Decision Point Two Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning

This decision was selected to help achieve the optimum dosage for the client in order to attain maximum results. The drug was also tolerated well by the patient and therefore, considering another drug change could have introduced new side effects and prolonged the recovery process. The reason for drug administration at bedtime sought to manage the side effects which include drowsiness which could affect the patient’s daytime activities (Stahl, 2014b). Calling the office on three days allows follow up and monitoring of the patients progress during the treatment. It will also help determine the tolerance of the patient to the drug.

This decision sought to achieve an optimum dosage for the patient. This helps in improving his recovery process. Moreover, the increase of medication dosage was hoping to reduce the pain to at the acceptable scale rating of 3 and improve the quality of the patient’s life (Stahl, 2014b). In addition, it sought to manage throbbing in the right leg of the client which he complained to have been affecting him adversely. The problem of curling toes was also being treated by the increase of this dosage.

The difference experienced is that the client reports a pain level of 4 contrary to the expected level of 3. A weight gain was observed by the client also. The difference resulted from the side effects of 125 mg of amitriptyline which includes weight changes (American Psychiatric Association, 2013).

Decision 3

Continue the current dose of Elavil of 125 mg per day; refer the client to a life coach who can counsel him on good dietary habits and exercise

I selected this decision because the client complained of weight gain and hence exercise and dietary advice would be of great help to him (Stahl, 2013). The continuation of drug was done because; the patient had demonstrated pain control and hence it was essential for maintenance and complete recovery. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Discussions and Assignments.

This decision sought to achieve a complete recovery of the patient. This includes the elimination of pain and curling of the toes, change in the color of the leg and numbness as well as the side effects. Diet counselling also sought to manage the client’s weight and prevent the increase (American Psychiatric Association, 2013).

This decision did not present any difference from what was expected.

Ethical considerations

Ethical considerations associated with communication and treatment of this patient includes confidentiality. The client’s confidentiality should be maintained during communication for privacy purposes. Additionally, the autonomy of the client during treatment should involve respecting of their rights and as well as involving them in decision making after giving them consent of the treatment plan (American Psychiatric Association, 2013).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author

National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.