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APA
Subject:
Health, Medicine, Nursing
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Case Study
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English (U.S.)
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Topic:

Back Pain and Its Treatments

Case Study Instructions:

Please see attached rubric. Please use references that are recent and up to date information. 

 

NUR550.NG006 Advanced Health Assessment

Online discussion: Week Five(S3 Online discussion: Week Five

HPI: You are a nurse working in a busy primary care clinic. Robert, a 56 year old male presents complaining of low back pain. Robert is married, lives at home with his wife and 2 high school aged children and works ftill-time in the construction field. He has a high school education and a trade school diploma. In speaking with Robert, you discover that he has had intermittent back pain for several years, usually “depending on what I do”. He states that the pain he has now spreads across his entire lower back and into his right hip. He also states he has an “achy” feeling in both anterior thighs. He states that over the past two months, the pain has become progressively worse and it is now to the point that it is interrupting his sleep at night and it is difficult to sit or stand for any significant length of time without discomfort. He states it is also difficult for him to climb stairs.

Physical Findings: General survey: well developed male sitting in chair in exam room with weight distributed on left buttock, pleasant, well-spoken VS: BP 158/90 P 75 T 98.1 Ht: 5' 8” Wt: 256 BMI: 39 Skin: warm and dry, no rashes, bruising or lesions Neck: supple, normal ROM Abdomen: soft, non-tender, no masses PV: pulses in upper and lower extremities +2 throughout, no pedal edema

Musculoskeletal: no vertebral tenderness on palpation, positive for paraspinous muscle tenderness, no swelling or deformity of the joints, good internal and external rotation of both hips, radicular pain to right hip, SLR normal in left leg, SLR positive in right leg at 45 degrees, pain on forward flexion and bending to the left side, gait normal, no pain on plantar or dorsiflexion Neurologic: oriented to person, place and time, cranial nerves II through XII intact, muscle strength 5/5 in hamstrings, quadriceps and gluteals on the left, 4/5 in the right hamstring, 5/5 in the right quadriceps and gluteal, sensation intact throughout to position, sharp, dull and vibratory sensation in bilateral lower extremities, reflexes +2 at the knee and ankle on the left, +1 at the knee and +2 at the ankle on the right

What additional information would you like to obtain?

What are some possible differential diagnoses for this patient?

What diagnostic testing would you like to obtain to rule in or out possible diagnoses?

What evidence-based treatment options based on that testing should you offer the patient or what referrals should be obtained for the patient? (please be sure to site your resources)

If the patient did not appear to be in acute distress and the subjective/objective findings and the diagnostic studies did not correlate, what would the appropriate treatment plan for this patient be? If on follow-цр, the patient has a marked increase in symptoms or progressive neurological deterioration yet states he does not want any intervention, how do you treat this patient?

 

Case Study Sample Content Preview:

Case Discussion
Student’s Name
Institutional Affiliation
Case Discussion
Low back pain is one of the disabling health conditions that are common among adults aged 50 and above. Although the causes of the condition are self-limiting, the seniors are more susceptible to the pathologies resulting from their deteriorating physical and psychosocial changes (Sahrmann et al., 2017). In the case study, Robert was likely to suffer from the condition based on his nature of work in a construction field and his age advancement. Therefore, age-related and physical factors would likely affect pain management for the victim. Therefore, the assessment and treatment strategy ought to be based on a consideration of the underlying factors. Notably, back pain remains one of the ubiquitous issues among adults near their retirement age.
In the diagnosis of low back pain, I understand the need to focus on the impact of repetitive and sustained bending due to the possibility of lifting construction materials. Sustained bending, static postures, rapid bending, and awkward postures are some of the possible risk factors for the occurrence of low back injury (Knezevic et al., 2017). In the case of Robert, he had a likelihood of experiencing a reduction of spinal range of motions, thus encountering pain. For that reason, an injury was likely to become more severe and costly to manage. Equally, workers in the construction field are likely to work while bending. Therefore, repetitive and sustained bending were factors that could have resulted in the progressive weakening of supportive tissues.
Evidence-based treatment options
Early psychosocial interventions are ideal examples of evidence-based practices of treating low back pain. In comparison to the usual care, the strategy can enhance the patient’s wellbeing while setting reactivation goals. Knezevic et al. (2017) argue that evidence-based practice entails the process of making relevant clinical decisions based on an integration of available evidence with clinical expertise and the values of Robert as the patient. In the case of the patient, I understand the need to make appropriate decisions regarding the welfare of the patient. However, I will have t...
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