Reply to my peers Peer 1 Tylenol (Acetaminophen) would be my recommended first line of therapy if a patient is unable to take NSAIDs due to adverse reaction like GI Bleed (CDC, 2020). Evidence shows that non-opioid treatments like acetaminophen or ibuprofen can be more effective than opioids in managing pain (CDC, 2020). According to the American College of Occupational and environmental medicine practice guidelines (2017), it is not recommended to start patients on opioids for minor injuries like sprains or strains. Tylenol (Acetaminophen) extra strength 500mg 1 to 2 tabs every 8 hours as needed for pain NOT to exceed 3grams in a 24-hour period. Also educate patient on RICE: Rest, Ice, Compression and Elevation for the first 2 days. Ice should be rotated 20 mins on and 20 mins off to prevent decrease in circulation to affected area. Place Affected ankle in brace or ankle stirrup and place patient on light duty or even off work for at least a week. F/u is needed to assess injury- swelling and pain. DO NOT take more than Rx due to risk of Liver damage and overdose of Tylenol. Educate patient not to exceed more than 3 grams of Tylenol in a 24-hour period. (do not take more than 6 pills of Tylenol extra strength in 24 hours). Monitor for discoloration to Right ankle (different than normal bruising). Numbness or tingling, increased pain that is different than the pain patient has been feeling. Contact Office of NP immediately. s/s of decreased CMS. Age influences choice of medication in opioid uses due to likelihood of long-term addiction and misuse (Hudgins et al., 2019). Young adults are more likely to likelihood to misuse opioids and use along with other substances like ETOH (Hudgins et al., 2019). NP should educate patient while opioids are not being Rx- studies show opioid use is only 30% effective in pain management and long-term addiction is always a risk. CDC recommendation is not to Rx Opioids for minor injuries that have shown effective treatment with NSAIDs or Tylenol. “Opioids provide an average of 20-30% pain relief when used for pain lasting less than 3 months” (CDC, 2020). Reference: Reference: Centers for Disease Control and Prevention. (2020, May 1
1). . Centers for Disease Control and Prevention. Retrieved October 4, 2021, from https://www.cdc.gov/acute-pain/ankle-sprain/index.html. Hudgins, J. D., Porter, J. J., Monuteaux, M. C., & Bourgeois, F. T. (2019, November 5). . PLOS Medicine. Retrieved October 4, 2021, from https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002922. Peer 2 An ankle sprain can result when the ankle is positioned in an unstable way, and this causes the ligaments to overstretch. Sprains are classified as Grade I, Grade II, and Grade III. Tom has a Grade I sprain, a partial tear, no instability or opening of the joint on stress maneuvers (Lynne M. Hektor Dunphy et al., 2019). Tom’s treatment plan will be to treat the symptoms. PRICE is implemented, Protect and Rest the affected part, apply Ice for 48 hours, Compression (Ace wrap bandage), and Elevation (Lynne M. Hektor Dunphy et al., 2019). NSAIDs are the first-line choice for pain relief. Ibuprofen is the drug of choice that I would prescribe. Ibuprofen is not only an analgesic but also an anti-inflammatory drug. Ibuprofen 400mg by mouth TID for pain and inflammation (Woo, 2019). Metabolized: Liver Excreted: Urine Half-life: 2-4 hours Patient education would include taking with meals or milk to reduce adverse GI reactions. Seek medical attention immediately if chest pain, shortness of breath or trouble breathing, weakness in one side of the body, or slurred speech occurs (Lippincott Williams & Wilkins & Lippincott Williams & Wilkins, 2021). Also, the patient should avoid using any other NSAIDs in combination while taking Ibuprofen to prevent potential bleeding complications. Patients should also wear sunscreen and avoid sunlight. Patients should also avoid alcohol. Tom is a healthy 26-year-old male so, his age would not influence my choice. If he were an elderly man on medications that included NSAIDS, his treatment would be affected by those factors. Lippincott Williams & Wilkins & Lippincott Williams & Wilkins. (2021). (42nd ed.). Wolters Kluwer Health. Lynne M. Hektor Dunphy, Winland-brown, J. E., Porter, B. O., & Thomas, D. J. (2019). (5th ed.). F.a. Davis,. Woo, T. M. (2019). (5th ed.). F. A. Davis Company.