Patient rounds involve various disciplines coming together to discuss the patient’s condition and coordinate care. They are used as an educational tool and also help keep everyone on the same page when it comes to the treatment plan. The following case is found in the textbook (Pharmacotherapy: Principles and Practices. Chisholm-Burns et al, eds. 5th edition.

McGraw-Hill. New York 2019. ISBN-978-1-260-01944-5; Chapter 34. "Patient encounter"). After reading the assigned chapters, resources identified in Dynamed and Evidence based practice guidelines, please present the case to your peers. This will be your initial post. Please be sure to address all the questions and your responses are well researched and include supporting, evidence based guidelines such those of the WHO, CDC, APS, etc.

You will then provide an evaluation of TWO peer submissions of the same case. These response posts / evaluations shall include a complete response (with references) either endorsing or refuting the post you are evaluating based upon your research and references (including the text). The response posts / evaluations will have one additional step; you will assign a rating to each of your TWO peers initial post using a five star rating system.

5 STARS = Excellent

4 STARS = Above Average 3 STARS = Average

2 STARS = Below Average 1 STAR = Poor

Rate the post by clicking on the number of stars you think the post deserves in the Ratings area of a user's post. You can give a maximum of five stars. [Ratings:

?????]

In essence, you will have three posts total. Your initial post and a two response posts (one for each of two classmates you are grouped with).

Part 1:

HPI: A 78-year-old man who is to undergo a left above the knee amputation due to a limb abscess

PMH: Peripheral artery disease for 18 years; cardiomyopathy, benign prostatic hypertrophy for 13 years

FH: Mother had osteoporosis; father had diabetes SH: Lives with wife; has two grown children

Meds: Aspirin 81mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; pantoprazole 40 mg daily; tamsulosin 0.4 mg daily

Pain Assessment: Patient rates pain as 8 on a scale of 0 to 10.

Based on the type of injury, what type of pain is this patient likely to experience?

What type of pain management regimen would you suggest in the postoperative period? Explain your answer

Part 2:

Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine.

Current Meds: Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.

You would like to convert him to a combination preparation of hydrocodone and APAP for as- needed pain relief.

What dosing regimen would you suggest?

What would your monitoring plan include for this patient? How would you assess pain response?

The patient is concerned about the redness and itching that he developed while on morphine. Would you document this as an allergic reaction?

What other interventions or education may be necessary at this time?