South University
This is a proposed care plan on a case study of a 40-year-old Asian American male, working as a roofer, with complains of low back pain. As such, to have full comprehension of the patient’s case and a comprehensive care plan, I intend to carry out in-depth literature review from the authentic databases and propose suitable evidence based care strategic plans in view of the complaints, pathophysiology, diagnosis and treatment.
Analyzing the Disorder
Low back pain is acute or chronic disorder that is manifested by pains at the lower back (Kantor and Creek, 2015). Patients might have back firmness, diminished development of the lower back, and trouble standing straight. Acute low back pain can last for few days and disappear due to self-care (Kantor and Creek, 2015). However, low back agony that gets prolonged is termed as chronic low back pain.
A single occasion might not have contributed to the pain. The individuals might have been doing numerous exercises, for example, lifting the wrong path, for quite a while. At that point abruptly, one basic development, for example, going after something or twisting from their waist, prompts torment. Several individuals with unending back agony have joint pain. On the other hand, they might have additional wear and tear of the spine, which might be because of: Overwhelming use from work or games, Wounds or cracks and surgical procedure (Kantor and Creek, 2015).The pain might have had a herniated plate, in which part of the spinal cord gets pushed onto adjacent nerves. Regularly, the plates give space and pad in their spine. In the event that these circles dry out and get to be more slender and weak, they can lose development in the spine after some time (Kantor and Creek, 2015).
Low back pain could be discogenic in nature. Discogenic low back pain is a genuine therapeutic and social issue accounting for 26%-42% of the patients with incessant low back agony (Peng, 2013). The intervertebral plate is the primary joint between two back to back vertebrae in the vertebral segment. It was reported that disc degeneration will happen if the framework of the disk is not ordinary. At the atomic level, degeneration will be communicated by the generation of unusual segments of the framework or by an expansion in the go betweens of network corruption, for example, IL-1 and TNF-α, and of MMPs and a diminishment in the levels of tissue inhibitors of metalloproteinases (TIMPs). A few variables have been considered to bring about plate degeneration (Peng, 2013). Hereditary inclination, mechanical burden, and nutritious components are broadly viewed as imperative supporters to the degenerative process (Peng, 2013). With the plate degeneration, there is a net loss of proteoglycans and water from the core, prompting poor hydrodynamic exchange of pivotal burdens to the external anulusfibrosus. The plate degeneration might come about because of the unevenness between the anabolic and catabolic procedures or the loss of consistent state digestion system that is kept up in the ordinary circle. Adjustments in both anabolic and catabolic procedures are thought to assume key parts in the onset and movement of plate degeneration (Peng, 2013).
The vital signs of low back pain include; shivering or blazing sensation, intense pain, a feeling of burning or tingling, and weakness in legs or feet. This could necessitate CT output of the lower spine and blood tests, for example, a complete blood check and erythrocyte sedimentation rate, MRI output of the lower spine. Apart from these different tests were reported to rely upon the patient’s therapeutic history and side effects.
The treatment includes, recommending cold packs and warmth treatment, back prop to bolster their back, physical treatment, including extending and fortifying activities, counseling to learn approaches to comprehend and deal with their pain, massage needle therapy and the use of chiropractor based spinal manipulation. Drugs could be ibuprofen (Advil) or Aspirin, naproxen (Aleve), or ibuprofen (Advil), opioids or narcotics when the pain is extreme (Kantor and Creek, 2015). In the event if the pain does not enhance with medication, non-intrusive treatment, and different medicines, then the specialist might prescribe an epidural infusion. Spinal surgery is considered in situations when severe nerve damage occurs.
Differentiate the Disorder from Normal Development
Difference from the normal: In individuals with low back pain, the spaces between the spinal nerves and spinal cord get to be contracted, this can prompt spinal stenosis. In normal people this kind of narrowing is not present. Likewise, other difference could be that in normal individuals, anxiety or depression appears to be more than those with the low back pain (Kantor and Creek, 2015).
Physical and Psychological Demands on the Patient and Family:
These demands are supposed to be the increased motivation and warmth from the health care professionals. As, patients with low back pain experience depression, they need a community assistance that could assist them to overcome physical inactivity, psychosocial disturbance and even economic or financial worry.
Key concepts to achieve the outcomes:
This could be accomplished by querying the relatives or companions to assist with physical workloads that could not be performed. The patient might need to incline toward loved ones when confronting troublesome circumstances created by incessant pain or different issues. Their friends and family can assume an essential part in supporting their recuperation. At the same time, families could help patients adapt to managing tasks by giving them solace and consolation.
Role of Interdisciplinary Team
Utilization of interdisciplinary model
For the present case situation, researchers could use an interdisciplinary model. This could be accomplished by employing a differing clinical group that incorporates behavioral experts, doctors, physical advisors, medical attendant caseworkers, and drug specialists working in a firmly planned design inside of the essential care setting (Debar et al., 2012).
