Exam 1/ Lecture 5: Basics EKG interpretation

Question 1

1/25/24

What does appropriate discharge planning take into account?

Answer 1

what interventions the patient has received during the visit and transportation home:

“consider pt transportation and driving precautions”
- Could the treatment or medication still be exerting its effects

(slide 85)

Question 2

1/25/24

What should be considered during discharge planning re: meds?

Answer 2

• whether the patient will be able to safely take the prescribed medications at home
• will patient be able to obtain the prescribed medications from their pharmacy? (ie cost, supply, etc.)

(slide 85)

Question 3

1/25/24

Why is sound management of pain during transitions of care important?

Answer 3

• reduces return visits
• expedites return to normal activities and work
• helps reduce risk of acute pain progressing to chronic pain

***This is why use of multimodal interventions and timely follow up is important.

(Slide 86)

Question 4

1/25/24

What does the reference “patients in pain are like a car with 4 flat tires” mean?

Answer 4

• Medications only pump up one of the tires
• they need to “pump” up the other tires with: nutrition, PT, counseling

(slide 87)

Question 5

1/25/24

What are PDMPs and why are they important?

Answer 5

• prescription drug monitoring program
• to make sure we are monitoring how much is being prescribed, in case someone wants to go get the same rx at multiple places

(slide 89)

Question 6

1/25/24
Case scenario 1:
- 54 yo non english speaking pt w road rash vs 23 yo female crying hysterically w “pain all over”

What factors account for the different reactions to pain in these two patients?

What are the potential barriers to adequately assessing their pain?

Answer 6

• Patients respond to and express their degree of pain differently due to a number of psychosocial factors.
• The severity of injury alone does not always dictate the degree of a patient’s pain.
• 54 yo - use a Translator or ipad, b/c family may not interpret or translate very well, may be biased
• 23 yr old – so upset, high anxiety, maybe give some ativan or versed

(slide 91)

Question 7

1/25/24

Case Scenario 2:
3 year-old right-handed male presents with his caregiver who reports that the child has complained of pain in his right arm since yesterday.

When questioned the child denies pain but cries and pulls away when any part of the right upper extremity is touched. He has no obvious deformity or swelling to either arm.

How would your approach to pain assessment in this child differ from that of an adult?

Answer 7

• use FACES pain scale
• Kids don’t go on and on for days c/o pain, so if its day later, they are being honest.
• Consider abuse?

(slide 94)

Question 8

1/25/24
Case scenario 3:
A 53 year-old male with chronic back pain underwent knee replacement one week ago. He presents to his primary care doctor complaining of persistent post-op pain. The patient reports his prescribed opioid is not controlling his pain. His pain has greatly limited his ability to perform his daily living activities.

How would you manage this patient’s pain? What important questions regarding his history should be asked?

Answer 8

This patient suffers with chronic back pain which he treats with a prescription opioid. It is important to ask the patient how long he has been receiving prescription opioids and at what dose. Also if he was prescribed any new medications after his surgery.

Upon further inquiry, the patient indicates that he has been taking the same opioid medication at the same dose for three years. It has always controlled his pain until his knee surgery. He reports that he was not given any new prescriptions for pain after his surgery. He was told that he should take ibuprofen as needed for pain.

class discussion:
In this case, the patient is suffering with an increase in his baseline pain due to his recent surgery. The prescription opioid which had controlled his pain for years is no longer effective given this increase in pain.
- may need an increase in dose.

• Pharm: Tylenol usually first, muscle relaxants, gabapentin, opioids
• Non pharm: heating pad, PT
• More complex: more chronic, he works, so need to address now before he gets bad
• What can we do to maximize the pt before surgery? -> maybe Prehab before they get sx to get them stronger

(slide 95)

Question 9

1/25/24

What does successful management of pain rely on?

Answer 9

• a thorough pain history and exam
• a stepwise approach
• timely re-assessments
• appropriate selection of pharmacological and nonpharmacologic management options

(slide 99)

Question 10

1/25/24

true or false:

“There is no test that can adequately identify or measure pain.”

Answer 10

True

(slide 99)

Question 11

1/25/24

What can happen if we leave acute pain untreated?

Answer 11

Chronic pain is a potential outcome of untreated acute pain.

(slide 99)

Question 12

1/25/24

What should discharge planning be centered on?

Answer 12

Discharge planning must take into account several safety concerns and should be centered on patient education.

(slide 99)