Tag: Patient diagnosis

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Handling a Patient who Constantly Complains about Pain

As nursing students, we are trained on how to care for patients (Grace, 2013). In health care, pain is one of the symptoms that is primarily managed. The pain is of different kinds, various degrees and some of the patients might experience recurring pain or a onetime pain. We as nursing students come across all these patients and are tasked to care for them. As different diseases have different kinds of pains, they are dealt with differently. A migraine is a disease which has severe pain as the primary symptom (Hale & Paauw, 2014).This paper aims to discuss the ways a nursing student can handle a patient who frequently complains about pain.

Event

         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. As with most headaches, he bought a painkiller to help him relieve the pain. However, the pain did not recede but became more specific to one-half of the head. This migraine was pulsing and throbbing, and every time he moved it became even more painful. After a day of pain, he decided not to go to work, as his job involved moving around a lot. 

In addition to the ache, he experienced sharp sensitivity to light. He, therefore, had to resort to staying in places that are relatively darker. He also vomited twice, within twenty-four hours of the migraine, thus eating less as a result. He also learned to predict his headaches, just before the headaches, he would have a visual disturbance and then the severe migraine on one side of the head would start.

His chief complaint, however, was the throbbing headache. I asked him about how frequently he had severe headaches. He informed me that it was a regular thing, and would occur at least once a fortnight. He further told me that the headaches had started while he was quite young, and he had not attributed it to anything other than regular headaches. The reason why he never took his headaches into serious consideration was that he would feel quite well after taking the painkillers.

He further told me that the pain, for him, would last up to a maximum of twelve hours. The recent attack, however, lasted for twenty-four hours and in this case, the pain was throbbing. He noted that even though the previous headaches lasting for less than twelve hours were less painful, they all began just after a bout of vomiting. The regularity and severity of his pain indicated that he was suffering from a migraine (Rolan, 2014).

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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. My diagnosis of the patient was a migraine. I came up with the diagnosis after observing that the headaches were a recurring symptom and that they were unilateral, specific to one side of the head (Stark et al.,).Furthermore, he experienced a bout of vomiting just before the headaches began, and they lasted for between twelve to twenty-four hours. To confirm my diagnosis, I consulted the doctor, who reviewed the patient and asserted the diagnosis.

There are two types of treatment plans for migraine: abortive prescriptions and preventive antibiotics (Lau &Nissen, 2015). Both medications were prescribed 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.

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 ache. 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.

References

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.

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