of chronic pain? The top three nursing diagnosis priorities for a patient with an acute exacerbation of chronic pain are: 1. Acute or chronic lower back pain. 2. Risk for injury due to lower back pain. 3. Risk for social isolation. 5. Identify and explain at least two adjuncts, other than medications, that are used for chronic pain management. Two other treatments that can be used to treat chronic pain are the rotation of hot and cold packs to reduce inflammation, and sooth the pain. The second adjunct treatment is relaxation by giving the muscles a break. 6. Describe the possible impact of chronic pain on the psychosocial, spiritual, cultural, and developmental levels of a patient. The person with chronic pain may withdraw socially because of the fear of being in pain all of the time. The patient might not participate...
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...Carolina born and raise, for the past four years I lived in Warner Robins, Georgia, and just recently moved back home after the death of my mother. I lost my husband on December 23, 2011, from a long time illness. I have my Associates of Science in Business Administration Degree, and just recently gotten my Bachelor of Science in Business Administration Degree, and also my Master’s in Marketing and Business Administration. Hopefully, I will soon be able to open my own Gym for Patients with Fibromyalgia. I am disabled as well, I have Fibromyalgia, along with Lupus with some other chronic pain disorders I do not care to mention, but I’m maintaining my life just fine. I have accomplished a lot for myself and still plan to accomplish a lot more. This is my main reason why I want to open this Gym in order to help disabled individuals cope with their life style and deal with their pain a whole lot better. Being that, I’ve experience this first hand it would really help many others to deal with their illnesses a whole lot better. My daughter is 24; her name is Tempestt S. Gavins has graduated from Columbia College in Columbia, South Carolina, she is presently teaching English in China for one year with plans to continue to her education there. Yes, I’m very proud. My son is 21, his name is Daniel J. Gavins, and he doesn’t know what he wants to do yet. But I do have two beautiful granddaughters from him at a very young age, and they are three years old. I also...
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...Chronic Intractable Pain Diane Purcell Sophia Praskala Types of Pain: * Acute pain- short term, self-limiting, recent onset, transient often follows an injury. * Chronic pain- 6 months or longer. Persistent pain which can be divided into malignant and non-malignant. These individuals usually present with a complex array of medical and psychosocial problems that render them as a “vulnerable population.” There is evidence of prejudicial attitude esp. by Health Care Providers. * Intractable pain-severe, constant pain that is not curable by any known * means and which may cause a bed or house-bound state. It may cause adverse biologic effects on the body’s cardiovascular, hormone, and neurological systems. Common Causes of Intractable Pain: * Spine degeneration * Auto immune rheumatoid disease- Fibromyalgia, Lupus * Peripheral nerve damage or Reflex systemic dystrophy * Abdominal adhesions * Headaches- post concussion or post trauma * Malignant Fibromyalgia * Arachnoiditis * Pelvic Floor, Groin, Vulvar, or Prostatic pain * Reflex Sympathetic Dystrophy Stats: * Back pain reported as primary source of chronic pain followed by osteoarthritis. * Internet survey- 30.7% reported chronic pain, females 34.3% and males 30.7%. Increasing age and lower socioeconomic status are indicators for increase in chronic pain. * In N.C. unintentional overdose accounts for approx. 3 deaths a day...
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...Prescription Concepts Applied to Patients Diagnosed With Fibromyalgia Pain is defined as an “unpleasant feeling, conveyed to the brain by sensory neurons” (Medical Dictionary, 2013). Pain is a subjective interpretation, which describes location, intensity and nature of sensory information resulted from noxious stimulation of nerve endings. The emotional response and other various conscious or unconscious responses add to the concept of pain. Acute pain usually results from tissue damage and it usually ends once the injury is healed. Chronic pain is a long term condition related to a persistent or degenerative disease or it doesn’t have an identifiable cause. Although there are different opinions about when a patient can be declared as suffering from chronic pain (after six months or twelve months), the presence of such sensation after the healing period usually leads to this diagnosis. One of the diseases with a generalized chronic pain as a symptom, which continues to generate many debates in the medical world, is fibromyalgia. Fibromyalgia, a disorder that affects the overall system and has an effect of generalized chronic pain, will be delineated in this paper, including its causes, manifestation, and part of the process of managing this disease in which a kinesiologist would have a central role. Fibromyalgia, estimated to affect 4% of the population, is a compilation of symptoms accompanying pain, which include fatigue, stiffness and sleep disturbance, along with psychiatric...
