{"id":15701,"date":"2020-11-24T09:12:38","date_gmt":"2020-11-24T09:12:38","guid":{"rendered":"http:\/\/onlineclassesguru.com\/index.php\/2020\/11\/24\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/"},"modified":"2020-11-24T09:12:38","modified_gmt":"2020-11-24T09:12:38","slug":"therapy-for-clients-with-pain-and-sleep-wake-disorders","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2020\/11\/24\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/","title":{"rendered":"Therapy for Clients With Pain and Sleep\/Wake Disorders"},"content":{"rendered":"<style type=\"text\/css\"><\/style><h1 id=\"section_container\">Week 7: Therapy for Clients With Pain and Sleep\/Wake Disorders<\/h1>\n<p>From negative changes in mood to problems<br \/>\nconcentrating, pain and sleep\/wake disorders can have a tremendous<br \/>\nimpact on clients\u2019 lives. When clients suffer from these disorders, they<br \/>\noften seek medical care with the intent of receiving medications to<br \/>\nmanage symptoms. However, many of the medications used to treat pain and<br \/>\nsleep\/wake disorders may be addictive, making thorough client<br \/>\nassessments and close follow-up care essential. To prescribe appropriate<br \/>\ntherapies with client safety in mind, you must understand not only the<br \/>\npathophysiology of these disorders, but also the pharmacologic agents<br \/>\nused to treat them.<\/p>\n<p>This week, as you study<br \/>\ntherapies for individuals with pain and sleep\/wake disorders, you<br \/>\nexamine the assessment and treatment of clients with these disorders.<br \/>\nYou also explore ethical and legal implications of these therapies.<\/p>\n<hr class=\"wp-block-separator\" \/>\n<h1 id=\"section_container0\">Discussion: Sleep\/Wake Disorders<\/h1>\n<p>It is not uncommon to experience a night or two<br \/>\nof disrupted sleep when there is something major going on in your life.<br \/>\nHowever, sleep\/wake disorders are much more than an occasional night of<br \/>\ndisrupted sleep. A recent report from the Centers for Disease Control<br \/>\nand Prevention estimated that between 50 and 70 million American have<br \/>\nproblems with sleep\/wake disorders (CDC, 2015). Although the vast<br \/>\nmajority of Americans will visit their primary care provider for<br \/>\ntreatment of these disorders, many providers will refer patients for<br \/>\nfurther evaluation. For this Discussion, you consider how you might<br \/>\nassess and treat the individuals based on the provided client factors.<\/p>\n<h2>Learning Objectives<\/h2>\n<h6 id=\"students-will-learn\">Students will:<\/h6>\n<ul>\n<li>Assess client factors and history to develop personalized therapy plans for clients with sleep\/wake disorders<\/li>\n<li>Analyze factors that influence pharmacokinetic and pharmacodynamic<br \/>\nprocesses in clients requiring therapy for sleep\/wake disorders<\/li>\n<li>Evaluate efficacy of treatment plans for clients presenting for sleep\/wake therapy<\/li>\n<li>Apply knowledge of providing care to adult and geriatric clients presenting for sleep\/wake disorders<\/li>\n<\/ul>\n<h2>Learning Resources<\/h2>\n<p><em><strong>Note:<\/strong>\u00a0To access this week\u2019s required library resources, please click on the link to the Course Readings List, found in the\u00a0<strong>Course Materials<\/strong>\u00a0section of your Syllabus.<\/em><\/p>\n<h4>Required Readings<\/h4>\n<p><strong>Note:<\/strong>\u00a0All Stahl resources can be accessed through this link provided.<\/p>\n<p>Stahl, S. M. (2013).\u00a0<em>Stahl\u2019s essential psychopharmacology: Neuroscientific basis and practical applications<\/em>\u00a0(4th ed.). New York, NY: Cambridge University Press.<\/p>\n<p>To access the following chapters, click on the\u00a0<strong><em>Essential Psychopharmacology, 4th ed<\/em><\/strong>\u00a0tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.<\/p>\n<ul>\n<li>Chapter 11, \u201cDisorders of Sleep and Wakefulness and Their Treatment\u201d<\/li>\n<\/ul>\n<p>Stahl, S. M. (2014b).\u00a0<em>The prescriber\u2019s guide<\/em>\u00a0(5th ed.). New York, NY: Cambridge University Press.