As such, the team could employ bioinformaticians, clinical trialists, subjective and execution specialists, health administrations analysts, and financial specialists who would guarantee a thorough assessment of the viability of this clinical methodology. This approach was believed to bring thorough care services’ attention to the incessant pain developed due to multiple factors for instance smoking, overweight, absence of development/reconditioning, torment catastrophizing/low pain self-viability, and other contributing comorbidities such as sleep apnea (Feldstein, 2012).
This method would also enable predictable informing from numerous suppliers to understanding about the ideal conduct change methodologies to enhance functioning. It could overcome financial crisis that patient could more likely encounter (Debar et al., 2012).
Barriers/Facilitators
Patients with low back pain could encounter barriers and facilitators that need to be well managed. The barriers could be time limitations, pain meddles with self-management
over-dependence on medications, stressors, confinements related to sadness, time limitations, absence of inspiration or self-control, insufficient pain alleviation from few techniques, restricted resources (e.g. transportation, money related) and absence of backing from companions, family, or managers (Bair et al. 2010).
Notably, the facilitators include strong family and companions, enhancing sadness after treatment, care groups with companions, support from medical attendant consideration directors, positive confirmations and considering, being a proactive patient, goal setting and accomplishing objectives, improving one's self-regard,
Strategies for overcoming barriers
Barriers could be well managed by controlling nervousness and trepidation of re-harm and low back torment is imperative to recapture ordinary muscle capacity. The rationale for these mental responses to low back pain lies in the focal sensory system, which reacts to pain by training the muscles close to the influenced part to ensure against further harm. To say, a suitable physical preparing particularly tells the muscles to enhance their capacity and conquer this neurological obstruction to typical muscle capacity (Mooney, 2016).
Sleep
It was reported that promoting rest could overcome physical exhaustion and promote dynamic activity. Unmistakably, stimulants, for example, caffeine or nicotine ought to be evaded at sleep time. Smoking ought to additionally be avoided in light of the fact that it decreases the accessible blood supply and makes the sensory system touchier.
Seeking help from professionals
Looking for the help of a fittingly prepared and authorized healthcare expert for back rehabilitation and activity is highly suggested. The back is a convoluted structure, and experts have a characterized convention to recognize the reason for back pain. It was also suggestive to see a doctor if the lower back pain goes on for more than a couple of weeks or a month or if there are any indications that cause worry, or side effects of the drugs might imply a genuine therapeutic condition.
Patient Initials: TS Age: 40 years old Sex: Male
As the ARNP I will clearly identify the medical problem(s) and layout the reasonable options for this patient. I will make sure they can properly see, hear, and in laymen terms, properly understand what I am telling them. I will ask if there is any family they would like to call before I begin so they will have an opportunity to be involved in the plan of care as well. I will explain to the patient that they have the primary responsibility for recognizing and conveying their concerns and goals pertinent to the decision they are facing.
Subjective data
Chief complaint: Low back pain radiating to the right buttock with numbness and tingling down the back of his right thigh to his toes.
HPI: The pain is amidst the back close to his waist. The pain increases during twisting in the forward direction, deadness and shivering in the toes right foot; pain in the mid lumbar zone, which emanates to the right butt cheek; also deadness and shivering down the back of his right thigh to his toes.
PMH: similar pain in the past, tried chiropractic manipulations in the past, 800mg of Ibuprofen every four hours, allergic to Penicillin, smokes marijuana and drinks on the weekend, 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, positive straight leg raise on the right at 20 degrees. Decreased sensation of right leg along L5: S 1 dermatome to pin prick stimulation compared with the left,decreased strength of right leg with resisted extension, no other chronic medical problems.
Significant family history: Both parents have hypercholesterolemia, 65-year-old father has prostate cancer, remote history of heart disease in his relatives.
Objective data
a. Vital signs:
Vital Signs: Height 6’, Weight 220Ibs; WC 40, Blood Pressure 120/78, Temperature 97, Pulse, 92 and regular, Respiration 18 and non-labored
b. Major physical assessment finding:
Obesity; 2+ pulses in the lower extremities; Alert and oriented; Cranial Nerves: II – XII intact, upper extremities equal strength 5/5; decreased strength of right leg with resisted extension; patient complains of pain in posterior thigh; decreased sensation of right leg along L5 : S 1 dermatome to pin prick stimulation compared with the left; DTRs 2+ in upper and lower extremities; Cerebellar function intact—Romberg test is negative; heel-to-toe walking is steady; Positive straight leg raise on the right at 20 degrees.
c. Lab test and results:
CBC: WNL, UA dip stick: WNL, 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.
T 14.9 Injury of the back
R45.81 Self-esteem
M54.5 Low back pain
Z73.3 Stress
Z88.0 Allergy status to penicillin
Z55.0 Level of literacy
Z56.6 Other physical and mental strain related to work
Z59.6 Low income
Z72.3 Lack of physical exercise
M54.9 Spine
E66.9 Obesity
M51.36 Other intervertebral disc degeneration, lumbar region
R20.9 Unspecified disturbance of skin sensation
M62.81 Muscle weakness
Goals of care
Plan of care
Diagnostic test
CT output of the lower spine, blood tests, for example, a complete blood check and erythrocyte sedimentation rate.
