For over a decade, acute and chronic back pain has been treated with opioid analgesics also known as opiates or narcotics (such as Percocet or Oxycontin), and nonopioid analgesic, including NSAID’s (such as Naproxen and Ibuprofen). On average, 182,727,272 opioid analgesic prescriptions are dispensed annually (Dal Pan, 2016). Unfortunately, each of which is accompanied by potentially serious adverse effects. Opioids serious side effects including respiratory depression, drowsiness, nausea, constipation, addiction, and ultimately death. Although constipation does not sound like a serious side effect, it does pose the potential for serious consequences. Because of the depressed peristalsis of the gastrointestinal tract or ileus the patient can develop constipation or
My patient, MG was a 72-year-old female who came to the emergency department because of a fall in her bathroom. Her admitting diagnosis was a right hip fracture. Other concurrent health challenges she had were: hypertension (HTN), high cholesterol, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). MG was a full code status with no known food or drug allergies. They surgery she had undergone was a right hip cannulated screw. My patient contributed in care and believed that partaking as much as possible will get her healthy and home sooner. Also, she believed in independence and doing things on her own if capable. After working with MG, I attained a great amount of knowledge in knowing: the
Since the addition of Crossing the Quality Chasm six aims of quality patient care was created by the Institute of Medicine (IOM), there has been a significant change in the effectiveness and condition of patient care. Before this report came out in 2001, health care providers did not realize that they were not providing proper care to patients in addition to disorganization and complexity of standards of care. The IOM was able to determine that, “failure of system processes, poor communication, and unhealthy work environments contribute to medical errors, ineffective delivery of care, and stress among health professionals” (Winterbottom 2012). It is essential for patients to feel
Based on the progress report dated 03/21/16, the patient reports that his low back pain tweaked again, after making the bed. He went to the emergency room last week and was provided with Toradol injection. He was told it was sciatica on the right leg. Now, it is in the center of the back and sacroiliac area. Current pain level is 8/10 with pain medications. He also reports that the left side of the back and leg is aggravated by sitting between 1 to 1.5 hours.
DOI: 4/16/2012. Patient is a 29-year-old male technician who sustained injury when he was 25-feet up on a ladder when the ladder slid and he fell onto the pavement. He had an open reduction internal fixation (ORIF x 2) for a compound tibia fibula fracture and had hardware removal in 4/25/2013.
Pt. is currently in Phase 7 of the tx program. Pt. has been able to maintain abstinence from mood-altering substances, her drug screen results has shown no evidence of ongoing BZP use. During the recent quarter, Pt. has maintained a positive balance in his AMS account. Pt. maintained his full-time employment status and self-reported that he has no issues or concerns with his current financial status. Pt. remains at 130 mg. of Methadone and she reported maintain a satisfactory dosing level. During the last quartet, Pt. learned about heroin use, resentment, powerlessness and treatment progress. Pt. seemed to understand that she was completely without power, without strength, without any ability to control how much she used during her addiction.
“OK, Team! We have a new patient in Room 3B who is being admitted with a progressive (gradual, advancing) decrease in mobility (movement) of his back and legs, and increase in pain located in the lumbosacral (lower back above the tailbone of the spine) area. The patient’s Primary Care Provider has sent along Computed Tomography scans (CT, a rotating x-ray emitter, detailed internal scanner) showing spinal stenosis (narrowing of the spine causing pressure on the nerves and spinal cord causing lower back pain.) and decrease of the normal lordosis (abnormal curvature lower spine, excessive inward curvature of the spine) in the thoracic vertebrae (upper and middle back). Lumbosacral
Per the progress report dated 5/18/16, the patient complained of low back and left leg pain. Percocet decreases pain by 80% and enables him to perform light gardening and household chores. No side effects with Percocet use. He is doing well with current medications and is compliant with no aberrant behavior. Upon lumbar examination, motion is associated with increase in pain. Left seated straight leg raise is slightly positive. There is decreased sensation of the left anterior thigh. He has forward leaning stiff gait with ability for heel and toe rise.
Per the medical report dated 09/29/16, patient complains of back pain, rated as 8/10, radiating to both lower extremities, worse with standing and walking.
This patient has been taking medication because they suffered a sports injury in 2010. The pills have been prescribed from by their PCP. Therefore, the client tested positive for opiates. The client also states that they have never had any issues with drugs in the past and that they have never had any problems with their professional license or employment. I would use the Prescribed Opiates Scale (PODS) in order to assess this client. The PODS may provide both an entry point and a framework for a patient-centered clinical dialogue about the pros and cons of the use of opioid medicines for managing chronic pain. Prescription Opioids are medications that are chemically similar to endorphins. Prescription opioids usually come in pill
As per office notes dated 7/19/16, the patient complains of chronic low back pain at the localized curvature. There is radiating pain, which is increased since the fall. There is limited range of motion. Pain is exacerbated with walking, standing, and sitting. The patient had post lumbar surgery on August 2015. She states that the pain is progressively getting worse. Objective findings revealed pain in the lumbosacral region, more in the sacroiliac joint. Positive findings on fortin finger flexion test. There is limited lumbar flexion. The patient is subsequently diagnosed with lumbar sacral spondylosis; sacroiliac joint arthritis; and low back pain. Treatment plan includes diagnostic bilateral sacroiliac joint injection under ultrasound guidance. Then if the patient received good relief, then she is to proceed with sacroiliac joint radiofrequency ablation. A course of physical therapy would be appropriate since she has not had any physical therapy for increasing range of motion since her surgery 8/4/2015. Plan also includes weaning off opioid
Ms. Smith is a 42-year-old African American female born November 10, 1972. She currently lives in with her mother. She states she has one adult son from a prior marriage. Ms. Smith states she has a 2-year nursing degree from and was employed as a nurse until 2012.
to get. It had been over a year since D.B had seen a doctor, and her leg pain did warrant an evaluation by a doctor. D.B. informed me that the doctor told her she has spinal stenosis. D.B. explained to me her understanding of spinal stenosis. She explained that it is a pinching of her leg nerves in her lower back as they run through her spine. She advised she discussed options with her doctor for relieving this pain and treatment. She made it clear that she would not have an operation or other procedure on her back as she believes this would only make things worse. She stated that she doesn’t see much she can do for her pain other than what she has been doing in the past. The things she has done in the past are using aspirin and walking to keep in shape. She explained that her doctor agrees with her
As per medical report dated 4/8/16, patient complains of having more pain lately. She notes that she had continued to maintain significant improvement to her low back and leg pain as a result of the bilateral L5-S1 transforaminal epidural injection on2/2/15. She also indicates that her low back and leg pain had continued to remain improved by more than 95%. She notes
Upon assessment, Chris vital signs are now within the normal range however, he is still verbalising pain. Chris reported that there is a slight reduction of pain, from a pain score of 7, it is now 4 out of 10. After an hour, a second dose of analgesia was given to Chris and after 30 minutes another pain assessment was conducted. During the assessment Chris voiced out that he is comfortable and his pain score is now 1 out of 10, he also mentioned that before we came and checked up on him he was doing deep breathing exercises for 10 minutes, Chris said it helped him “soothes his body and reduce his pain.” These interventions are effective in managing Chris’s pain because his pain is now minimal and almost diminished compared to what he was experiencing before. To ensure that the goal is achieved, pharmacological and nonpharmacological interventions must be regularly implemented and