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Reply the following discussion, at least 150 words, APA style, No IA, Turnitin less than 20%, 2 reference or more 

The opioid crisis in the United States has significantly influenced the approach to managing chronic pain by clinicians, including advanced practice nurses (Coffee et al., 2024). Initially considered one of the essential elements of pain management, opioids are now being questioned for their addictive and deadly impact. For advanced nursing practice pharmacology students, understanding how to reduce pain without causing more harm is paramount. Hence, compelling and successful chronic pain management involves a comprehensive, evidence-based approach. This approach is patient-centered, with an emphasis on safety, performance, and conservative medication use.

This context aims to explore chronic pain, which is pain that lasts for more than three months or beyond the normal recovery period. This type of pain (chronic pain) affects millions of Americans and poses significant physical, emotional, and socioeconomic burdens. Opioids, while effective for acute and cancer-related pain, present numerous challenges when used in the long term for non-malignant chronic pain (Nadeau, Wu & Lawhern, 2021). However, liberal prescribing practices for opioids for pain over the last two decades have been associated with increased cases of misuse, addiction, overdoses, and deaths, leading to a national public health crisis.

An initial and fundamental step in the management of chronic pain involves a thorough assessment of the patient. This encompasses pain history, functional impairment, treatment history, psychiatric profile, and factors associated with substance use disorder. Validated screening tools such as the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) can be used to assess those with a higher risk (Esteve et al., 2022).

Prescribing opioids must adhere to the rule “lowest effective dose for the shortest possible duration.” Initial prescriptions should favor immediate-release formulations over extended-release options. Moreover, treatment goals should be clearly defined in terms of both pain relief and functional improvement. The CDC guidelines stress that the goals are attainable, the potential risks and benefits are communicated to the patient, and that informed consent is necessary.

Non-opioid and Non-Pharmacologic Approaches

Advanced practice nurses ought to possess a comprehensive knowledge of pain management procedures. Non-opioid pharmacologic therapies—such as acetaminophen, NSAIDs, certain antidepressants (for example, duloxetine), and anticonvulsants (for example, gabapentin, pregabalin)—can offer significant relief, particularly for neuropathic and musculoskeletal pain syndromes (Ayub et al., 2024).

Equally important are non-pharmacologic interventions. Pain treatment involves cognitive behavioral therapy (CBT), physical therapy, acupuncture, mindfulness-based stress reduction, and other integrative therapies, which have proven to be effective in alleviating pain and enhancing the quality of life. A biopsychosocial model of pain that incorporates pharmacological treatment, as well as psychological and social interventions, is considered optimal. In this model, the patients are treated by a team of doctors, APNs, psychologists, physiotherapists, and social workers.

Preventing opioid misuse and overdose is a moral and clinical imperative. For patients at increased risk, such as those on high-dose opioids or those using concomitant benzodiazepines, who might experience respiratory depression, it is recommended that naloxone, an opioid antagonist, be prescribed simultaneously. Additional education about proper storage and disposal of unused medication and the signs of overdose is another way to empower patients and families.

The prescription of opioids has legal and ethical implications that are pretty profound. Advanced practice nurses must keep up with federal or state laws and policies on the use of controlled substances as well as other standards of professional practice. Documentation should be clear and cover the treatments’ rationale, patient counseling and consent, and follow-up care.

Navigating the complexities of chronic pain management in the context of the opioid epidemic requires a multifaceted, patient-centered approach. Hence, pharmacology in an advanced nursing practice requires a more profound knowledge of pain and its mechanisms, opioids and how they work, and the science behind addiction. 

Powerpoint with speaker notes

https://www.pechakucha.com/presentations/ramonas-presentation-336-3027

Application of Course Knowledge: Type 2 Diabetes Mellitus (T2DM)

Type 2 Diabetes is a condition where the body doesn’t use insulin properly or doesn’t make enough of it. Insulin is what helps sugar move out of the blood and into the cells to be used as energy. When the body becomes resistant to insulin or isn’t making enough, sugar builds up in the blood (Galicia-Garcia et al., 2020; Mayo Clinic, n.d.). This buildup in the blood vessels can lead to several health complications, including atherosclerosis, which increases the risk for cardiovascular disease.

