A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife’s reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However, the spermatic cord on the left has the feel of a ‘bag of worms’. Laboratory studies show oligospermia. Which of the following conditions is this man most likely to have? Explain your answer.

A Hydrocele

B Testicular torsion

C Spermatocele

D Varicocele

E Seminoma

Discussion related to the management of chronic pain for the patient in the listed case study.

Case Study Scenario

Rhonda, a 37-year-old white female, states that she transferred her care to you because she is dissatisfied with her previous primary care provider. She describes constant pain in her neck, shoulders, arms, knees, and ankles that started about 5 years ago. Sometimes her skin hurts, and her muscles ache frequently. She recovered from numerous fractures sustained in a motor vehicle accident nearly 8 years ago. She is unable to exercise owing to pain and fatigue. She is employed as a bank teller, but has missed work frequently. She has used up all of her vacation time, and is afraid that she will lose her job if she continues to call in sick. She is unable to keep up with household duties, enlisting the help of her husband. Her teenage daughter has recently been failing in school, adding to her overall stress level. She smokes one pack of cigarettes a day and drinks two glasses of wine after work. She often purchases fast food for dinner. She has frequent heartburn and non-restful, insufficient sleep. She stays in bed up to 20 hours per day on the weekends. She has become isolated from family and friends over the past year.

Current drugs include amitriptyline (Elavil) 75 mg at bedtime and ibuprofen 400 mg every 8 hours prn pain. Upon review of the patient history form, she had written voluminous notes describing her history, pain, and associated symptoms, filling in all margins of the forms.

Assessment

Physical examination revealed 11/18 pairs of tender points. She was anxious and unable to sit during the interview. She meets the diagnostic criteria for major depression and anxiety. The remainder of the examination was normal. Initial assessment included myofascial pain and anxiety/depression. Amitriptyline, the first-line drug treatment for fibromyalgia is, by her report, failing. Sleep is poor, and she is anxious and depressed. Functional status is poor in physical, psychosocial, social , and vocational.

For the Discussion (Include the corresponding number below as you respond in your initial post):

1. What non-pharmacologic and pharmacologic (controlled and noncontrolled drugs) treatment plan will you prescribe to the scenario?
2. Give the rationale why you chose certain treatment plans and not others.
3. Provide the follow up plan for the patient and why you made the decision.

Advanced Pharmacology

Reflection

Please discuss 3 things you have learned throughout this course.

Spirituality is much valued in the profession of nursing. As such, this means that nurses must be able to recognize and evaluate the spiritual needs of their patients. To accomplish this goal, nurses must be familiar with various tools used to evaluate patients’ spiritual needs. The first tool can be interviewing the patient is the first step in determining their spiritual needs. Also the nurse can gain a deeper understanding of the patient’s spiritual beliefs, practices, and values by conversing with the patient (Demmrich & Huber, 2019). The patient’s understanding on what is their relationship with God and their participation in spiritual practices such as prayer, meditation, and rituals, are some possible questions to address. As a result, the nurse can in a better way understand the patient’s spiritual needs thus aiding them.

The second most commonly used tool is an assessment questionnaire for the patient’s spiritual needs. According to Bussing (2021) questionnaire inquiries aim to ascertain the patient’s spiritual beliefs and the guiding principles and actions that reflect those beliefs. The purpose of the questions is to determine the patient’s sense of purpose and direction in life with their views regards to the existence of a higher power, the afterlife, and spiritual pursuits. These questions can give the nurses important information on the patient’s spiritual well-being, enabling them to offer the patient the necessary treatment possible. The spiritual care plan is the third method for assessing a patient’s spiritual requirements. These requirements and goals are laid out in writing in this plan, along with a procedure for meeting those needs. Nissen et al. (2021) states that the method involves a plan that patients can use to accomplish their spiritual goals. Also the plan should contain a list of the patient’s spiritual assets and weaknesses which increases the possibility that the patient’s spiritual needs will be met, making monitoring the patient’s spiritual well-being simple. The final approach that can be used to determine whether a patient has any spiritual needs is spiritual treatment. Counseling and assistance are required to understand and treat the patient’s spiritual issues effectively. Through the counseling session, the nurse can assist the patient in developing resilience and coping mechanisms and acquiring an understanding of their spiritual beliefs, values, and practices.

In conclusion, various techniques can be applied to assess a patient’s spiritual needs, including spiritual care plans, spiritual treatment, spiritual evaluation surveys or the use of questionnaire, and interviews. By utilizing these resources, nurses may get a deeper understanding of their patient’s spiritual health and ensure that their patients’ spiritual requirements are met.