Question

1. Jane Wagner, a 22-year-old patient with no previous medical history, presents to the emergency department with complaint of low back pain after slipping on a wet floor at work and falling. The patient states that the pain is constant aching and radiates down both legs (sciatica). The MRI shows pulled muscles and ligaments surrounding the LA- L5 area. The emergency physician provides the following discharge orders: Bed rest with bathroom privileges for 2 days. Apply ice pack to lower back for 20 minutes several times a day for the first 48 hours, and then starting day 3 and on, apply a heating pad for 20 minutes on and 20 minutes off several times per day for the next several days, as needed, to relieve pain. Take 400 mg of ibuprofen every 6 hours and 5 mg cyclobenzaprine (Flexeril) three times a day. Limit sitting to 30 minutes at one time Ambulate around home and yard, as tolerated, gradually increasing activity. Avoid twisting, bending, or reaching for objects. Avoid lifting anything more than 5 pounds of weight for 1 week. See physician in 1 week for further evaluation. (Learning Objective 1) a. Explain the rationale for the administration of ice for 48 hours followed by the application of heat. Explain the rationale for the administration of the ibuprofen and muscle relaxer What are the expected patient outcomes for the patient in this case study? b. c.

Answer 1

Answer

Q. No. a. Answer :

Rationale for the administration of ice for pain:

* cold application can reduces the pain by increasing (anesthetize) numb ness on the site.

* cold application can constict the blood vessels and decreases the blood flow to the site and controls the hemorrhage.

* and it can reduces the inflammation and swelling or edema.

* it can apply only for 10-20 minutes at a time because continues application leads to continues decreased blood supply leads to poor wound healing.

* so with in 48 hours cold application means in this time patient may have severe pain to control this pain and swelling cold application is necessary. After that we can use hot application.

Followed by hot application

* heat application can relieve the local pain mainly stiffness at muscles and joints.

* it will helps in wound healing by proper blood circulation.

* increases the patient in comfortable.

Q. No. b. Answer

Ibuprofen :

* it is non steroidal anti inflammatory drugs.

* the prostaglandins are pain causing hormones or chemicals.

* ibuprofen will reduces the production of these prostaglandins so that the pain may come down.

Muscle relaxers :

Cyclobenzaprin

* it is one of the muscles relaxant.

* during pain there will be a stiff ness of muscle.

* so it will relax the skeletal muscle with out interfering it's functions.

* so that the patient can able to move the parts.

* it can use along with physiotherapy exercises.

Q. No. c. Answer :

Expected patient out comes:

* pain may reduced by using cold and heat application .

* reduces the inflammation and swelling by using non steroidal anti inflammatory drugs like ibuprofen.

* reduces muscles spasms and pain by using muscle relaxers like Cyclobenzaprin.

* after using all these client may walk with support and next with out support by 3 - 6months.

* because he is only 22 yrs early also he can Ready depending upon nutritional and functional status of the client.

These are the expected outcomes.