NUR 634 Topic 12 DQ 2

Discussion: A 53-year-old male presents to you with a 4-week history of low back pain. He does not have an identified traumatic event.

NUR 634 Topic 12 DQ 2 Assessment Description

A 53-year-old male presents to you with a 4-week history of low back pain. He does not have an identified traumatic event. He requests something for pain. He has history of alcohol abuse but has abstained for 5 years. He has a 25-pack-year smoking history and is a current smoker. He takes fluoxetine 20 mg po daily for depression.

How would you use the Opioid Risk Tool resource to determine his risk for opioid abuse?

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NUR 634 Topic 12 DQ 2 How would you counsel him regarding treating his pain and maintaining overall health?

Refer to the Bates’ Communication and Interpersonal Skills video number 27 on Motivational Interviewing (MI), discuss how you could use Motivational Interviewing to foster a change in behavior for this patient.

Support your response with a minimum of two APRN-approved scholarly resources.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 1.3.

NUR 634 Topic 12 DQ 2 Sample

A 53-year-old male presents with a four-week history of low back pain but lacks an identified traumatic event. He requests something for pain. He has a history of alcohol abuse but has abstained for five years. He also has a 25-pack-year smoking history, is a current smoker, and takes fluoxetine 20 mg PO daily for depression. I would use the opioid risk tool (ORT) to determine the patient’s risk for opioid abuse (Keall et al., 2022). The screening tool has several questions that inquire about family and personal history of substance use, age of the patient, history of preadolescent sexual abuse, and psychological diseases such as bipolar, depression, and schizophrenia. Using the ORT screening tool, the patient would have scored a nine, which would indicate he is at a high risk of opioid abuse.

To provide quality care to this patient, I would educate him about opioids and why he is at high risk for opioid abuse. I would then recommend exercises, physiotherapy, yoga, chiropractic medicine, and massage therapy as a complementary therapy for his pain (Cho et al., 2021). NUR 634 Topic 12 DQ 2 I would advise the patient to avoid extraneous activities that worsen back pain. If any medications are needed, I would prescribe acetaminophen or NSAIDs such as diclofenac and ketorolac to help in pain management. In addition, I would advise him on smoking cessation and inform him of appropriate programs he can enroll in to ease the cessation journey. I would also reinforce psychotherapy for his depression and encourage follow-up visits.

Motivational interviewing (MI) aims to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring an individual’s reasons for change. For this patient, I would use open-ended questions that draw out and explore the person’s experiences, perspectives, and ideas (Bischof et al., 2021). I would empathetically affirm the patient’s strengths, efforts, and past successes to help him build hope and confidence in his ability to change. In addition, I would also support the patient to consolidate the commitment to change and develop a plan based on evidence-based expertise.

NUR 634 Topic 12 DQ 2 References

Bischof, G., Bischof, A., & Rumpf, J. (2021). Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice. Deutsches ÄRzteblatt International, 118(7), 109-115. https://doi.org/10.3238/arztebl.m2021.0014

Cho, H., Arya, A., & Fernandez, J. A. (2021). Complementary and Alternative Medicine’s Effectiveness in Reducing High-Impact Chronic Pain and Opioid Consumption: A Case Report in the Veteran Population. Integrative Medicine: A Clinician’s Journal, 20(2), 26-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325491/

Keall, R., Keall, P., Kiani, C., Luckett, T., McNeill, R., & Lovell, M. (2022). A systematic review of assessment approaches to predict opioid misuse in people with cancer. Supportive Care in Cancer, 30(7), 5645-5658. https://doi.org/10.1007/s00520-022-06895-w NUR 634 Topic 12 DQ 2