<\/p>\n<p>To access information on the following medications, click on\u00a0<strong><em>The Prescriber\u2019s Guide, 5th ed<\/em><\/strong>\u00a0tab on the Stahl Online website and select the appropriate medication.<\/p>\n<p><strong>Review the following medications:<\/strong><\/p>\n<p>For insomnia<\/p>\n<ul>\n<li>alprazolam<\/li>\n<li>amitriptyline<\/li>\n<li>amoxapine<\/li>\n<li>clomipramine<\/li>\n<li>clonazepam<\/li>\n<li>desipramine<\/li>\n<li>diazepam<\/li>\n<li>doxepin<\/li>\n<li>flunitrazepam<\/li>\n<li>flurazepam<\/li>\n<li>hydroxyzine<\/li>\n<\/ul>\n<ul>\n<li>imipramine<\/li>\n<li>lorazepam<\/li>\n<li>nortriptyline<\/li>\n<li>ramelteon<\/li>\n<li>temazepam<\/li>\n<li>trazodone<\/li>\n<li>triazolam<\/li>\n<li>trimipramine<\/li>\n<li>zaleplon<\/li>\n<li>zolpidem<\/li>\n<\/ul>\n<p>American Psychiatric Association. (2013).\u00a0<em>Diagnostic and statistical manual of mental disorders<\/em>\u00a0(5th ed.). Washington, DC: Author.<\/p>\n<p>Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines.\u00a0<em>British Journal of Psychiatry<\/em>, 2(6), e16-e18. doi:10.1192\/bjpo.bp.116.003707. Retrieved from http:\/\/bjpo.rcpsych.org\/content\/2\/6\/e16<\/p>\n<p><strong>To prepare for this Discussion:<\/strong><\/p>\n<p><em><strong>Note:<\/strong>\u00a0By Day 1 of this week, your Instructor will have<br \/>\nassigned you to one of the following case studies to review for this<br \/>\nDiscussion. To access the following case studies, click on the\u00a0<strong>Case Studies<\/strong>\u00a0tab on the Stahl Online website and select the appropriate volume and case number.<\/em><\/p>\n<p><strong>Case 1:<\/strong>\u00a0Volume 2, Case #16: The woman who liked late-night TV<\/p>\n<p><strong>Case 2:<\/strong>\u00a0Volume 2, Case #11: The figment of a man who looked upon the lady<\/p>\n<p><strong>Case 3:<\/strong>\u00a0Volume 1, Case #5: The sleepy woman with anxiety<\/p>\n<ul>\n<li>Review this week\u2019s Learning Resources and reflect on the insights they provide.<\/li>\n<li>Go to the Stahl Online website and examine the case study you were assigned.<\/li>\n<li>Take the pretest for the case study.<\/li>\n<li>Review the patient intake documentation, psychiatric history,<br \/>\npatient file, medication history, etc. As you progress through each<br \/>\nsection, formulate a list of questions that you might ask the patient if<br \/>\nhe or she were in your office.<\/li>\n<li>Based on the patient\u2019s case history, consider other people in his<br \/>\nor her life that you would need to speak to or get feedback from (i.e.,<br \/>\nfamily members, teachers, nursing home aides, etc.).<\/li>\n<li>Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.<\/li>\n<li>Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week\u2019s Learning Resources for guidance.<\/li>\n<li>Review the patient\u2019s past and current medications. Refer to Stahl\u2019s\u00a0<em>Prescriber\u2019s Guide<\/em>\u00a0and consider medications you might select for this patient.<\/li>\n<li>Review the posttest for the case study.<\/li>\n<\/ul>\n<p><em><strong>Note:<\/strong>\u00a0For this Discussion, you are required to complete<br \/>\nyour initial post before you will be able to view and respond to your<br \/>\ncolleagues\u2019 postings. Begin by clicking on the \u201cPost to Discussion<br \/>\nQuestion\u201d link and then select \u201cCreate Thread\u201d to complete your initial<br \/>\npost. Remember, once you click on Submit, you cannot delete or edit your<br \/>\nown posts, and you cannot post anonymously. Please check your post<br \/>\ncarefully before clicking on\u00a0<strong>Submit<\/strong>!<\/em><\/p>\n<h4>By Day 3<\/h4>\n<p><strong>Post<\/strong>\u00a0a response to the following:<\/p>\n<ul>\n<li>Provide the case number in the subject line of the Discussion.<\/li>\n<li>List three questions you might ask the patient if he or she were in<br \/>\nyour office. Provide a rationale for why you might ask these questions.<\/li>\n<li>Identify people in the patient\u2019s life you would need to speak to or<br \/>\nget feedback from to further assess the patient\u2019s situation. Include<br \/>\nspecific questions you might ask these people and why.<\/li>\n<li>Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.<\/li>\n<li>List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.