Advanced Nursing Practice I Custom Essay

This question(Discussion Question )is not for you. It is for peer #1 and # 2. I am asking you to do the question #2 below which is comment and review the posted by two peers. Please do not write an essay

which is not helping me and you. Just a wasting time for both and I will return it back to you and get a refund. It happened in the past. Sorry I am so blunt about this.
Musculoskeletal Clinical Case
The Musculoskeletal Clinical case, it in on the bottom of the that you will see after Peer 2?s paper. This musculoskeletal clinical case informations for Peers # 1 and # 2 to read then they must answer discussion

question 2.
1. Discussion Question 2
After diagnostic testing, this patient was diagnosed with low back pain without any specific injury. One of the most important aspects of the care at this point is to create a comprehensive teaching plan. What

are the important teaching points you need to consider for the acute care of this individual? And what would you suggest for prevention of potential future injuries?
2. #2 review and comment on the discussion question responses posted by two peers (just do one paragraph for each peer and one citation for each paragraph. 3-5 sentences for each paragraph please).

Peer # 1 Lindsey
o A common cause of lower back pain is injury to muscles or ligaments in the back. This could be caused by lifting, working, poor posture, or being overweight.
o The patient can use over-the-counter pain relievers or even a short period of bed rest if needed, but more than a couple of days actually do more harm than good. The patient should continue their daily

activities as tolerated. Light activity, such as walking and daily activities, is usually OK. But, if an activity increases pain, instruct the patient to stop doing that activity. If the pain is not relieved by over- the?

counter medication for example acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen. Narcotics, such as codeine or hydrocodone, may be used for a short period of time

with a possible muscle relaxer.
o Refer the patient to physical therapy. A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to the back muscles and soft tissues

to reduce pain. The therapist can teach the patient specific exercises that may help increase your flexibility, strengthen the back and abdominal muscles, and improve posture. Regular use of these techniques

can help prevent pain from returning.
o If other measures don’t relieve pain and if the pain radiates, your doctor may inject cortisone into the epidural space. A cortisone injection helps decrease inflammation around the nerve roots, but the pain

relief usually lasts less than a few months.
? Alternative treatments may help ease symptoms of back pain. These treatments include chiropractic care, acupuncture, massage therapy, and yoga.
? Reference:
? Mayo Clinic. (2014). Back pain. Retrieved from http://www.mayoclinic.org/diseases-conditions/back-pain/basics/definition/con-20020797

? Peer # 2 Adriana

The patient complains of low back pain due to an untreated back injury. He is a roofer by profession and it is imperative that he understands how to use good body mechanics to prevent future injuries. Patient

does not have proper medical insurance and this is preventing him from seeking proper medical care for his back. Along with not using proper body mechanics, as he is working, his oversize abdominal girth

puts added pressure to his back from the extra weight.
For his immediate treatment he needs an anti-inflammatory medication, he needs to know to use ice to relieve the pain and after two weeks he must use heat to relieve the inflammation. (The Mayo Clinic,

2013) His f/up care must include teaching on proper body mechanics, diet; he needs to apply for community resources for medical care or coverage. This is important because he will need to be followed up

for his low back pain.
Low back pain (LBP) is defined as chronic after 3 months because most normal connective tissues heal within 6-12 weeks, unless path anatomic instability persists. Our patient does not allow his body to heal

because he does not seek medical attention and is not able to stop working for a few days. An estimated 15-20% develop protracted pain, and approximately 2-8% have chronic pain. LBP is the most

common cause of disability in Americans younger than 45 years. (E-medicine, 2002). Each year, 3-4% of the US population is temporarily disabled, and 1% of the working-age population is totally and

permanently disabled. (E-medicine, 2002) Most commonly, diagnoses of acute painful spinal conditions are nonspecific, such as neck or back strain, although injuries may affect any of several pain-sensitive

structures, which include the disk, facet joints, spinal musculature, and ligamentous support. The origin of chronic back pain is often assumed degenerative conditions of the spine; however, some are from work

injuries because the patient fails to use proper body mechanics.
Sciatica describes leg pain that is localized in the distribution of one or more lumbosacral nerve roots, typically L4-S2, with or without neurological deficit. However, physicians often refer to leg pain from any

lumbosacral segment as sciatica. When initially evaluating a patient with lower back and leg pain, it is important to first determine, that pain symptoms are consistent with common activity-related disorders of

the spine resulting from the wear and tear of excessive biomechanical and gravitational loading that some traditionally describe as mechanical. Our patient must also be informed and given information on a

healthy diet, one that meets all of his physical needs.
Back Pain Health Center retrieved from http://www.webmd.com/back-pain/features/manage-low-back-pain-home
Low Back Pain and Sciatica http://emedicine.medscape.com/article/1144130-overview
McConnell, E. A. (2002). Using proper body mechanics. Nursing, 32(5), 17. Retrieved from http://search.proquest.com/docview/71726996?accountid=87314

Musculoskeletal Clinical Case

HPI
A 40-year-old Asian American male, who works as a roofer, complains that three days ago he was lifting a heavy object at work, following which he got low back pain. The pain is in the middle of the back

near his waist. The pain increases when he bends forward and he is experiencing numbness and tingling in the toes of his right foot. He has had similar symptoms before, but it has not been so bad in the past.

This is the worst he has had because in the earlier instances, he has never had the tingling sensation in his right foot before.

