Question

Case Study
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”

 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?

What observable characteristics does J.C. have that makes him highly susceptible to low back injury?

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.  

What points would you include when teaching J.C. about muscle relaxants?

What is Celecoxib and how does it work?  What advantage dos this medication have over Tylenol?

What can be some long-term complications of using Celecoxib?

Answer 1

1)There is no relation between the two. backache is due to the heavy lifting at the workplace.

2) the signs and symptoms that are expected

Dull pain in the stomach

Weight loss

Not wanting to eat because of [pain

nausea

Bloating

Feeling easily full

Burping or acidic reflux

Heartburn

Pain that may improve that improve when you eat, drink,

Tiredness, shortness of breath, paler skin

Dark, tarry stools

vomit that 's bloody

3) He had lifted heavy in the previous day and he has past history of backache. he is 6 feet and 275lb weight and also has a prominent potbelly.

4) whether he do any exercise, if so how many hours, what kind of exercises does he do? and what kind of diet does he follow?

5) JC must be taught about the potential side effects,

Drowsiness, dizziness, headache, fatigue, sleepiness (should not drive after taking this medicine)

Interaction with alcohol( it may lead to fatal)

urinary retention, and also may develop its own habit

the discontinuation must be gradual

6) celecoxib is a nonsteroidal anti-inflammatory drug. It works by reducing hormones that cause inflammation and pain in the body

7) Faster control over pain, it involves in inhibits of cox1 and cox2 while acetaminophen the involvement is very less, so it results in the lack of efficiency.

8) serious skin problems

Serious liver problems

kideney problems

hypertention

dizziness

breathing difficulty, shortness of breaths