BCCNM LEARNING MODULE / NURSE PRACTITIONER CONTROLLED DRUGS AND SUBSTANCES / 14
Appl
ying My Learning
Activity
Work through the following case study and questions about Anna, a nurse practitioner working in primary care
clinic. When you’re finished, you may wish to compare your responses with those provided in the “Perspectives”
section at the end of this Workbook.
Case Scenario Part 1
Anna works in a busy primary care clinic, along with another NP and two GPs. She provides care for her own
group of clients, covers for colleagues and sees walk-in clients as well. Anna has practised as an NP for 6 months
and recently obtained prescribing authority for controlled drugs and substances.
Anna’s not familiar with Gerald, her last client of the day, and takes a few minutes to review his chart before
seeing him. She notes he has a history of anxiety, hypertension and chronic back pain due to a car accident three
years ago. She determines that, after an initial, unsuccessful trial of extended release morphine, his pain has
been managed with Fentanyl 50mcg/hr transdermal patch every 72 hours. He’s been on this medication for the
last two and a half years.
Entering the exam room, Anna introduces herself and listens to Gerald explain the reason for his visit. He
reports that he is bothered by increasing anxiety and difficulty focusing. He believes these issues are side
effects of his pain medication. He reports that although his pain is mostly under control, rating it 1-2 on a scale
of 10, he expresses that his daily activities are increasingly affected and he needs to do something..
After asking Gerald a few more questions about his medical history, Anna conducts a full assessment, focusing
on pain and management of pain medication symptoms.
Anna gathers some assessment tools including the Canadian Guideline for Safe and Effective Use of Opioids for
Chronic Non-Cancer Pain, Opioid Manager, GAD7, PHQ9 (see the links below).
As she conducts her assessment, she explains each tool’s purpose. As she documents her assessment, she
describes how the data will inform decisions about managing Gerald’s care.
Following the assessment, Gerald asks Anna several questions about his pain management plan and the side
effects he is experiencing. Anna is able to answer most but not all of Gerald questions. She explains that she’d
like to consult with a GP colleague in order to come up with a plan that would meet Gerald’s pain and symptom
management needs. Gerald agrees. While Anna waits for her colleague to arrive, she signs into PharmaNet to
gather a CDS prescriber history for Gerald.
