Pain Management

Ripley Walker is a 57-year-old attorney referred to you by his primary care physician (PCP) for treatment of depression. He has been depressed for approximately eight months, since the death of his wife from breast cancer. He feels the depression is worsening. Ripley reports having problems with decreased appetite, poor sleep, and anhedonia. His PCP prescribed paroxetine three months ago, but Ripley hasn’t noticed much improvement in his symptoms—even at a dose of 50 mg/d.

Ripley reports that he takes tramadol regularly for low back pain. He has had chronic low back pain since an automobile accident 20 years ago. He had taken ibuprofen or naproxen for the back pain with some relief, but he began having epigastric distress about two years ago when using these. At the time, his PCP recommended discontinuing them. Once he stopped taking the NSAIDs, the epigastric distress resolved.

Questions
From your perspective as Ripley’s psychiatric nurse practitioner, answer the following questions in a paper no longer than two double-spaced pages (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

What assessment questions should you ask Ripley?
When you ask about his back pain, Ripley replies that he is willing to talk about it but doesn’t see how it’s relevant to the depression he came in for. How do you respond to Ripley?
You decide that a trial of a different antidepressant is indicated. Which would be the best choice? Why?
Ripley mentions that, to help him sleep, he had taken diazepam that his wife had been prescribed during her terminal illness. He asked his PCP to prescribe diazepam for him, but she was hesitant and suggested he discuss this with you. How should you proceed?
You consider prescribing pain medication. Select a pain medication appropriate for Ripley. What is the mechanism of action of this medication? How does it relieve pain (that is, how does it interact with the function and structure of the nervous system relative to pain)?
Select a controlled pain medication appropriate for Ripley (it can be the same as you chose in the prior question). Explain the FDA regulations and legal ramifications of prescribing this controlled pain medication for Ripley.

 

Sample Solution

 

 

Seamus Heaney’s Poems

Seamus Heaney’s writer Heaney was conceived on April 13, 1939. He is the biggest of nine youngsters. In current society, typically there are 2 to 3 youngsters, 8 to 9 kids are viewed as bizarre. Heaney lives in Mossbawn family ranch around 30 miles northwest of Belfast in Delhi. The vast majority of UK occupants live in urban territories and few inhabitants live in provincial regions. In country territories it was progressively mainstream and lived. Individuals in rustic territories live in a culture totally not quite the same as the individuals in the industrialized regions of the city.

Conversation sonnet Seamus Heaney ‘s naturalist and individual Helicon’ s demise are both verse encompassing Seamus Heaney ‘s youth. In the two stanzas, the peruser is educated about the memory of Heaney as a kid and his developing memory as he develops, and a superior comprehension of his environmental factors from the grown-up’s perspective. This article inspects and assesses how grown-ups can be molded from their youth experience and delineates his own feelings and issues Seamus Heaney drives him to an incredible phase We will examine what to use for. I anticipated it from his kid’s viewpoint, and when he composed a sonnet.

Investigate Seamus Heaney, an artist with two kids’ topics. Examination and Comparison of Two Children’s Theme Poems After looking at Seamus Heaney’s “Demise of Naturalism” with four sonnets, I think about and analyze two most loved sonnets “The Death of Naturalism” I made it. “Also, devotees” These are accounts of a youth age in the nation. These mirror Heiny’s emotions about the different parts of life around him. This is one motivation behind why I picked these two sections.

Seamus Heaney’s “exhuming” is the principal sonnet of the main full volume of Heaney’s sonnet, “the passing of naturalism”. “Demise of a naturalist” is about the change to adulthood and the way toward losing guiltlessness. This sonnet shows what Hynie looked like at his dad and granddad, particularly their perseverance. Regardless of whether Heaney didn’t follow their strides however turned into a ranch specialist, he regarded the work they did, particularly the abilities they burrow. This sonnet is a free verse. There are 8 segments and 2 caplets. Now and then it rhymes, however there is no rhyming example. The initial two lines are rhyming with “thumb” and “firearm”, and there are some rhyming words in the subsequent quarter. This sonnet is the narrative of the primary individual, this can be found in the principal line utilizing “my” and in different lines utilizing words, for example, “I” or “us”. As every one of the three ages referenced are burrowing, the title is identified with verse

 

 

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