Event 3: Edna's Follow-Up

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Edna, older lady resting palm on chin

It's been a few weeks, and Edna's back for a follow up visit. She tells Dr. Weiner that the anti-inflammatory shot helped a little bit, but only for a few weeks. Now her pain is back where it was before the shot.

Dr. Weiner asks if physical therapy helped with Edna's pain. Edna says she went a couple times to physical therapy, but doesn't think it's helping.

QUESTION: Edna said physical therapy isn’t helping with her pain. You should suggest which of the following?

Correct
Incorrect

Dr. Weiner's Recommendation on Physical Therapy

Dr. Weiner tells Edna, "It would be a good idea to give it a little bit longer. Remember, you’ve had pain now for quite some time and it’s a process to get better."

"And the other really important thing to remember is that what I want you to mainly focus on, is improving your function, rather than getting rid of your pain. You’re going to continue having some pain, but even though you do have some pain you will be able to function significantly better. Would you be willing to try physical therapy a little bit longer?"

Edna responds that she'd like something to help with the pain.

Dr. Weiner Describes Why Edna Should Continue Physical Therapy

Analgesia Use During Physical Therapy

Edna wants medication to relieve pain as she attempts to improve function through physical therapy.

QUESTION: Edna wants medication to relieve pain as she attempts to improve function through physical therapy. You recommend which of the following?

Incorrect
Correct
Incorrect
Incorrect

QUESTION: Maintaining a constant presence of analgesic (pain relieving) medication can help prevent pain crises. However, which over the counter medication should you avoid prescribing to older adults?

Correct
Correct
Correct

Physical Therapy

Physical therapy is part of Edna's treatment plan. 

QUESTION: Physical therapy is part of Edna’s treatment plan. As a physical therapist, you should be concerned if which of the following occurs?

Correct
Correct
Correct
Incorrect

QUESTION: Additionally, as Edna’s physical therapist, you should be concerned if which of the following occurs?

Correct
Correct
Incorrect

QUESTION: True or false? Physical therapy outcomes can be affected by mood disorders?

Correct
Incorrect

QUESTION: As the physical therapist, what should you do about your concerns about Edna?

Incorrect
Correct
Incorrect

Mood Disorders

QUESTION: During Edna’s next primary care appointment, how can you determine if she suffers from a mood disorder?

Correct
Incorrect
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Depression

As Edna's primary care provider, you've decided to screen Edna for possible mood disorders. The following are screening questions, followed by Edna's response.

(To learn more about screening for mood disorders, visit the "Mood Screening" tab.)

  • Over the past two weeks, how often have you felt little interest or pleasure in doing things?
    • "Most of the time."
  • Over the past two weeks, how often have you felt down, depressed, or hopeless?
    • "At least half the time."

QUESTION: Is Edna depressed, based on her answers to the questions you asked?

Correct
Incorrect

Anxiety

Edna agreed to take an anti-depressant. However, you also want to screen for additional mood disorders, like anxiety. The following are screening questions for anxiety, followed by Edna's response.

(To learn more about screening for mood disorders, visit the "Mood Screening" tab.)

  • Are you afraid being active will make the pain worse?
    • I"'m pretty sure it'll make it worse. In fact, it might actually damage my back. Which is why I haven't been doing anything."
  • Would it be helpful to have someone to be active with?
    • "Yeah, I think so. I mean, I feel very alone living with this pain. And I'm really fearful about my future."

QUESTION: Does Edna exhibit anxiety through fear avoidance behavior, based on her answers to the questions you asked?

Correct
Incorrect

Pain Behavior

QUESTION: You now know about Edna's mood, health history, and physical exam results. Which pain behaviors does Edna display?

Correct
Correct
Correct

QUESTION: Edna said she felt alone. Remember, she just moved to town and she lives by herself. Do you have any recommendations for her?

Incorrect
Incorrect
Correct

 

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