What is the most appropriate initial nursing intervention for a patient experiencing mild lower back pain related to prolonged sitting at work?

B) Educate the patient on proper ergonomic adjustments

A) Recommend over-the-counter pain medication

B) Educate the patient on proper ergonomic adjustments

C) Suggest complete bed rest for a few days

D) Advise applying heat packs to the lower back area

Based on the patient's initial assessment findings, which nursing intervention should be prioritized to address her mild lower back pain?

B) Educate the patient on proper ergonomic adjustments at her workstation

A) Administer prescribed pain medication

B) Educate the patient on proper ergonomic adjustments at her workstation

C) Schedule an immediate MRI to rule out serious conditions

D) Encourage complete bed rest to alleviate pain

Which intervention has the patient implemented to help alleviate her lower back pain according to the follow-up assessment?

B) Incorporating regular stretching exercises

C) Taking prescribed medication

D) Undergoing physical therapy sessions

Which ergonomic adjustment is most likely to have contributed to the patient's reported improvement in lower back pain?

A) Using a chair with lumbar support

B) Increasing screen brightness

D) Adding a decorative desk lamp

What is the most important lifestyle change the nurse should reinforce to help the patient prevent future episodes of lower back pain?

B) Engage in regular core-strengthening exercises

A) Continue practicing mindfulness techniques

B) Engage in regular core-strengthening exercises

C) Monitor blood pressure daily

D) Increase dietary calcium intake

Which of the following actions by the patient indicates effective management of her lower back pain?

B) Engaging in light physical activities like walking and yoga

A) Taking pain medication daily

B) Engaging in light physical activities like walking and yoga

C) Increasing sedentary activities to avoid discomfort

D) Ignoring early signs of discomfort

Which of the following lifestyle modifications mentioned in the case is most likely contributing to the patient's improved spinal alignment and reduced pain levels?

C) Core-strengthening exercises

What is the primary reason the nurse suggests a basic blood panel for the patient during the follow-up visit?

B) To assess for any underlying issues contributing to fatigue and stiffness

A) To monitor the patient's hydration status

B) To assess for any underlying issues contributing to fatigue and stiffness

C) To evaluate the patient's compliance with her exercise regimen

D) To check for signs of infection

What dietary recommendation should the nurse make to a patient with mild anemia characterized by slightly low hemoglobin levels?

A) Increase intake of leafy greens

B) Decrease intake of dairy products

D) Increase intake of carbonated beverages

A patient presents with fatigue and a slightly low hemoglobin level of 11.5 g/dL. Which dietary recommendation should the nurse prioritize to help address the patient's potential mild anemia?

A) Increase intake of leafy green vegetables.

B) Consume more dairy products.

Pain - Nursing Case Study

Pathophysiology

• Primary mechanism: Nociception - Pain begins when nociceptors (pain receptors) in the skin or internal organs detect harmful stimuli, such as injury or inflammation. This triggers the transmission of signals to the spinal cord and brain, where pain is perceived.

• Secondary mechanism: Inflammation - In response to injury, the body releases chemicals like prostaglandins and cytokines, which can sensitize nociceptors, enhancing pain perception. This is crucial in conditions like arthritis, where inflammation directly causes pain.

• Key complication: Chronic pain - If pain signaling persists, it can lead to changes in the nervous system, resulting in chronic pain where pain occurs without a clear ongoing injury or stimulus. This can complicate treatment and affect quality of life.

Patient Profile

Demographics:

32-year-old female, office worker

History:

• Key past medical history: Occasional tension headaches

• Current medications: None

• Allergies: None

Current Presentation:

• Chief complaint: Mild lower back pain

• Key symptoms: Dull ache in the lower back, no radiation, worsens with prolonged sitting

• Vital signs: Blood pressure 118/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, SpO2 99% on room air

Section 1

Initial Assessment Findings:

During the initial assessment, the patient reports that her mild lower back pain has been present for about two weeks and seems to worsen with prolonged sitting at her job. She describes the pain as a dull ache, rated as a 4 out of 10 on the pain scale, which occasionally intensifies after extended periods of inactivity. Upon physical examination, there is no visible swelling or redness in the lower back area, and palpation does not elicit any acute tenderness. The patient demonstrates a full range of motion with some discomfort noted during forward flexion of the spine. Neurological assessment indicates normal reflexes and sensation in the lower extremities, ruling out any radiculopathy or nerve involvement at this stage.

The patient's posture is noted to be slightly hunched, which she attributes to her prolonged desk work. Her gait is steady, and she does not report any recent history of trauma or significant physical activity changes. Given her sedentary lifestyle, the initial assessment suggests that the pain may be related to poor ergonomics and muscle tension rather than a more serious underlying condition. The nursing goal is to address these ergonomic factors and provide education on posture and exercises to alleviate symptoms and prevent progression to chronic pain. This will also include discussing the potential benefits of regular breaks and stretching exercises during her workday to reduce strain and improve muscle conditioning.

Section 2

Response to Interventions:

Two weeks following the initial assessment, the patient returns for a follow-up visit. She reports moderate improvement in her lower back pain after implementing the recommended ergonomic adjustments and incorporating regular stretching exercises into her routine. She has rearranged her workstation to promote better posture, using a chair with lumbar support and adjusting her computer monitor to eye level to prevent hunching. The patient now takes short breaks every hour to stand and stretch, which she believes has reduced the frequency of her pain episodes.

