J is a 59 year old male who works as a roofer presents with bilateral knee pain.
C. J is a 59 year old male who works as a roofer presents with bilateral knee pain. He was a high school athlete and had his ACL repaired on his left knee 20 years ago. He is currently obese and states the pain is worse going downstairs, with activity, and at night when sleeping. He reports the pain is interfering with his quality of life. He denies any recent injuries and is just here to “get something for the pain”. He has not been to a provider for 5 years.
Past medical history: Hypertension, Obesity
Past Surgical History: Left ACL repair
Medications: Lisinopril 10 mg QD
Family History: Mother had Type II Diabetes. Father had COPD and Rheumatoid Arthritis
Pertinent Physical Exam Findings: Bilateral knees are slightly swollen without erythema or warmth. No tenderness on palpation. Drawer, McMurray, and Lachman tests are negative. The bulge and ballottement signs are also negative. Mild non pitting ankle edema.
Diagnosis: Osteoarthritis
1. Describe the first line nonpharmacological treatment for this patient?
2. Describe all pharmacological options for treating Osteoarthritis.
3. The patient in this scenario is asking the provider for Percocet to manage his pain as it has worked in the past. Discuss your thoughts on this topic and what would your answer to the patient be regarding this request?
4. Discuss strategy for pharmacological management with a patient that has a history of chronic pain and addiction. Include your state laws on Advance Practice Nurses prescribing Opioids in the discussion.
5. Provide the patient with education on your selected first line therapy.
6. Why should Acetaminophen not be recommended in this case? And why?
7. Patients with Osteoarthritis can benefit from Vitamin D and Vitamin C supplementation if they are deficient. What is the rationale for this and what are your recommendations in regard to dosing and follow up labs.
8. NP students: Write a prescription for your recommendation for topical pharmacologic therapy for this patient. Please note insurance may cover other counter medications if the script is provided.
Please include
Goals for pharmacology treatment of Osteoarthritis
First line therapy
Monitoring parameters
Patient education
Side effects of NSAIDS
Provides patient education on the use of narcotic medication for treatment of acute pain and Laws surrounding prescriptive authority related to opioid prescribing.
Alternative therapeutic measures for Osteoarthritis
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