iHuman Case Study: Tina Williams, 41Yrs Old Female Cc: Low Back Pain
J.C. is a 41-year-old man who comes to the ED (emergency department) C/O acute low
... [Show More] 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 several episodes of similar back pain each year over the past 10 years. In the past the pain has been treated by diazepam, codeine, NSAIDs, and several weeks of bed rest. J.C. has a past medical history (PMH) of a peptic ulcer. He is 6 ft tall, weighs 265 pounds, and has a prominent "potbelly." The ED admitting clerk calls J.C.'s insurance company to
authorize payment for treatment at your facility. J.C.'s health maintenance organization (HMO) has identified him as a consumer of "high-cost care" with poor prior outcome. The ED is authorized to perform emergency treatment only and the case manager will make a home visit within 24 hours to devise a treatment plan. The ED - ANS-J.C. is a 41-year-old man who comes to the ED (emergency department) C/O 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 several episodes of similar back pain each year over the past 10 years. In the past the pain has been treated by diazepam, codeine, NSAIDs, and several weeks of bed rest. J.C. has a past medical history (PMH) of a peptic ulcer. He is 6 ft tall, weighs 265 pounds, and has a prominent "potbelly." The ED admitting clerk calls J.C.'s insurance company to
authorize payment for treatment at your facility. J.C.'s health maintenance organization (HMO) has identified him as a consumer of "high-cost care" with poor prior outcome. The ED is authorized to perform emergency treatment only and the case manager will make a home visit within 24 hours to devise a treatment plan. The ED physician diagnoses muscular strain of the lower back and orders the following:
cyclobenzaprene (Flexeril) 10 mg qid, celecoxib (Celebrex) 200 mg qd; bed rest for 2 days then gradually increase activity; ice packs to the lower back 30 minutes out of every hour. You are a case manager RN working for Grubabuck HMO and make the initial visit to J.C.'s residence. His wife lets you in and you find J.C. lying on the sofa with his knees flexed and watching videos.
Obtain a clear chronologic narrative of problem onset, setting, manifestation, and treatment.
Principal symptoms should be described.
Location: Where does it hurt?
Quality: What does it feel like?
Quantity or severity: How bad is it?
Timing (onset, duration, frequency): When does it happen? When is it worse?
Setting: Where are you when it happens? Under what conditions is it worse?
Factors that aggravate or relieve the pain: What makes it feel better? What makes it worse?
Associated manifestations: Is there anything else you feel with it?
Ask what the meaning of the symptoms is to J.C. and what impact it has on his life. - ANS-1. What are several history and assessment questions appropriate to ask J.C. in evaluating the extent of his back pain and injury?
His potbelly puts undue strain on his lower back muscles. - ANS-2. What observable characteristic does J.C. have that makes him highly susceptible to low back injury and chronic pain? [Show Less]