<\/li>\n<li>List two pharmacologic agents and their dosing that would be<br \/>\nappropriate for the patient\u2019s sleep\/wake therapy based on<br \/>\npharmacokinetics and pharmacodynamics. From a mechanism of action<br \/>\nperspective, provide a rationale for why you might choose one agent over<br \/>\nthe other.<\/li>\n<li>If your assigned case includes \u201ccheck points\u201d (i.e., follow-up data<br \/>\nat week 4, 8, 12, etc.), indicate any therapeutic changes that you<br \/>\nmight make based on the data provided.<\/li>\n<li>Explain \u201clessons learned\u201d from this case study, including how you<br \/>\nmight apply this case to your own practice when providing care to<br \/>\npatients with similar clinical presentations.<\/li>\n<\/ul>\n<p><strong>Read<\/strong>\u00a0a selection of your colleagues\u2019 responses.<\/p>\n<h4>By Day 6<\/h4>\n<p><strong>Respond<\/strong>\u00a0to at least\u00a0<strong>two<\/strong><br \/>\nof your colleagues who were assigned to a different case than you. For<br \/>\nexample, if you were assigned to Case Study 1, respond to one colleague<br \/>\nassigned to Case Study 2 and one colleague assigned to Case Study 3.<br \/>\nExplain how you might apply knowledge gained from your colleagues\u2019 case<br \/>\nstudies to you own practice in clinical settings.<\/p>\n<h4>Submission and Grading Information<\/h4>\n<h5>Grading Criteria<\/h5>\n<p><a href=\"https:\/\/www.ukessayswriters.com\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/ActivateLink('WK07.DB1.RUBRIC',true)\"><br \/>\nTo access your rubric:Week 7 Discussion Rubric<br \/>\n<\/a><\/p>\n<h5>Post by Day 3 and Respond by Day 6<\/h5>\n<p><a href=\"https:\/\/www.ukessayswriters.com\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/ActivateLink('WK07.DB1.TH1',true)\"><br \/>\nTo participate in this Discussion:Week 7 Discussion<br \/>\n<\/a><\/p>\n<hr class=\"wp-block-separator\" \/>\n<h1 id=\"section_container1\">Assignment: Assessing and Treating Clients With Pain<\/h1>\n<p>Pain can greatly influence an individual\u2019s<br \/>\nquality of life, as uncontrolled pain negatively impacts mood,<br \/>\nconcentration, and the overall physical and mental well-being of<br \/>\nclients. Although pain can often be controlled with medications, the<br \/>\nprocess of assessing and treating clients can be challenging because<br \/>\npain is such a subjective experience. Only the person experiencing the<br \/>\npain truly knows the intensity of the pain and whether there is a need<br \/>\nfor medication therapies. Sometimes, beliefs about pain and treatments<br \/>\nfor pain can have an adverse effect on the provider-client relationship.<br \/>\nFor this Assignment, as you examine the interactive case study consider<br \/>\nhow you might assess and treat clients presenting with pain.<\/p>\n<h2>Learning Objectives<\/h2>\n<h6 id=\"students-will-learn\">Students will:<\/h6>\n<ul>\n<li>Assess client factors and history to develop personalized therapy plans for clients with pain<\/li>\n<li>Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for pain<\/li>\n<li>Evaluate efficacy of treatment plans for clients presenting for pain therapy<\/li>\n<li>Analyze ethical and legal implications related to prescribing therapy for clients with pain<\/li>\n<\/ul>\n<h2>Learning Resources<\/h2>\n<p><em><strong>Note:<\/strong>\u00a0To access this week\u2019s required library resources, please click on the link to the Course Readings List, found in the\u00a0<strong>Course Materials<\/strong>\u00a0section of your Syllabus.<\/em><\/p>\n<h4>Required Readings<\/h4>\n<p><strong>Note:<\/strong>\u00a0All Stahl resources can be accessed through this link provided.<\/p>\n<p>Stahl, S. M. (2013).\u00a0<em>Stahl\u2019s essential psychopharmacology: Neuroscientific basis and practical applications<\/em>\u00a0(4th ed.). New York, NY: Cambridge University Press.<\/p>\n<p>To access the following chapters, click on the\u00a0<strong><em>Essential Psychopharmacology, 4th ed<\/em><\/strong>\u00a0tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.<\/p>\n<ul>\n<li>Chapter 10, \u201cChronic Pain and Its Treatment\u201d<\/li>\n<\/ul>\n<p>Stahl, S. M., &amp; Ball, S. (2009a).\u00a0<em>Stahl\u2019s illustrated chronic pain and fibromyalgia.