I only need 150 words in a peer review form. See attached for information of the review.
ASSESSMENT 3 (Peer-Review) Case study number: Your name: Your ID: Section A (highlight or bold your response) 1. Overall structure (select one): • Unclear • Vague • Organised • Very well structured 2. Demonstrates good theoretical knowledge on the problem presented (select one): • Poor • Fair • Good • Very Good • Excellent 3. Contains relevant information showing insight in the problem. The solution offered is based on theoretical background and scientific analysis (select one): • Poor • Fair • Good • Very Good • Excellent 4. Shows ability to plan and complete all parts of a written report that fit into the requirements of reporting the case (select one): • Poor • Fair • Good • Very Good • Excellent 5. Meets the standards of technical writing (select one): • Poor • Fair • Good • Very Good • Excellent 6. Your overall impression (select one): • Poor • Fair • Good • Very Good • Excellent 7. General aspects of the report (select only if apply): • Too hurriedly written • Report not set out in formal order • Poor spelling • Poor grammar • Difficult to follow arguments: muddled, disorganized Section B Personal comments/considerations (200 – 250 words) Question 1. Underlying conditions, mental state and current medications may change the effectiveness of analgesia. When a person is usually regularly active, and pain is limiting physical activity and ability to work they may display behavioural and physical symptoms related to their pain. A person may become depressed, agitated, withdrawn, sleep deprived and reluctant to seek help due to fear. Other signs may also include grimacing, sweating and inability to concentrate or sit still. (Ali et al., 2018) Elderly people have a somewhat altered pain threshold in comparison to younger adults. There are multiple aspects to consider. An elderly person may have a decreased tolerance to medications, NSAIDS may not be as effective due to decreased renal function causing the medication to metabolise and absorb at a slower rate, making the medication less effective for the patient. Other risks for an elderly person taking NSAID medications are Gastrointestinal problems such as gastric ulcers. There are also cardiovascular risks involved including myocardial infarction and risk for thrombosis.(Park et al., 2012) Another factor may also be multiple medications. Current medications must be considered to reduce the risk of contraindications. Thorough assessment including looking at current medications and co- morbidities are required to ensure appropriate and effective pain relief.(Reid et al., 2015) NSAIDS may be effective pain management however this takes careful consideration. Question 2 Bob has already expressed that NSAIDs have not been working in relieving his pain effectively and given there are many adverse effects with NSAID use in the elderly they can be ruled out in this case.(Reid et al., 2015) Careful consideration and comprehensive assessment of Bob should be made prior to selecting an appropriate analgesia to ensure the best possible outcomes. Use of the Analgesic pain ladder would suggest that the first step would be to commence the patient on a non- opioid analgesic such as paracetamol along with an adjuvant analgesic such as Pregabalin or Gabapentin. Paracetamol is a simple analgesia and known to be an effective treatment if taken in conjunction with other analgesics. Adjuvant analgesics are commonly used in the treatment of bone pain and are known to be effective in treating neuropathic pain.(Tredgett, 2020) Further to this a strong opioid analgesic such as Fentanyl in the form of a long acting transdermal patch would be an appropriate choice. Fentanyl is commonly used in elderly patients as it is considered a safer option in terms of protecting liver and renal function. Commencing on low dose and monitoring all new medications closely is imperative. This will allow titration to achieve effective pain relief. Monitoring closely will also ensure there are no adverse effects. The most common adverse effects of opioid analgesics are nausea and constipation. To ensure some of the treatable adverse effects are controlled, the patient may need to commence taking a stool softener regularly and an anti-emetic to treat nausea. (Ghosh & Berger, 2014) References Ali, A., Arif, A. W., Bhan, C., Kumar, D., Malik, M. B., Sayyed, Z., Akhtar, K. H., & Ahmad, M. Q. (2018). Managing Chronic Pain in the Elderly: An Overview of the Recent Therapeutic Advancements. Cureus. https://doi.org/10.7759/cureus.3293 Ghosh, A., & Berger, A. (2014). Opioids, adjuvants, and interventional options for pain management of symptomatic metastases. Annals of Palliative Medicine, 3(3), 172–17291. https://doi.org/10.3978/j.issn.2224-5820.2014.07.07 Park, K. E., Qin, Y., & Bavry, A. A. (2012). Nonsteroidal anti-inflammatory drugs and their effects in the elderly. Aging Health, 8(2), 167–177. https://doi.org/10.2217/ahe.12.6 Reid, M. C., Eccleston, C., & Pillemer, K. (2015). Management of chronic pain in older adults. In BMJ (Online) (Vol. 350). BMJ Publishing Group. https://doi.org/10.1136/bmj.h532 Tredgett, K. M. (2020). Pain control in palliative care. Medicine, 48(1), 2–8. https://doi.org/10.1016/j.mpmed.2019.10.003 Question 1. Question 2 References NUR231 Assessment 2: Case Study Bob, a 67-year-old school janitor presented to his GP with lower back pain. He informed his GP that he has been generally active, walking and cycling regularly but his lower back pain has started to restrict these activities lately, in addition to affecting his daily job. Upon questioning, Bob related that the lower pain has been there for the last 2 months and has gradually become more severe. On physical examination, there was acute tenderness over T12–L1. There were no other clinical signs. The GP was unsure of the origin of the lower back pain and prescribed a non-steroidal anti-inflammatory medication to be taken when he experienced pain. Bob saw his GP one week later and complained of worsening pain. The GP referred him to a rheumatologist. The rheumatologist advised Bob to have magnetic resonance imaging (MRI) of the spine. Two weeks later MRI scan was done, and the report showed metastatic lesions in thoracic and lumbar vertebrae. Bob received a call from the clinic to come for an immediate consultation. Please answer the following TWO questions: 1. What happens to pain threshold and behavioural response to pain in the older people and discuss briefly the effectiveness of NSAIDS for pain management in elderly. (150 words approx.) 2. Following the MRI report, and the pain being persistent, which analgesics should be prescribed to Bob? Support your answer with evidence. (250 words approx.) GENERAL GUIDELINES ON HOW TO WRITE YOUR ASSIGNMENT 1. The maximum word limit for this assignment is 400, this does not include references. 2. This assignment must be submitted via safe assign on Learnline. 3. No other form of submission is acceptable including email, hand delivery or post. 4. It is advised to have a foot note on your assessment containing your name, student number and unit code. No COVER SHEET REQUIRED for Safe assign submission as per CDU policy. 5. Please click on assessment details where it says, “click on the above link to submit your assignment”. Please note there is NO DRAFT SUBMISSION for this assignment. 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