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Discussion

Case Study Help Needed!

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 L4- L5 area. The emergency physician provides the following discharge orders: Bed rest with bathroom privileges for two days. Apply ice pack to lower back for 20 minutes several times a day for the first 48 hours, and then starting day three 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 six hours and 5 mg cyclobenzaprine (Flexeril) t.i.d. After two days of bed rest, sit in chair three times per day for no more than 20 minutes. 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 one week. See physician in one week for further evaluation.

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?

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    Just a warning, you are probably not going to getting help until you show some thoughts on what you think so far. Most folks here are pretty helpful, but want you to put forth some effort first. They don't want to spoon feed you the answer.

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    ^ What the PP has stated is true...why do you think ice should be applied before heat therapy?

    What are the mechanism of action for ibuprofen and cyclobenzaprine?

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    • Author

    Sorry about that... I should have included what I already had!

    Explain the rationale for the administration of ice for 48 hours followed by the application of heat.

    - You shouldn't use heat within the first 48 hours because heat increases blood flow and therefore will increase the amount of swelling and pain at the site of injury. Instead, ice should be used which will help to reduce the amount of swelling due to vasoconstriction as a result of the cold. Using heat after the first 48 hours will increase blood flow and speed healing while easing tight muscles.

    Explain the rationale for the administration of the ibuprofen and muscle relaxer.

    - Giving them in conjunction with each other is beneficial. The Ibuprofen will continue the job of the ice by reducing swelling and inflammation. The Flexeril will give the muscles a chance to relax. This will make ambulation and movement easier.

    What are the expected patient outcomes for the patient in this case study?

    - Describes pain as

    - The patient will be able to tolerate sitting in chair three times a day, no more than 20 minutes each time, by day 4.

    - The patient will be able to ambulate freely around home and yard, as tolerated, gradually increasing activity after the first week.

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    It sounds like you have the bases covered pretty well. Not sure what else you might want to add. Maybe someone else will chime in.

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