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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