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...Stroke _________ Skin Disease ______ Bladder Infections _Kidney Disease ___________ Ulcers ________ DM _________ Dental Problems _________ Fractures _________Congenital Heart Defects Surgeries Family Health History Condition Family Members Condition Family Members Heart Disease Mom died of heart attack Tuberculosis Hypertension Asthma Stroke Mental Illness Diabetes Alcoholism Cancer Aunt died of mylethoma Kidney Disease Other Health Problems in Family: _________________________________________________________________ Medications Prior to Admission: (List) Prescription: She only takes aspirin and pain medications, but she doesn’t know the exact medications. Nonprescription: None Allergies and Reactions: Identify the drugs allergic to and describe the client’s response to them: 1.) Penicillin – Drug: causes...
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...debilitating neurological disorder characterized by chronic widespread pain and fatigue. It affects approximately 2% of the population, and is more common in women than in men. Central nervous system sensitization affects the entire body, leading to many secondary symptoms. This paper will cover the history, symptoms, and causes of FMS as well as known treatments and exercise prescription for the syndrome. Fibromyalgia has been described as a full-body migraine. Another common explanation is to compare everyday life with FMS as being similar to the aches and pains associated with a severe case of the flu. FMS patients experience intermittent flares, which are episodes of increased symptoms. Flares usually occur in response to physical or emotional stress, a schedule change, an illness or injury, a new job, the birth of a child, etc. While fibromyalgia is not considered a degenerative disorder, its symptoms usually become more severe if the patient also has a degenerative disorder such as arthritis. First, a patient must have experienced continuous pain in all four quadrants of the body for at least three months (Wolfe et al., 1990). Doctors will usually order many tests in order to rule out other conditions that might be confused with fibromyalgia. The key diagnostic tool for FMS is the tender point exam. No more than 4kg/1.54km2 of pressure is applied to 18 specific points (see Table 1). If there is significant pain in at least 11 of the 18 points, the patient may...
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...Fibromyalgia (FM) is a complex chronic pain disorder that causes widespread pain and tenderness to touch that may occur body wide or migrate over the body. The pain itself waxes and wanes over time. Fibromyalgia affects people physically, mentally and socially. Approximately 10 million Americans have FM with a ratio of about 8 to 2, women over men. It occurs in people of all ages, including children. Healthcare providers diagnose FM based on a combination of relevant symptoms, including fatigue, tenderness, functionality, and overall well-being. Additional common symptoms may include depression or anxiety, migraines, tension headaches, pelvic pain, irritable or overactive bladder, irritable bowel syndrome (IBS), TMJD (including tinnitus),...
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...HLSC111 Stress and Health Continuing with psychosocial aspects affecting health and particularly the role of stress and its possible mechanisms Week 6 Lecture A PNI, Pain and Health We will examine PNI ‐ Psychoneuroimmunology The immune system – its role in preventing disease Lect B – coping – what works Where are we? This lect draws a number of threads together: So far we have looked at: People and ways to understand them What people share with each other – developmental psychology What makes people unique – individual differences The role of groups people belong to Stress – causes and effects Psychoneuroimmunology (PNI) What is it? PNI ‐ examines the relationships between the mind/brain and immune system “The field that studies the interactions between the central nervous system, the endocrine system and the immune system; the impact of behaviour/stress on these interactions; and the implications for health of these interactions” Ronald Glaser Now we will examine in more detail the relationship between behaviour, 1919 ‐ researchers noted increased stress increased the the nervous system, the endocrine system, immunity and coping ‐ ways to stay healthy Back to Physiology progression of pulmonary tuberculosis. Research foundations Psychosocial factors modulating immunity Immune system problems result from Increased Age Genetic disorders Infectious diseases Nutrition...
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...Gender: Male Birthplace: Anywhere, NY Marital status: Married Employer: East House Corporation Occupation: Mental Health Counselor Race/ethnicity: Caucasian Identifying data: JP is a 36-year-old, married, Caucasian male, a willing participant in interview, appearing stated age; resides at 123 Penny Lane, Anywhere, NY; born 10/16/1975; mental health counselor Source of history: Contributor of data was client; alert and oriented to person, place, and time; engaged in interview, reliable Reason for seeking care: Client presents with cough with sputum production, sharp chest pain on inspiration, shortness of breath, body aches and fever, “my fever was 103.2 before coming in” History of present illness: Thirty-six-year-old male presents to office complaining of cough pain in chest, body aches and fever, states pains and fever started 6 days ago. Rates pain as 6 to 10 out of 10, continuous. Patient states he took his own temperature with an oral thermometer with temps ranging from 101.9 to 103.2. Past medical history: • Fibromyalgia • Epilepsy • Pericarditis • Heart Burn Past surgical history: Denies any past surgeries Childhood illnesses: • Chickenpox Accidents or injuries: • Car accident, 1992 History of hospitalizations: • Full cardiac workup, 2004 • Monitored 1994, due to black outs Immunizations: Up-to-date, including PPD and influenza, Hep B series 2011 Examinations/screening/diagnostic...
