What questions might you want to ask James in evaluating the extent of his back pain and injury?

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Case Study: Week 4

Case: James is a 41-year-old
man who comes into the ER with complaints of acute low back pain. He states that he did some heavy lifting
yesterday, went to sleep with some back pain, and woke up this morning with
horrible back pain. He rates the pain as
a 10 on a scale of 1 to 10 scale. He had
a similar episode a few years ago after lifting something heavy at work. James has a medical history of peptic ulcer
disease secondary to NSAID use. He is 5’
9” tall, weighs 265 pounds, and has a large potbelly.
Discussion:
1.
What questions might you want to ask James in
evaluating the extent of his back pain and injury?
2.
What characteristics does James have that makes
him highly susceptible to low back injury?
3.
JC used to take piroxicam 20 mg until he
developed an ulcer. What is the relationship between the two?
4.
What signs/symptoms would you expect to see if
an ulcer developed?
Case Study
James is diagnosed with a lumbar strain after all serious
causes are ruled out. The NP orders
physical therapy consultation to him James develop back strengthening and a
dietary consult for weight reduction.
James receives prescriptions for celecoxib 100 mg/day for 90 days. He also receives instructions to apply heat
to the lower back for 20 to 30 minutes qid, no twisting or unnecessary bending,
and no lifting more than 10 pounds. He
is also instructed to rest his back and is given an excuse to stay home from
work for 5 days. Once James returns to work he cannot lift more than 10 pounds
for 3 months. He is also told to contact
his primary care provider if the pain worsens.
5.
James looks at the prescription for
cyclobenzaprine and says, “I’m glad you didn’t give me any of that valium. They gave me valium the last time and that
stuff knocked me out.” How would you respond to James?
6.
Why do you think James is given celecoxib
instead of the piroxicam?
7.
It has been over 5 years since James had a bleeding
episode. Are there any conditions that
you need to assess for before James begins taking the celecoxib? Explain.
8.
Why did the NP prescribe an NSAID instead of
acetaminophen?
9.
The physical therapist teaches James maintenance
exercises he can do on his own to promote back health. Identify two common
exercises that would be included.
10. Describe
the teaching you would perform regarding the celecoxib.

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