In the past, he got better with rest and some Ibuprofen. He is worried that he will not be able to continue his work and make money. He is out of work as a result of the pain. He has a lot of difficulty getting

sleep at night. He has started taking some of his friend?s medication and it seems to help.

He has pain in the mid lumbar area, which radiates to the right buttock. He also has numbness and tingling down the back of his right thigh to his toes. The pain and numbness has been increasing since the

problem started three days ago. He has tried over-the-counter Ibuprofen and some stretching exercises, but it does not seem to help. He has not sought any medical care yet. In the past, the pain had just gone

away, but this time the pain is persistent. There is a gradual worsening of his symptoms and he is concerned about the pain that has been increasing steadily over the past three days. He is wondering whether he

has a herniated disc. His major concern is that he has no health insurance and will be missing work.

PMH

He has had similar pain in the past, but it was not so severe. He saw a chiropractor around two or three years ago and that gave him some relief. Otherwise, the patient has no chronic medical problems. He

does not seek medical care on a routine basis.

He has had no diagnostic measures in the past. He has never had any blood work
reports, CT scan reports, X-ray reports and so forth done in the past. He has been gaining weight over the past few years and does not do any stretching exercises before

work. Patient does not have any other risk factors. There are no records of any past surgeries. He has neither had any significant illnesses in the past nor any hospitalizations.

ROS
Pain in the mid lumbar area radiating to the right buttock. There is a tingling sensation that goes down the back of his right thigh to the toes. He does not have urinary or bowel incontinence. No nausea,

vomiting, or fever. He denies abdominal pain and pain with urination. There is no gross hematuria.

MEDICATIONS
Patient does not take any prescription medications, only over-the-counter Ibuprofen. He is using 800mg of Ibuprofen every four hours. Patient is compliant with the prescribed regimen; in fact, he could be

using too much. Patient is seeking care because of the increasing pain. He has tried chiropractic manipulations in the past for low back pain.

ALLERGIES/REACTIONS
He is allergic to Penicillin. It has caused a rash in the past.

SOCIAL HISTORY
This patient works for a local roofing company and makes $30,000.00 per year, which is just a little over the minimum wage. He has a high school education certificate and makes just enough money to get by.

He has no health insurance. The patient feels that the last thing that he wants to do is spend money on healthcare. He feels his body will get better on its own, and so he can just keep working. He made the

appointment at this outpatient clinic because his friends told him about it. He was not sure where to go for help. He has decreased access to healthcare because he is not aware of the services available. The

patient has had essentially no healthcare to date. The patient states that he is starting to realize that his body will not last forever at his current position as a laborer.

The patient is divorced and thinks he was a failure as a husband. He is behind in alimony payments. His wife is alive and well without any medical problems. They do not communicate anymore. They have no

children. He would like to try and get back
together with her, but she refuses to speak to him. He has been holding himself back

from expressing the amount of stress he has in life for many years. He thinks he is becoming depressed as a result of this. His parents still live in the area and he sees them every weekend. He has friends from

work and they do social things together. The patient has not sought any emotional support from anybody. There is no element of family dysfunction. He becomes easily stressed out. He lives in social isolation

from his community. The patient has always taken his health for granted and not thought much about it in the past.

HABITS
Smoking: Non smoker
Alcohol: Drinks at bars on weekends to excess with his friends Substance abuse: He smokes marijuana.

DIET HABITS
He skips breakfast and eats at fast food restaurants twice every day. He sips coffee and caffeinated beverages throughout the day. The patient feels that his job gives him enough exercise and so he need not do

anything else. He plans to go on a ?diet? soon to lose the weight he has gained over the past few years, but is not sure about the diet he is going to follow.

WORK HABITS
The patient works as a roofer. He has had other labor-intensive jobs in the past that do not require an educational background. He does not enjoy his job. He knows it is a dead end job and wants to go to

school. He is originally from United States and lives in a suburban community where resources are easily accessible, but he is not aware of them.

FAMILY HISTORY
Both parents have hypercholesterolemia. His 65-year-old father has prostate cancer. Both parents are being treated with medications for their high cholesterol levels. He has no siblings. There is a remote

history of heart disease in his relatives.

PHYSICAL EXAMINATION
Vital Signs: Ht: 6?; Wt: 220; WC: 40; BP: 120/78; T: 97 po; P: 92 and regular; R: 18 non- labored
HEENT: WNL

Lymph Nodes: None Lungs: Clear
Heart: RRR without murmur Carotids: Not examined
Abdomen: Android obesity, otherwise benign Rectum: Not examined
Genital/Pelvic: NA

Extremities, Including Pulses: 2+ pulses in the lower extremities Neurologic:
Mental Status: Alert and oriented Cranial Nerves: II ? XII intact
Motor Strength: Upper extremities equal strength 5/5.

Lower extremities: decreased strength of right leg with resisted extension; patient complains of pain in posterior thigh.
Sensation (light touch, pin prick, vibration, and position): Decreased sensation of right leg along L5 : S 1 dermatome to pin prick stimulation compared with the left.
Reflexes: DTRs 2+ in upper and lower extremities

Cerebellar function intact?Romberg test is negative; heel-to-toe walking is steady. Postive straight leg raise on the right at 20 degrees.

LAB RESULTS/RADIOLOGICAL STUDIES/EKG INTERPRETATION
Lab Results CBC: WNL
UA dip stick: WNL Radiological Studies
Plain film of lumbar spine: loss of disc height at L5 to S1. Mild degenerative changes of lumbar vertebrae.
MRI: moderate disc bulge at L5: S1. EKG: Not performed

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