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... Firstly, Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf. Sciatic pain can range from being mild to very painful. A slipped disc is the most common identified cause of sciatica, but in some cases there is no obvious cause. Less common causes include spinal stenosis (narrowing of the nerve passages in the spine), injury, infection or a growth in the spine. Most people find their sciatic pain goes away naturally within a few days or weeks, but medical advice should be sought if any other symptoms are experienced together with back and leg pain, such as weight loss or loss of bladder or bowel control, or if increasingly more pain and discomfort is experienced or pain is too severe to manage with self-help measures. Acute sciatic pain occurs suddenly and usually heals within several days to weeks. Its severity relates directly to the extent of tissue injury and resolves with over time. It is often called acute mechanical back pain, because the source of the pain may be in the spinal joints, discs, vertebrae, or soft tissues. Chronic sciatic pain, on the other hand, persists (lasts more than...
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...Chronic back pain can occur due to a variety of situations. It is a difficult condition to live with and even more difficult for a medical provider to treat. This is because the spine is literally the backbone of your body. It is why you can sit down and stand up, walk and bend over. Feeling and movement would not exist as we know it without these 24 vertebrae lined up vertically in your back. Each of these vertebrae provide support and structure. They hold and protect your spinal cord and when something goes wrong in this area, the nerves and tendons attaching to and moving through them are affected. Pain, numbness, tingling and loss of feeling or movement can result. How the damage occurs is key to treating the problem. Most chronic problems develop from acute or one time conditions that are not addressed. There are many contributing factors that increase the chances your spine can be injured and become a long term or chronic condition. Because our vertebrae are bones, they are made up of salts which are minerals. The tendons and muscles that attach to them are elastic and they need to be flexible yet strong. Many people do not take the time to “feed” their spine and stretch their muscles. Feeding your spine mineral supplements along with vitamin D can help keep your vertebrae strong. Over the years the bones can degrade, and these minerals and vitamin are the hammers and nails that keep your bones strong. What exercise does for the muscles and tendons, minerals...
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...“Drug Seeking” in Health Care Chronic pain affects a significant number of individuals living worldwide. The International Association on the Study of Pain [IASP] and the European Federation of the IASP Chapters [EFIC] indicates that one in five people suffer from moderate to severe chronic pain, and one in three are unable to maintain a lifestyle of independence due to their pain (World Health Organization [WHO], 2004). The WHO identifies that pain relief is an integral right for individuals to attain the highest level of physical and mental health (2004). The Committee on Advancing Pain Research, Care, and Education at the Institute of Medicine [IOM] (2011) examines pain as a public concern. The report concluded that chronic pain affects the lives of about 100 million US adults, “more than the total affected by heart disease, cancer, and diabetes combined” and is a national challenge (2011). Pain is a subjective physiologic phenomenon that cannot be objectified or verified and is often un-assessed, un-diagnosed, and undertreated. This stands as a serious public health concern because individuals experiencing chronic pain are at great risk for decreased functional status and quality of life. Additionally, individuals living with chronic pain experience the common co-morbidities of depression, anxiety, and anger (Wilsey et al., 2008). The IASP/EFIC data from WHO (2004) concludes that one in four individuals experiencing pain, report that relationships with family and...
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...Chronic Pain 1. What are the risk factors for low back injury? 2. Describe differences between acute pain management and chronic pain management. 3. Identify common concerns related to long-term use of opiod medications. 4. What are the top three nursing diagnosis priorities for a patient with an acute exacerbation of chronic pain? 5. Identify and explain at least two adjuncts, other than medications, that are used for chronic pain management. 6. Describe the possible impact of chronic pain on the psychosocial, spiritual, cultural, and developmental levels of a patient. Asthma 1. What are the risk factors for asthma? 2. Describe routine nursing care that would be appropriate for a homecare patient. 3. Describe education a patient requires to self-administer nebulizer treatments. 4. What are the top three nursing diagnosis priorities for the patient having an asthma attack in the home. 5. Identify three common complications for untreated asthma. Explain the nursing care designed to prevent each of these complications from occurring. 6. Describe the effects of common asthma medications. 7. Prepare for teaching a patient with limited English proficiency how to manage asthma at home. Tuberculosis 1. What are the risk factors for tuberculosis? 2. Describe three different types of tuberculosis and the common treatment recommendations for each. 3. Identify common concerns related to long-term administration of tuberculosis...
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