<\/em>\u00a0New York, NY: Cambridge University Press.<\/p>\n<p>To access the following chapter, click on the\u00a0<strong><em>Illustrated Guides<\/em><\/strong>\u00a0tab and then the\u00a0<strong><em>Chronic Pain and Fibromyalgia<\/em><\/strong>\u00a0tab.<\/p>\n<ul>\n<li>Chapter 5, \u201cPain Drugs\u201d<\/li>\n<\/ul>\n<p>Stahl, S. M. (2014b).\u00a0<em>The prescriber\u2019s guide<\/em>\u00a0(5th ed.). New York, NY: Cambridge University Press.<\/p>\n<p>To access information on the following medications, click on\u00a0<strong><em>The Prescriber\u2019s Guide, 5th ed<\/em><\/strong>\u00a0tab on the Stahl Online website and select the appropriate medication.<\/p>\n<p><strong>Review the following medications:<\/strong><\/p>\n<p>For insomnia<\/p>\n<ul>\n<li>amitriptyline<\/li>\n<li>amoxapine<\/li>\n<li>carbamazepine<\/li>\n<li>clomipramine<\/li>\n<li>clonidine (adjunct)<\/li>\n<li>desipramine<\/li>\n<li>dothiepin<\/li>\n<li>doxepin<\/li>\n<li>duloxetine<\/li>\n<li>gabapentin<\/li>\n<li>imipramine<\/li>\n<li>lamotrigine<\/li>\n<\/ul>\n<ul>\n<li>levetiracetam<\/li>\n<li>lofepramine<\/li>\n<li>maprotiline<\/li>\n<li>memantine<\/li>\n<li>milnacipran<\/li>\n<li>nortriptyline<\/li>\n<li>pregabalin<\/li>\n<li>tiagabine<\/li>\n<li>topiramate<\/li>\n<li>trimipramine<\/li>\n<li>valproate (divalproex)<\/li>\n<li>zonisamide<\/li>\n<\/ul>\n<blockquote class=\"wp-block-quote\"><p>American Psychiatric Association. (2013).\u00a0<em>Diagnostic and statistical manual of mental disorders<\/em>\u00a0(5th ed.). Washington, DC: Author.<\/p>\n<p><strong>Note:<\/strong>\u00a0Retrieved from Walden Library databases.<\/p><\/blockquote>\n<p>National Institute of Neurological Disorders and Stroke. (2016).\u00a0<em>Pain: Hope through research<\/em>. Retrieved from http:\/\/www.ninds.nih.gov\/disorders\/chronic_pain\/detail_chronic_pain.htm#3084_2<\/p>\n<h4>Required Media<\/h4>\n<p>Laureate Education (2016a).\u00a0<em>Case study: A Caucasian man with hip pain<\/em>\u00a0[Interactive media file]. Baltimore, MD: Author<strong>Note:<\/strong>\u00a0This case study will serve as the foundation for this week\u2019s Assignment.<\/p>\n<p><strong>To prepare for this Assignment:<\/strong><\/p>\n<ul>\n<li>Review this week\u2019s Learning Resources. Consider how to assess and<br \/>\ntreat clients requiring therapy for pain and sleep\/wake disorders.<\/li>\n<\/ul>\n<h4>The Assignment<\/h4>\n<p>Examine\u00a0<em>Case Study: A Caucasian Man With Hip Pain.<\/em><br \/>\nYou will be asked to make three decisions concerning the medication to<br \/>\nprescribe to this client. Be sure to consider factors that might impact<br \/>\nthe client\u2019s pharmacokinetic and pharmacodynamic processes.<\/p>\n<p>At each decision point stop to complete the following:<\/p>\n<ul>\n<li>Decision #1\n<ul>\n<li>Which decision did you select?<\/li>\n<li>Why did you select this decision? Support your response with evidence and references to the Learning Resources.<\/li>\n<li>What were you hoping to achieve by making this decision? Support<br \/>\nyour response with evidence and references to the Learning Resources.<\/li>\n<li>Explain any difference between what you expected to achieve with<br \/>\nDecision #1 and the results of the decision. Why were they different?<\/li>\n<\/ul>\n<\/li>\n<li>Decision #2\n<ul>\n<li>Why did you select this decision? Support your response with evidence and references to the Learning Resources.<\/li>\n<li>What were you hoping to achieve by making this decision? Support<br \/>\nyour response with evidence and references to the Learning Resources.<\/li>\n<li>Explain any difference between what you expected to achieve with<br \/>\nDecision #2 and the results of the decision. Why were they different?<\/li>\n<\/ul>\n<\/li>\n<li>Decision #3\n<ul>\n<li>Why did you select this decision? Support your response with evidence and references to the Learning Resources.<\/li>\n<li>What were you hoping to achieve by making this decision? Support<br \/>\nyour response with evidence and references to the Learning Resources.<\/li>\n<li>Explain any difference between what you expected to achieve with<br \/>\nDecision #3 and the results of the decision. Why were they different?