Pain management case study

Scenario

J.C. is a 41-year-old man who comes to the emergency department (ED) with complaints of acute low back pain. He states that he did some heavy lifting yesterday, went to bed with a mild backache, and awoke this morning with terrible back pain. He admits to having had a similar episode of back pain “after I lifted something heavy at work.” J.C. has a past medical history (PMH) of peptic ulcer disease (PUD) related to NSAIDs use, non-insulin dependent diabetes, and hypertension. His is 6’ tall, weighs 265 pounds, and has a prominent “potbelly.”

***** Question

1)J.C. used to take celecoxib (Celebrex) 100 mg daily until he developed his duodenal ulcer. What is the relationship between the two? What signs and symptoms (S/S) would you expect if an ulcer developed?

2) What observable characteristic does J.C. have that makes him highly susceptible to low back injury?

3) What questions would be appropriate to ask J.C. in evaluating the extent of his back pain and injury?

4) What pain scale would you select to use with this patient? Why?

Case study progress

All serious medical conditions are ruled out, and J.C. is diagnosed with lumbar strain. The midlevel provider orders a physical therapy consult to develop a home stretching and back-strengthening exercise program and a dietary consult for weight reduction. J.C. is given prescriptions for cyclobenzaprine (Flexeril) 10 mg tid prn x 3 days only and naproxen 500 mg twice daily for one month. He receives the following instructions: Ice packs to the lower back for 20 minutes every hour, no twisting or unnecessary bending, and no lifting more than 10 pounds. J.C. is instructed to rest his back for 1 or 2 days, getting up only now and then to move around to relieve muscle spasms in his back and strengthen his back muscles. He is given and excuse to stay off work for 5 days, and he is instructed to return to the ED if he gets worse.

**** Questions

5) Why do you think that naproxen was prescribed instead of Tylenol#3 or Percocet?

6) What points would you include when Teaching J.C. about muscle relaxants?

7) A physical therapist teaches J.C. maintenance exercises he can do on his own to promote back health. Identify two common exercises that would be included.

8) Why was naproxen and Flexeril chosen? How would he benefit from taking this medications?

9) Why would J.C. want to use an NSAID rather than acetaminophen for pain?

10) Develop a primary nursing care plan for J.C.