You’re a new FNP in a restricted state and you’ve got your DEA license and state furnishing for schedule II-V managed substances. You’re working at a busy household observe group and you’ve got a affected person, ML, that’s establishing take care of the primary time along with your observe, and involves you with the next state of affairs:
• ML is a 54 y.o. Hispanic feminine with hx of continual shoulder and again ache that started 10 years in the past when she was in a boating accident
• She lives in each US and Mexico, making common visits throughout the border; currently, she has stayed in US as a result of Covid border crossing constraints, residing together with her daughter’s household
• She had rotator cuff surgical procedure in 2011 and studies to you that as a result of an extended operation and poor positioning, she has suffered from not solely ache, but in addition continual numbness and tingling in her R shoulder
• As “la abuela” (grandma) she is the first caregiver of the youngsters and homemaker for her household and her ache is exacerbated with housekeeping, and particularly with the extended carrying of her grandchildren; considered one of which is 10 m.o.
• At present, her med listing is as follows
o Losartan 50 mg BID for HTN
o Gabapentin 300 mg po BID for ache
o Atorvastatin 40 mg day by day for ldl cholesterol
o Diazepam 5 mg po as much as TID prn ache
o Norco 5/325 mg – takes as much as two, typically as much as Four-5x a day, prn ache
• She is a smoker, solely smokes exterior the home, and drinks 2-Three cans of beer on the weekends, however extra on household celebrations
• Denies leisure medicine and denies previous overdoses
• Just lately moved to CA extra completely to remain to maintain kids throughout Covid/faculty closures
• She asks you to refill all her meds for six months like her physician in Mexico did so she does not should make one other co-pay and are available again and see you so typically; it is laborious for her to get an appointment, and with Covid her daughter has to take off of labor to look at the youngsters simply so she will be able to come to you by bus since there is just one household automotive
• Right here VS are 135/75, 80, 97.5, 20 and PE unremarkable aside from R shoulder examination with ache with ROM, however full ROM, no tenderness, in any other case regular, again examination together with SLR are regular/neg
In 600 or fewer phrases, however a minimal of 250, please describe your method with this affected person. In your paragraphs, embody the next:
• What considerations do you have got about her present routine, and what alternate options will you talk about and provide? What different screenings may you apply? What are your personal moral requirements on this case that you simply may contemplate along with authorized requirements?
• Present a pattern of an acceptable ache contract that might go well with this affected person and tackle her particular security considerations (cite it and fasten the precise contract you discovered – you don’t have to make your personal – there are lots on-line)
• Embrace your steps to make sure secure prescribing. Embrace the registry you’ll search previous to any prescribing; title the CA registry and in case you are in a distinct state, it is best to title that registry additionally.
• In the event you have been to maintain her present listing, what are the legal guidelines surrounding refills and the quantities you’re allowed to dispense with the schedule II and III drugs within the state of CA? In your personal state?
• Which drugs on her listing could you name into the pharmacy and which might you want a written script or digital order? What are some components required to incorporate on the prescription kind (paper or digital signature) for the scheduled drugs?
• After you prescribe, how, when, and the place would you (or your workers) go about making a report of your scheduled prescription within the state registry in order that different prescribers and pharmacies might be conscious?
• In restricted states, APRN prescribers should observe a standardized process or protocol for furnishing schedule II and III managed substances with a patient-specific method. Please define the minimal required parts of a protocol. You might define this in bullet kind. Alternatively, you might discover an acceptable protocol, medical guideline, or standardized process from a literature search and fasten it in lieu of outlining your personal protocol.