<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Also include how ethical considerations might impact your treatment plan and communication with clients.<\/p>\n<p><em><strong>Note:\u00a0<\/strong>Support your rationale with a minimum of three<br \/>\nacademic resources. While you may use the course text to support your<br \/>\nrationale, it will not count toward the resource requirement.<\/em><\/p>\n<h4>Submission and Grading Information<\/h4>\n<p><strong>To submit your completed Assignment for review and grading, do the following:<\/strong><\/p>\n<ul>\n<li>Please save your Assignment using the naming convention \u201cWK7Assgn+last name+first initial.(extension)\u201d as the name.<\/li>\n<li>Click the\u00a0<strong>Week 7 Assignment Rubric\u00a0<\/strong>to review the Grading Criteria for the Assignment.<\/li>\n<li>Click the\u00a0<strong>Week 7 Assignment\u00a0<\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n<li>Next, from the Attach File area, click on the\u00a0<strong>Browse My Computer<\/strong>\u00a0button. Find the document you saved as \u201cWK7Assgn+last name+first initial.(extension)\u201d and click\u00a0<strong>Open<\/strong>.<\/li>\n<li>If applicable: From the Plagiarism Tools area, click the checkbox for\u00a0<strong>I agree to submit my paper(s) to the Global Reference Database<\/strong>.<\/li>\n<li>Click on the\u00a0<strong>Submit<\/strong>\u00a0button to complete your submission.<\/li>\n<\/ul>\n<h5>Grading Criteria<\/h5>\n<p><a href=\"https:\/\/www.ukessayswriters.com\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/ActivateLink('WK07.AS1.RUBRIC',true)\"><br \/>\nTo access your rubric:Week 7 Assignment Rubric<br \/>\n<\/a><\/p>\n<h5>Check Your Assignment Draft for Authenticity<\/h5>\n<p><a href=\"https:\/\/www.ukessayswriters.com\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/ActivateLink('SA.DR1',true)\"><br \/>\nTo check your Assignment draft for authenticity:Submit your Week 7 Assignment draft and review the originality report.<br \/>\n<\/a><\/p>\n<h5>Submit Your Assignment by Day 7<\/h5>\n<p><a href=\"https:\/\/www.ukessayswriters.com\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/ActivateLink('WK07.AS1',true)\"><br \/>\nTo submit your Assignment:Week 7 Assignment<br \/>\n<\/a><\/p>\n<hr class=\"wp-block-separator\" \/>\n<h1 id=\"section_container2\">Making Connections<\/h1>\n<p>Now that you have:<\/p>\n<ul>\n<li>Assessed clients presenting with pain and sleep\/wake disorders<\/li>\n<li>Developed personalized plans of therapy for clients with pain and sleep\/wake disorders<\/li>\n<li>Examined factors that influence pharmacokinetic and pharmacodynamic<br \/>\nprocesses in clients requiring therapy for pain and sleep\/wake<br \/>\ndisorders<\/li>\n<li>Explored ethical and legal implications of prescribing therapy to clients with pain and sleep\/wake disorders<\/li>\n<\/ul>\n<p>Next week, you will build on your<br \/>\nassessment and treatment skills as you examine clients presenting for<br \/>\ntherapy for impulsivity, compulsivity, and addiction.<br \/>\nTo go to the next week:Week 8<\/p>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>Week 7: Therapy for Clients With Pain and Sleep\/Wake Disorders From negative changes in mood to problems concentrating, pain and sleep\/wake disorders can have a tremendous impact on clients\u2019 lives. When clients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-15701","post","type-post","status-publish","format-standard","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Therapy for Clients With Pain and Sleep\/Wake Disorders - onlineclassesguru<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/onlineclassesguru.com\/index.php\/2020\/11\/24\/therapy-for-clients-with-pain-and-sleep-wake-disorders\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Therapy for Clients With Pain and Sleep\/Wake Disorders - onlineclassesguru\" \/>\n<meta property=\"og:description\" content=\"Week 7: Therapy for Clients With Pain and Sleep\/Wake Disorders From negative changes in mood to problems concentrating, pain and sleep\/wake disorders can have a tremendous impact on clients\u2019 lives. When clients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. 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