Over time, high blood sugar can cause damage to major organs—especially the heart, kidneys, eyes, and nerves. Some of the early signs of Type 2 Diabetes include drinking a lot of water, peeing more than usual, blurry vision, feeling really tired, and getting infections more easily—particularly urinary tract infections (Mayo Clinic, n.d.).

In Bayani’s case, the signs are definitely pointing toward something like Type 2 Diabetes. His wife says he’s been drinking a lot of water and using the bathroom more, which are both classic symptoms. She also mentioned that his urine smells bad, and she’s concerned about a UTI. That’s a valid concern—people with diabetes often get UTIs because the sugar in their urine creates a perfect environment for bacteria to grow. His confusion could also be from dehydration or elevated blood sugar levels (Galicia-Garcia et al., 2020).

Based on all these symptoms, Type 2 Diabetes is a possible cause.

Diagnostic Tests

To evaluate Bayani and investigate Type 2 Diabetes, I would recommend the following tests:

• Fasting blood glucose – A result of 126 mg/dL or higher supports a diabetes diagnosis.
• Hemoglobin A1c – Reflects average blood sugar over the past 2–3 months. A level of 6.5% or higher confirms the diagnosis.
• Random blood glucose – A value over 200 mg/dL with symptoms is also diagnostic.
• Urinalysis – To check for glucose in the urine and any signs of infection.
• Urine culture – To identify bacteria and confirm a UTI.
• Basic metabolic panel (BMP) – To evaluate kidney function and hydration status.

If Bayani has Type 2 Diabetes, we would expect to see high blood glucose, sugar in the urine, and possibly signs of infection.

References:

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275Links to an external site.

Mayo Clinic. (n.d.). Type 2 diabetes – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

 Reply the following discussion in APA style, No IA, use 150 words or more, Turnitin less than 20 %, 2 or more references.

The opioid epidemic has significantly impacted healthcare practices in the United States, highlighting the importance of safe and effective chronic pain management. Advanced practice nurses (APNs) must balance the necessity of treating chronic pain with the responsibility of minimizing the risks of opioid misuse, dependence, and overdose. To achieve this, evidence-based strategies are vital in clinical decision-making.

A comprehensive, multimodal approach is recommended for chronic pain treatment. Non-pharmacologic and non-opioid pharmacologic therapies should be prioritized when possible, including physical therapy, cognitive-behavioral therapy, acetaminophen, NSAIDs, and antidepressants. When opioids are deemed necessary, they should be prescribed at the lowest effective dose, with a preference for immediate-release formulations over extended-release versions (Centers for Disease Control and Prevention [CDC], 2022).

Before initiating opioid therapy, clinicians should perform a thorough patient assessment, including pain history, functional goals, psychological status, and risk factors for opioid misuse. Educating patients about the risks and benefits of opioid therapy is essential, as is obtaining informed consent. Treatment agreements and periodic reassessment help promote accountability and safety. The use of Prescription Drug Monitoring Programs (PDMPs) and urine drug screening are effective tools for monitoring adherence and detecting potential misuse (Dowell et al., 2022).

Ongoing monitoring and follow-up are crucial. Providers should regularly evaluate the patient’s progress toward functional goals, assess side effects, and watch for signs of misuse or opioid use disorder. If opioids are not providing meaningful improvement in function or quality of life, tapering or discontinuation should be considered, with support and alternative therapies offered.

In conclusion, safe opioid prescribing requires a patient-centered, evidence-based approach that includes careful assessment, risk mitigation strategies, and continuous monitoring. APNs are in a pivotal position to lead these efforts and advocate for responsible pain management practices that prioritize both relief and safety.

