Author Question: All serious medical conditions are ruled out, and J.C. is diagnosed with lumbar strain. The nurse ... (Read 38 times)

Frost2351 · **on:** Jun 25, 2018

All serious medical conditions are ruled out, and J.C. is diagnosed with lumbar strain. The nurse practitioner (NP) orders a physical therapy consultation to develop a home stretching and back-strengthening exercise program and a dietary consultation for

weight reduction. J.C. is given prescriptions for cyclobenzaprine (Flexeril) 10 mg tid 3 days only, and celecoxib (Celebrex) 100 mg/day for 3 months. He receives
the following instructions: heat applications to the lower back for 20 to 30 minutes four times a day (using
moist heat from heat packs or hot towels), no twisting or unnecessary bending, and no lifting more than
10 pounds. J.C. is instructed to rest his back for 1 or 2 days, getting up only now and then to move around
to relieve muscle spasms in his back and strengthen his back muscles. He is given a written excuse to
stay off work for 5 days and, when he returns to work, specifying the limitation of lifting no more than 10
pounds for 3 months. He is instructed to contact his primary care provider if the pain gets worse.
J.C. looks at the prescription for cyclobenzaprine (Flexeril) and states, I'm glad you didn't
give me that Valium. They gave me Valium last time and that stuff knocked me out. How
would you respond to J.C.?

Why do you think that cyclobenzaprine was prescribed instead of diazepam (Valium)?

J.C. states, Well, I'm glad I'll still be able to take my sleeping pill. True or False? Explain.

Question 2

J.C. is a 41-year-old man who comes to the emergency department with complaints of acute low back pain.

He states that he did some heavy lifting yesterday, went to bed with a mild backache, and awoke
this morning with terrible back pain, which he rates as a 10 on a 1-to-10 scale. He admits to having had
a similar episode of back pain years ago after I lifted something heavy at work. J.C. has a past medical
history of peptic ulcer disease (Pud) related to nonsteroidal anti-inflammatory drug (NSAId) use. He is 6
feet tall, weighs 265 pounds, and has a prominent potbelly.
What questions would be appropriate to ask J.C. in evaluating the extent of his back pain and
injury?
What observable characteristic does J.C. have that makes him highly susceptible to low back
injury?
J.C. used to take piroxicam (Feldene) 20 mg until he developed his duodenal ulcer. What is
the relationship between the two? What signs and symptoms (S/S) would you expect if an
ulcer developed?

nmyers · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

The skeletal muscle relaxant cyclobenzaprine might also cause extreme drowsiness, as well as
dizziness and blurred vision. He needs to change position slowly to avoid orthostatic hypotension.
General instructions also include to avoid driving and using sharp objects until the response to the
drug is known, but he is to stay off work for 5 days and in bed for the first 1 to 2 days.
Cyclobenzaprine is a centrally acting skeletal muscle relaxant. There is no evidence that muscle
relaxants help when used for more than 1 week.
Diazepam is a sedative hypnotic, anticonvulsant, and muscle relaxant. It is a Schedule IV drug
because of the risk for abuse.
False You need to remind him that skeletal muscle relaxants, such as Flexeril, cannot be taken with
other central nervous system (CNS) depressants such as sleeping pills (hypnotics), sedatives, or
alcohol, because increased CNS depression and mental confusion might result.

Answer to Question 2

Obtain a clear chronologic narrative of problem onset, setting, manifestation, and past medical
treatment. Principal symptoms should be described. Use the COLDERRA mnemonic to guide
questions (COLDERRA: Characteristics, Onset, Location, Duration, Exacerbation, Radiation, Relief,
Associated signs and symptoms S/S).
His potbelly puts undue strain on the lumbar joints, muscles, and tendons in his low back.

Piroxicam, like other NSAIDs, can precipitate peptic ulceration and gastrointestinal (GI) bleeding,
especially if taken on an empty stomach. S/S of GI bleeding include abdominal pain or other GI
discomfort and tarry, maroon, or bloody stools.