VNSG 1304

FOUNDATIONS OF NURSING
DEPARMENT OF VOCATIONAL NURSING
ST. PHILIPS COLLEGE
FALL 2016

CASE STUDY

J.C. is a 41-year-old man who comes to the emergency department with

complaints of 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.

1. What questions would be appropriate to ask J.C. in evaluating the extent of

his back pain and injury?
2. What observable characteristics does J.C. have that makes him highly
susceptible to low back injury?
3. 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
would you expect if an ulcer developed?
CASE STUDY PROGRESS
All serious medical conditions are ruled out and J.C. is diagnosed with lumbar
strain. The nurse practitioner (NP) orders a physical therapy consult to develop
a home stretching and back strengthening exercise program and a dietary
consult for weight reduction. J.C. is given prescriptions for cyclobenzaprine
(Flexeril) 0 mg tid x 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 to 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.
4. J.C. looks at the prescripton for cyclobenzaprine (Flexeril) and states, Im
glad you didnt give me that Valium. They gave me Valium last time and that
stuff knocked me out. How would you respond to J.C.?
5. Why do you think that cyclobenzaprine was prescribed instead of diazepam
(Valium)?
6. J.C. states, Well, I am glad Ill still be able to take my sleeping pill. True or
False? Explain.
CASE STUDY PROGRESS
J.C. asks, What is Celebrex? I hope it wont do what that Feldene did to me
years ago?
7. Why do you think it was prescribed for J.C. considering his GI history?
8. You know that it has been over 5 years since his last episode of GI bleeding.
Are there any other conditions that you need to assess for before J.C. begins
to take the celecoxib? Explain.
9. Why would the NP prescribe an NSAID rather than acetaminophen for J.C.s
pain?
10. A physical therapist teaches J.C. maintenance trainings he can do on
his own to promote back health. Identify two common exercises that would
be included.