Question

J.C. is a 41-year-old man who comes to the ED 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.  He admits to having had a similar episode of back pain “after I lifted something heavy at work”.  J.C. has a past medical history of peptic ulcer disease related to the use of NSAIDS.  He is 6 feet tall and weighs 275lbs and has a prominent “potbelly”

1. J.C. used to take Motrin 600mg until he developed his duodenal ulcer.  What is the relationship between the two? What are the signs and symptoms would you expect if an ulcer developed?
2. What observable characteristics does J.C. have that makes him highly susceptible to low back injury?
3. What questions would be appropriate to ask J.C. in evaluating the extent of his back pain

All other serious conditions were ruled out and J.C. is diagnosed with lumbar strain.  The provider orders a physical therapy consult for development of a program which is includes stretching, strengthening and exercise program with a dietary consult.  J.C. is given a prescription for Flexeril 10mg TID x 10 days. He is ordered to use an ice pack for 20 minutes every hour every day.  He is ordered to rest his back for 1 to 2 days.  He should only get up when needed to relieve muscle spasms in his back which will strengthen his back muscles. He is instructed to return to the ED for worsening pain.  

4. What points would you include when teaching J.C. about muscle relaxants?
5. What is Celecoxib and how does it work?  What advantage dos this medication have over Tylenol?
6. What can be some long-term complications of using Celecoxib?

Answer 1

Q

Use of Motrin 600 along with NSAIDS such as ibuprofen can lead to damaging/ bleeding intestine or stomach, that is the relationship with duodenal ulcer and Motrin 600

Q

signs and symptoms include

Pain- sometimes relieved while eating

Pyrosis-burning sensation in stomach

Vomiting

Constipation

Bleeding- bleeding through the passage of melena also called tarry stools

Q

BMI is 37.29 which is over weighted, and reference also suggests that the person is not fit, and has a pot belly. The best chance is the IVDP due to the weight lift.

Q

since the drug can make you drowsy, if you feel drowsy do not use any machineries, avoid driving, and do not take alcohol.

You can’t stop the drug suddenly, slowly reduce dosage and then you can stop as by physician

Withdrawal symptoms are inevitable once you stop the medicine

Other than this you may feel, sleepy, light headed, weak, depressed, sometimes hallucinations too

Q

Celecoxib is a non-steroidal anti-inflammatory (NSAID) drug which used to treat swelling/ Inflamation due to arthritis.