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select one of these two

Discussion Question 1

MP is a sixty-five-year-old male who has recently retired. He is coming in today for a complaint about pain in his back, knees, and hips. He reports that he has been experiencing this pain for the past six months, and he has been able to control the symptoms with OTC Advil. He describes the pain as stiffness and occasional shooting and aching pains radiating all over. He denies any swelling of his joints. However, the OTC medications are not working well, and he is here to see whether there are any other options he might try. On physical exam, he has tenderness on palpation on the right and left hips and both knees are positive for crepitus. All blood work is within normal limits. Answer the following questions:

• What additional information would you like to have? Does MP need any additional testing?
• What possible issues could contribute to his symptoms?
• He asks about injections to both knees to increase his comfort. How would you respond to that?
• What would your treatment plan be?

For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

Discussion Question 2

EP is a twenty-five-year-old African American female who has just moved to town and comes to the clinic for her first visit. She has been diagnosed with fibromyalgia. She reports that her previous primary care physician (PCP) was treating her with opiates only. She has been taking hydrocodone/ibuprofen 7.5 mg/200 mg four times daily but notes that this is not helping her. She is asking you for a refill of this medication and any additional treatment you can advise. On physical exam, she is in moderate distress and reports pain when being touched. Answer the following questions:

• How would you validate the diagnosis of fibromyalgia?
• How would you handle EP’s request for ongoing hydrocodone? Locate any evidence of the efficacy of this treatment for fibromyalgia.
• Assuming that the diagnosis is correct, what would your treatment plan be?
• Would you recommend any nontraditional therapies?

For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

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