Identifying the Migraine Headache
Migraine
Instructions:
It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.
Classroom Participation
Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.
All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.
Discussion Prompt
Scenario:
A 46-year-old white male comes in for evaluation of his migraine headache management.
His medical history is inclusive for hypertension and a myocardial infarction at the age of 39. He was diagnosed with migraine headaches three years ago.
Current medications include Losartan 50 mg a day, verapamil SR 100 mg at bedtime, Carvedilol 25 mg a day, Lipitor 40 mg a day, Topamax 50mg a day
He has been admitted to the hospital for migraine management 3 times over the last 6 months. Inpatient admissions have ranged anywhere from 3 to 6 days. Management strategies utilized during the hospitalization include IV corticosteroids, IV Dilaudid and IV magnesium sulfate.
BP 132/84, P 82, R 15
Skin: pink, warm, dry
Neuro: alert and oriented, CNs II – XII intact
Cardio: radial and pedal pulses 2+, heart regular rate and rhythm without murmur or gallop
Lungs: clear to auscultation
Abdomen: large, non-distended, active bowel sounds all quadrants, non-tender to palpation
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
Initial post
Utilize the information provided in the scenario to create your discussion post.
Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).
Structure your ‘P’ in the following format: [NOTE: if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]
Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional - any other therapies in lieu of pharmacologic intervention]
Educational: health information clients need to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit
Consultation/Collaboration: if appropriate - collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making
Support the interventions outlined in your ‘P’ with scholarly resources.
Please be sure to validate your opinions and ideas with citations and references in APA format.
The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.
Estimated time to complete: 2 hours
Peer Response: Unit 7, Due Sunday by 11:59 pm CT
Migraine
Instructions:
Read the SOAP notes constructed by your course colleagues.
Review the ‘P’s posted by your peers from your advanced practice nursing role perspective – educator, leader or practitioner. From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example - if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the ‘P’, or do you want to comment on the fact that a peer put N/A for educational, etc.?’; if you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the ‘P’, or adherence to the Patient Bill of Rights, etc.?; if you are a nurse practitioner did your peer develop a ‘P’ that aligns with EBP/CPG guidelines and/or the foundational basic sciences, etc.?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Estimated time to complete: 1 hour
Migraine
Student’s Name
Institutional Affiliation
Date
Migraine
Patient:46-year old while male reports for assessment of migraine headache
Subjective Data
Past medical history: hypertension and myocardial infection at the age of 39
Current migraine headache was diagnosed three years ago
Currently on losartan 50mg/day, verapamil SR 100 during bedtime, Lipitor 40mg/day,Carvedilol 25mg/day and Topamax 50mg/day
The previous hospitalization involved admissions of between three to six days, with IV corticosteroids, magnesium sulfate, and IV Dilaudid
Subjective Data
BP 132/84mmhg, pulse 82, and Respiratory rate 15
His skin appears dry, pink, and warm
Neurological examinations: CNS intact, alert, and oriented to time, place, and space
Cardiovascular: pedal and radial pulses 2+, regular heart rate and rhythm, and devoid of gallop or murmurs
Lungs: Clear upon auscultation
Abdomen: appear large and non-distended, active bowel sounds are present, and tenderness upon palpation is absent.
Assessment
Migraine headache should be assessed on different aspects in including chronicity, comorbidities, and health-related concepts of quality of life. In individuals with migraine, the severity of migraine is a crucial determinant of various health outcomes, including patient quality of life and health care resource utilization, where the severity of the migraine amongst patients contribute to adverse socio-demographic, clinical, and psycho-social characteristics (Sajobi et al.,2019). For instance, the patient, in this case, can be assessed based on the economic effect resulting from the use of daily prescription drugs for migraine headaches and hypertension.
Plan
Migraine headache requires a comprehensive, evidence-based, and collaborative management approach. For acute migraine headache therapy, it is critical to avoid opiates and restrict acute medication to 2 days a week, but instead use simple analgesics such as aspirin 900mg or ibuprofen 400–600mg and Triptans such as sumatriptan 50–100 mg, which is the first choice (Chaplin, 2018).
If the patient vomits due to these medications, antiemetics such as metoclopramide 10mg or prochlorperazine 10mg and nasal zolmitriptan or subcutaneous sumatriptan can be...