References

Centers for Disease Control and Prevention. (2022). CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. U.S. Department of Health and Human Services. https://www.cdc.gov/opioids/guideline/index.html

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., Chou, R., & Duong, N. (2022). CDC guideline for prescribing opioids for chronic pain — United States, 2022. Morbidity and Mortality Weekly Report, 71(3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1

Discuss the underlying pathophysiological mechanisms of your assigned disease process. Which clinical manifestations observed in Bayani’s case could be explained by the pathophysiological mechanisms? 

Cirrhosis can have multiple etiologies including hepatitis, metabolic syndrome (nonalcoholic fatty liver disease), and alcohol abuse over a long period of time (Mayo Clinic, 2025). Cirrhosis is the process of the liver being injured and forming scar tissue, which then impairs it’s function (Mayo Clinic, 2025).

Analyze Bayani’s clinical manifestations in the context of your assigned disease process. Do these findings support a diagnosis of your assigned disease process? Why or why not?  

Bayani’s clinical manifestations of abdominal pain and altered mental status are consistent with cirrhosis; however, most of his symptoms are not related to cirrhosis. Clients with cirrhosis usually have ascites, which would make their abdomen appear taut and distended, rather than soft and non-distended. Additionally, frequent urination, foul smelling urine, and drinking more water than usual are not common findings in cirrhosis, but rather diabetes and a UTI as evidenced by the increased water intake, foul smelling urine, and frequent urination. Patients with diabetes are more likely to develop urinary tract infections and experience complications related to urinary tract infection (Ahmed et al., 2023).

Identify and justify the diagnostic tests (including labs, imaging, or other diagnostic tests) that would be most appropriate for investigating a diagnosis of your assigned disease process in Bayani. What could the results of these tests look like in your assigned disease process? 

Diagnostics for cirrhosis include labs for liver function, including alanine aminotransferase, aspartame aminotransferase, and Y-galactosyltransferase which would all be elevated (Rogers & Brashers, 2023). You would also expect elevated bilirubin levels. In a patient with cirrhosis, you would anticipate decreased levels of albumin and longer prothrombin times (Rogers & Brashers, 2023). A liver biopsy can be done if needed to confirm cirrhosis; however, it is invasive and not always necessary (Rogers & Brashers, 2023). While these tests are appropriate for a patient with suspected cirrhosis, they do not seem appropriate for Bayani, as his clinical manifestations do not align with cirrhosis.

References

Ahmed, A. E., Abdelkarim, S., Zenida, M., Baiti, M. A., Alhazmi, A. A., Alfaifi, B. A., Majrabi, R. Q., Khormi, N. Q., Hakami, A. A., Alqaari, R. A., Alhasani, R. A., Alajam, R. A., Alshehri, M. M., Alenazi, A. M., Alqahtani, B., Alshamrani, M., Alhowimel, A., & Abdelwahab, S. I. (2023). Prevalence and associated risk factors of urinary tract infection among diabetic patients: A cross-sectional study. Healthcare, 11(6), 861. https://doi.org/10.3390/healthcare11060861

Mayo Foundation for Medical Education and Research. (2025, February 22). Cirrhosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

Rogers, J. L., & Brashers, V. L. (2023). McCance & Huether’s pathophysiology: The biologic basis for disease in adults and children. Elsevier.

The opioid epidemic in the United States has raised critical concerns about the appropriate use of opioids for chronic pain management. As advanced nursing practice pharmacology students, understanding the risks, benefits, and evidence-based strategies is essential. How to safely approach chronic pain patients while minimizing the potential for opioid misuse and overdose?

Every student must provide a substantive response to the topic of the discussion 

APA format is mandatory. At least 3 appropriate references should be used. No “IA” 

Post at least 350 words.

Turnitin less than 20 %

PLEASE READ THE ATTACHED FILE. 500 WORDS