low back pain and anxiety in 85yo female resident-HELP!

[cargal]

In our personal care/assisted living , I have an 85 yo ambulatory female with short term memory loss and acute anxiety. When she came around 4-5 months ago, she suffered from mild anxiety related to loss of home, new surroundings etc. She is aware of her forgetfulness, has a marvelous sense of humor, ie when she is given her meds , she says "Are these my birth control pills" -she was never married and states she had never dated more than casually! She's a hoot! The problem is that she fell about 6 weeks ago and now suffers from "grabbing" pain B/L low back. Darvocet, vioxx prn are prescribed. She has been receiving only Darvocet, which takes the edge off only. The problem- X-rays show no fracture, and the pain is exacerbating her anxiety. She stays in her room except for meals and repeatedly questions her prognosis and reports her pain. The MD prescribed Buspar. When I was showering her for an aid on Sat evening, she showed me bruises on her knee, and when I questioned them she stated that she has been biting them, I am the only one she trusted to tell, and she said "I'm so ashamed". Of course I reassured her that it was nothing to be ashamed of and that it was the right thing and the healthy thing to tell me, and I talked to her about positive and negative coping methods and tried to reinforce them over the weekend. Her attention span is very short, and reverts immediately to the anxiety mode. I feel that the other staff (by experience) will not continue these efforts and the woman will fall through the cracks- and the MDs will just medicate. What kind of injury can cause this kind of pain-would it be soft tissue? Spasms? And what can I do to help her? Please advise. Thanks very much in advance.

[oramar]

Where I work{LTC} this person would be trans fered to a hospital and admitted as an in patient. She would recieve a bone scan, a CT and a consult to a orthopedic surgeon and an internest. X-rays done after a fall do not always show a fracture, some times they take a while to show up, she also needs to be worked up for other things. The poor little thing.

[mustangsheba]

As Oramar says, early on x-rays don't always reveal fractures, especially if it's a compression fracture. If she is still having severe pain after six weeks, she does indeed need to be re-evaluated. Sometimes whoever reads the x-rays looks for where they think a fracture should be and go no futher, i.e., LOL, so look at hips and ignore spine and/or pelvis. She's already becoming depressed and other systems will start to go. It's time to call the doc and jump up and down a little. Tell him what's happening and your concerns. At the very least, he will probably get a repeat x-ray and you can go from there. Pain in our elderly is one of my soap boxes, so you may be sorry you asked. Keep us posted.

[PPL, BSN, RN]

Yep, I agree with the above posters, in fact, the first thing I thought of is aortic aneurysm too, possibly disecting after the fall? They frequently C/O back pain, but compression fx is a good bet too. She needs to be evaluated and not written off because of her age. An antidepressant may be in order too and might really help get her anxiety under control. Go for it, if your patient is willing. Good luck.

[prmenrs, RN]

What about an aortic anuerysm? Have the docs really examined her? maybe I've been watching ER too much??? Hope you can solve the problem. There's a poster who's a GNP. I think his name is Tim--maybe he can help.

[PFryRN]

I am fairly new to the LTC scene as a "new" nurse of 1 year, but my FIRST thought, when I read the post, was possibly that a UTI may be involved here. I find that UTI symptoms come in many non-textbook forms ie. when a resident falls (thatis not typically at high risk), or all of a sudden become confused, c/o back pain rather than burning, urgency or frequency etc...there is a good chance a UTI may be contributing to her symptoms. I was also wondering Did she bang her head when she fell? Does she have osteoporosis? Does she take coumadin or ASA? Is her pain refered pain? etc.....From what I read in the post, my apporach now (after xrays, pain control etc) would to be to find the cause of the fall (assuming she was not a high risk pt)? Was her back injured before she fell? Is she afebrile? Does she have urinary c/o? etc.. etc.. Let me know how she made out..I hope I was helpful. Have a good day.