1. How would you handle a patient who constantly complains about pain? (reflective writing)
Using the E.A.R (event, action, result) interview method and your reflective skills provide a written (800 word) summary to this question. You are also required to refer to the criter ion referenced rubric on page 13 of the unit outline. This rubric will also form the basis of your feedback for this assessment item
How to Handle a Patient Who Constantly Complains About Pain
Handling a Patient who complains about Pain
I recently encountered a patient who complained of severe headaches. He said that his headaches began just after a nasty bout of vomiting, which he attributed to spoilt milk. The pain was pulsing and throbbing, and every time he moved it became even more painful. It was specific to one side of the head. He also experienced a sharp sensitivity to light, and a visual disturbance just before the headaches began.
His chief complaint, however, was the throbbing pain, which would occur at least once a fortnight. The headaches would last to a maximum of twelve hours, after which he would feel quite well. The recent attack, however, lasted for twenty-four hours and in this case, the pain was throbbing. The regularity and severity of his pain indicated that he was suffering from a migraine. As a result, he did not go to work, as it involved a lot of movement, resorted to dark places and ate less to reduce the regularity of vomiting.
Action: Diagnosis and Treatment of the Migraine
As I was asking him about his symptoms, I took note of everything he told me to the detail. I noted that the headaches started when he was quite young, and was worsened every time he moved. My diagnosis of the patient was a migraine. I arrived to this conclusion after observing that the headaches were a recurring symptom and had started while he was quite young. To confirm my diagnosis, I consulted the doctor, who asserted the diagnosis.
To reduce the severity of his pain, I advised the patient to reduce the frequency of movement every time he had an attack. As his migraine was accompanied by a sensitivity to light, I advised him to stay in relatively darker places when he had an attack. I advised him against eating less during his attacks, as he did this to prevent more vomiting. Instead, I suggested that he should eat regularly and healthily, to boost his immune system. Enough sleep would also go a long way in reducing the severity of him migraine. Sleep, I informed him, relaxes the mind, hence reducing stress, which could lead to a migraine.
He would also require medication. There are two types of treatment plans for migraine: abortive prescriptions and preventive antibiotics (Lau & Nissen, 2015). Both prescriptions were administered to the patient. The abortive prescriptions would aid to reduce the head pain he was experiencing, and get rid of the accompanying symptoms. The preventive medications would be to reduce the severity and frequency of future migraines. I also warned that the preventive antibiotics might be accompanied by a few side effects. These side effects included nausea, sleepiness, fatigue and a bit of physical weakness (Martin et al., 2014). However, I assured him that the cases of people experiencing these side effects were few.
Biofeedback is another important technique that has been used in the management of patients with migraine. The patient was taught about how to use special equipment so that he can assess and regulate different physical responses that are associated with stress such as muscle tension. The patient was also advised to take meals that are rich in riboflavin such as beef, yoghurt, and spinach as and magnesium such as whole grains and wheat bread which have been shown to be effective in the management of migraines.
I further advised the patient to follow the instructions on the medications to the letter as this was the only way the desired therapy of medications would be achieved. Moreover, the patient was given a phone number where he could call the support team at the health center whenever he had felt something is wrong or had a question regarding his health.
Rolan, (2014) reports that some of the common factors that have been cited to trigger the onset of migraines include fatigue, lack of sleep, certain foods, as well as use of medications especially the vasodilators which increase blood flow to the brain. I therefore made it clear to the patient that it is of great importance for him to stay away from these triggers. Moreover, I encouraged the patient to have a daily diary where he can document the sequence of his headaches. This is an inexpensive as well as effective tool the will be useful in following up the course of the patient’s condition.
Result: The Patient after Treatment
The patient before treatment was experiencing difficulty with movement and had stayed home from work as his job included a lot of movement. After treatment, he was able to move comfortably without experiencing debilitating pain. His sensitivity to light reduced and he became once more comfortable enough to stay in a well-lit room. He was more relieved by the fact that he no longer felt the excruciating throbbing pain to one side of the head. The preventive drugs that were given to him reduced the occurrence of the headaches he felt were normal, and the severity of pain during one of the attacks was also reduced.
|Hale, N., & Paauw, D. S. (2014). Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. Medical Clinics of North America, 98(3), 505-527. Lau, E., &Nissen, L. (2015). Nausea associated with migraines. Australian Journal of Pharmacy. Martin, P. R., Reece, J., Callan, M., MacLeod, C., Kaur, A., Gregg, K., &Goadsby, P. J. (2014). Behavioral management of the triggers of recurrent headache: a randomized controlled trial. Behaviour research and therapy, 61, 1-11. Silberstein, S. D. (2016). Considerations for management of migraine symptoms in the primary care setting. Postgraduate medicine, 128(5), 523-537. Rolan, P. E. (2014). Understanding the pharmacology of headache. Current opinion in pharmacology, 14, 30-33. Stark, R. J., Ravishankar, K., Siow, H. C., Lee, K. S., Pepperle,R., & Wang, S. J. (2013). Chronic migraine and chronic dailheadache in the Asia-Pacific region: a systematic review. Cephalalgia, 33(4), 266-283. Pietrobon, D., & Moskowitz, M. A. (2013). Pathophysiology of migraine.Annual review of physiology, 75, 365-391|