Current Medications:
800mg of Ibuprofen every 4 hours (stop med)
New Medication List:
Muscle relaxer, fentanyl patch
Conservative treatments:
Bed rest for temporary periods, low-stretch high-impact exercises, particularly strolling, is the best early action (Atlas and Deyo, 2011). Physical Treatments: Spinal manipulation.
Education:
Teach patient on the use of good body mechanics.
Teach weight loss habits through good eating
Talk about the pathophysiology of the disease making sure you stress the requirements for managing and preventing back strain.
Referrals
Spinal surgeon for MRI results
Physical therapy for weakness
Situational/Clinical depression or screening
Social worker for outside resources
Nutritionist for better eating habits
Follow up
Patients might require normal follow-up in 4 weeks to observe:
At this time I will re-evaluate. Determine if medication is working or is symptoms are getting better. Discuss with the patient what the recommendations from the consultations from the other doctors. Continue to make sure the patient is compliant with home meds.
Rationale
Medication and Implementation of low back pain
In order to lessen torment Nurse practitioners can recommend clients to disengage from manual work, take bed rest and frequently to change posture to improve on the lumbar flexion. Essentially, patients’ education has to be incorporated in the treatment plan, to educate patients on how to control and mange pain and lessen the muscle strain. Additionally, physical exercise is instrumental in diverting patient’s attention from the agony, as such; various techniques can be employed such as perusing books, sitting in front of the TV and with creative ability (Nursing Care Plan for low Back Pain, 2011).
Back rub of the delicate tissue, tenderly is extremely helpful for lessening muscle fits, enhance course and diminish the damming and decrease torment. At the point when given the medication the attendant ought to evaluate the patient’s reaction to every medication.
The medications recommended in treating low back pain are opioids and Muscle relaxants (Hills, 2016). However, these two have not been viable treating the low back pain than NSAIDs and acetaminophen (Hills, 2016). On the other hand, patients with acute pain, muscle relaxants such as diazepam or cyclobenzaprine; and opiate painkillers for example acetaminophen with codeine or oxycodone offer viable treatment (Hills, 2016). However, when these medications are used that is opioids and muscle relaxants, they have to be consumed only for short term basis, two weeks at most. On the severe pain serene rest, tranquilizers, including antihistamines for instance diphenhydramine, are effective (Hills, 2016). Furthermore, it is advisable for patient who experience pain that extend to the legs, to use opiate painkillers periodically, on the other hand, to patients who experience evening uneasiness, muscle relaxants can be of great help in causing sedation at the affected areas (Hills, 2016).
Enhancing physical portability
Physical portability is checked through persistent evaluation. Nurse practitioners should evaluate patient posture and gait. Once rear torment has lessened, patients can perform individual exercises without putting strain on the affected areas i.e. the back muscles. The physical exercise on the posture and gait ought to be performed gradually and assistance should be given to patients where they face difficulties. Essentially, patients need to advise to change positions during physical exercise often from strolling, sitting to lying down. Health practitioners need to motivate and encourage patients to adopt and incorporate physical exercise into their daily routine and follow the guidelines given (Nursing Care Plan for Low Back Pain, 2011).
Instruction about health
Patients need to be educated on sitting, standing, resting and lifting heavy objects in the most appropriate manner.
Enhancing the execution of the part
Obligations connected with the part might have changed subsequent to the event of lower back agony. Once agony recuperated, patients can come back to his part of obligation once more. In any case, when the movement is affecting on the base of the back torment happens once more, it might be hard to come back to the first obligation without bearing the danger of perpetual low back agony with incapacity and sadness brought about (Nursing Care Plan for Low Back Pain, 2011).
Changing nourishment and weight reduction
Weight reduction through eating method for alteration can avert repeat of back torment, by method for the objective sustenance arrange to incorporate changes in dietary patterns to keep up a wanted weight (Nursing Care Plan for Low Back Pain, 2011).
References
2016 ICD-10-CM Diagnosis Code (n.d.).Retrieved http://www.icd10data.com/ICD10CM/Codes/M00-M99/M50-M54/M54-/M54.5
Atlas, S.J. &Deyo, RA. (2011). Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med, 16(2) 120-31.
Debar, L.L., Kindler, L., Keefe, F.J., Green, C.A., Smith, D.H., Deyo, R.A., Ames, K. &
Education and Counseling to Prevent Low Back Pain. (2016). Retrieved http://www.webmd.com/back-pain/education-counseling-low-back-pain?page=2
Feldstein, A. (2012). A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. TranslBehav Med, 2(4),523-530
Hills, E.C. (2016).Mechanical Low Back Pain Follow-up. Retrieved http://emedicine.medscape.com/article/310353-followup.
Mooney,V.(2016).Guidelines: Recovering low back pain. Retrieved http://www.spine-health.com/treatment/physical-therapy/guidelines-recovering-low-back-pain
Nursing Care Plan for Low Back Pain: Assessment, Diagnosis, Interventions, Implementation and Evaluation. (2011). Retrieved http://nursing-care-plan.blogspot.in/2011/11/nursing-care-plan-for-low-back-pain.html
Referral criteria from primary care (low back pain). (2013).Retrieved http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1227882441