During the follow-up assessment, the patient rates her pain as a 2 out of 10, noting that it has become less frequent and intense. She describes a sense of increased flexibility and comfort throughout the day. On physical examination, her posture appears more aligned, and she demonstrates improved forward flexion of the spine with minimal discomfort. Vital signs remain stable, with a blood pressure of 118/76 mmHg, a heart rate of 72 beats per minute, and a respiratory rate of 16 breaths per minute. The patient expresses satisfaction with the progress she has made and is eager to continue with her current regimen to maintain improvement.

The nurse reinforces the importance of maintaining these healthy habits and introduces additional strategies to further enhance her recovery. These include engaging in core-strengthening exercises to support the lower back and integrating mindfulness techniques to manage any residual discomfort. The patient is encouraged to continue monitoring her symptoms and to return for another evaluation in four weeks, or sooner if she experiences any significant changes or worsening of her condition. This ongoing monitoring will ensure that any potential complications are identified early and managed effectively.

Section 3

Four weeks later, the patient returns for her scheduled evaluation, reporting continued improvement in her lower back pain and overall functionality. She has diligently followed the recommended ergonomic practices and stretching exercises, complementing them with the newly introduced core-strengthening and mindfulness techniques. The patient now rates her pain as a 1 out of 10, indicating rare and mild discomfort that does not interfere with her daily activities. She has also started engaging in light physical activities, such as walking and yoga, which she finds beneficial in maintaining her flexibility and strengthening her back muscles.

During the physical examination, the nurse observes further improvement in the patient's posture and spinal alignment. The patient exhibits a full range of motion in her lower back, with no pain reported during movement. Her vital signs remain within normal limits, with a blood pressure of 116/74 mmHg, a heart rate of 70 beats per minute, and a respiratory rate of 15 breaths per minute. The patient expresses satisfaction with her progress and confidence in her ability to manage her symptoms effectively.

The nurse commends the patient for her adherence to the regimen and discusses the importance of maintaining these lifestyle changes to prevent future episodes of back pain. As a proactive measure, the patient is provided with educational materials on recognizing early signs of discomfort and advised on when to seek medical attention. The nurse schedules a follow-up visit in three months to assess long-term outcomes and ensure sustained well-being. This structured plan aims to empower the patient to manage her condition effectively and prevent any potential setbacks.

Section 4

Three months later, the patient returns for her follow-up visit as scheduled. During the initial assessment, the nurse notes that the patient continues to report a pain level of 1 out of 10, indicating persistent but minimal discomfort. The patient shares that she has been consistent with her regimen of ergonomic practices, stretching, and core-strengthening exercises. She has also maintained her routine of walking and practicing yoga, which she feels helps in sustaining her back strength and flexibility. The patient mentions occasionally experiencing mild stiffness in her lower back, particularly after long periods of sitting, but states that it resolves quickly with stretching.

The nurse conducts a thorough physical examination, observing that the patient's posture remains improved and her spinal alignment is normal. There is still a full range of motion in the lower back with no pain elicited during movement. Vital signs are stable: blood pressure is 118/76 mmHg, heart rate is 72 beats per minute, and respiratory rate is 14 breaths per minute. These findings suggest that the patient continues to manage her condition effectively. However, the nurse notices that the patient looks slightly more fatigued than during previous visits.

To ensure a comprehensive evaluation, the nurse suggests a basic blood panel to rule out any underlying issues that may be contributing to the patient's occasional stiffness and fatigue. The patient agrees, and the nurse explains that this proactive approach will help in identifying any potential areas that need attention. The patient is advised to maintain her current regimen and to monitor her symptoms closely, particularly in relation to any changes in her physical activities or lifestyle that might affect her back health. The nurse schedules another follow-up visit in three months, aiming to continue supporting the patient's journey toward long-term well-being.

Section 5

Three months later, the patient returns for her follow-up visit, and the nurse conducts another thorough assessment. The patient reports that her pain level remains at a 1 out of 10, with occasional mild stiffness in her lower back. Her fatigue has slightly increased since the last visit, particularly noticeable after long workdays. She continues to adhere to her regimen of ergonomic practices, stretching, core-strengthening exercises, walking, and yoga. Despite these efforts, she mentions that the fatigue is starting to impact her motivation to exercise as regularly as she did before.

The nurse reviews the results of the basic blood panel conducted during the previous visit. The results show a slightly low hemoglobin level at 11.5 g/dL, with a normal range being 12.0 to 15.5 g/dL for females. Other values, including white blood cell count, platelets, and electrolytes, are within normal limits. The slightly low hemoglobin level may explain the patient's increased fatigue and suggests the possibility of mild anemia. The nurse discusses these findings with the patient, emphasizing the importance of dietary adjustments to include more iron-rich foods, such as leafy greens, lean red meats, and iron-fortified cereals, to help address the anemia.

To support the patient's overall health and well-being, the nurse advises integrating short, frequent breaks during long periods of sitting to alleviate stiffness and improve circulation. The patient is encouraged to continue her current exercise regimen while monitoring her energy levels and making adjustments as needed. The nurse schedules another follow-up appointment in three months to reassess the patient's condition and progress. This approach ensures ongoing support and early intervention should any new issues arise, guiding the patient towards sustained improvement in her back health and energy levels.