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Case Study, Chapter 41, Management of Patients With Musculoskeletal Disorders

1. Jane Wagner, a 22-year-old patient, presents to the emergency department with low back pain after falling at work. MRI shows pulled muscles and ligaments in her lower back. She is discharged with orders for bed rest, ice then heat therapy, ibuprofen, a muscle relaxer, and follow up with her doctor in a week. 2. John Ringer, a 32-year-old patient, is admitted with a infected gunshot wound in his right leg and osteomyelitis. He is placed on bed rest with his leg elevated and gets saline soaks, antibiotics, and pain medication. Nursing interventions include assessing vital signs and pain levels.

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274 views

Case Study, Chapter 41, Management of Patients With Musculoskeletal Disorders

1. Jane Wagner, a 22-year-old patient, presents to the emergency department with low back pain after falling at work. MRI shows pulled muscles and ligaments in her lower back. She is discharged with orders for bed rest, ice then heat therapy, ibuprofen, a muscle relaxer, and follow up with her doctor in a week. 2. John Ringer, a 32-year-old patient, is admitted with a infected gunshot wound in his right leg and osteomyelitis. He is placed on bed rest with his leg elevated and gets saline soaks, antibiotics, and pain medication. Nursing interventions include assessing vital signs and pain levels.

Uploaded by

Ahmad Baolayyan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Case Study, Chapter 41, Management of Patients With

Musculoskeletal Disorders

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 a 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 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.

The patient has an acute traumatic injury to the back muscles and
ligaments so the application of ice is used to decrease edema and
inflammation. After 48 hours, the edema and inflammation have
resolved, and application of heat is used to promote circulation and
decrease muscle spasms that can result.

b. Explain the rationale for the administration of the ibuprofen


and muscle relaxer.

The ibuprofen reduces inflammation and decreases pain. The


cyclobenzaprine relaxes the skeletal muscles and decreases muscle
spasms.

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

• Patient verbalizes adequate pain relief.


• Patient resumes normal mobility within one week of discharge.
• Patient verbalizes how to use back-conserving body mechanics when
performing activities of daily living.
• Patient resumes role-related activities upon physician release

2. John Ringer, a 32-year-old patient, is admitted to the medical-


surgical unit following a débridement of a right lower leg wound
secondary to a gunshot wound. The wound is infected with
Staphylococcus aureus. The patient is diagnosed with osteomyelitis.
The patient’s right lower leg is warm to touch and edematous, and
the patient states that the extremity has a constant pulsating pain
that increases with any movement of the leg. The patient’s
sedimentation rate and leukocyte rates are elevated. The physician
orders the following for the patient:

Admit to medical unit with


 Vital signs every 4 hours
 Bed rest
 Elevate affected leg on pillows above the level of the heart
 Warm sterile saline soaks for 20 minutes three times per day,
with wet-to-dry dressing change
 Levofloxacin (Levaquin), 750 mg IVPB every day
 Renal profile, CBC with differential in the morning
 Regular diet with high-protein supplement shakes
 Vitamin C, 250 mg po twice a day
 Hydrocodone, 1 tablet po every 4 hours as needed for pain
 Docusate sodium (Colace) 100 mg b.i.d.
(Learning Objective 6)

a. The patient asks the nurse why he has to stay in bed. The nurse
should provide what rationale for this measure?

The bone is weakened by the infection, and providing bed rest and
elevation of the limb will help decrease pain and promote healing.

b. What nursing interventions should the nurse provide the


patient?

• Assess vital signs and pain as to quality, onset, duration, intensity


using pain scale, and presence of radiation before and 30 minutes
after administering pain medication.
• Assess right lower leg for presence of odor, purulent drainage, or
increased inflammation, and report findings to physician and obtain
culture of wound as directed by the physician.
• Monitor neurovascular status of right leg every four hours and as
needed. Report abnormal sensation, increased edema, or decrease or
absence of pulses to physician immediately.
• Provide wet-to dry sterile warm saline soaks x 20 minutes using a K-
pad wrapped over the wet-to dry saline dressing every eight hours.
• Elevate right lower leg on pillow supports above the level of the
heart.
• Provide 2 to 3 liters of fluids (noncaffeinated) per day and monitor
intake and output and renal profile carefully. Report abnormalities to
physician immediately.
• Provide diet high in protein and Vitamin C to keep positive nitrogen
balance and promote healing of wound. Provide fresh fruits and
vegetables to provide high fiber to promote normal bowel elimination.
Provide one serving of buttermilk or yogurt each day to help prevent
superinfection from long-term antibiotic therapy.

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