NUR2447 Clinical Concepts

Question:

Fred is observant and organized and can answer questions correctly.

Mobility: Fred is unable to move his trunk, and this causes him distress.

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Clear the chest

Vital signs: BP/80: P: 82; R/16; temp. 37; SaO2 : 97%

Fred feels constant burning pain in his lower back, with some tingling.

Sometimes, the pain radiates down to Fred’s right leg and feels almost like an electric shock.

Fred said that his pain score of 4/10 was a result of Fred’s assessment.

Sometimes the pain is more severe and affects his ability to move.

Fred stated that Fred has had difficulty walking more than 500 metres due to his decreased activity.

Fred says that he is depressed by his circumstances and answers questions about his mood.

From day to day, mood swings are caused by the constant pain.

These can range from suicidal anger to anger and he feels constantly frustrated.

He is unable concentrate on activities and his mood swings have an impact on his family relationships.

Section 1: A:

Discuss Fred’s pain.

Asking the first questions about your son and making observations about his behavior are important.

You might use four relevant assessment tools to evaluate the different elements and reflect Fred’s pain.

Please include your reasons for using assessment tools and processes

Part B: Types Of Pain

What kind of pain does Fred feel?

Please provide reasoning.

Please describe the symptoms that Fred might experience, and give reasons.

Section 2: A: Management plan

Write down a plan of treatment that addresses Fred’s needs.

To promote optimal results, your plan must be patient-centred (physical and psychological).

You should include any treatments that might be appropriate for the type and severity of his pain.

You should not include medication in this section.

Answer:

Section 1: A Part

Fred’s pain can be assessed by assessing the patient’s muscle tension and sprain patterns after an injury such as a fall from a ladder.

To assess the intensity of low back pain, the nurse would use a visual analog scale.

The intensity of the pain would then be determined in terms “worst pain” and “no-pain” (Lalloo& Henry, 2011,).

The patient would need to indicate the exact location of the pain and explain the pattern of any tingling sensations that he may have felt after the onset of localized-pain.

A nurse professional must evaluate the patient to determine the severity, duration, and timing for pain.

In this case, radiating pain is the patient’s quality. However, other symptoms that may accompany it include tingling sensation, restricted trunk movement and psychological distress or depression.

The nurse should also record the psychosocial and behavioural symptoms that Fred experienced in the case study.

The nurse professional needs to evaluate the effect of pain on patient’s somatic and psychosocial functional status. (Song. Eaton. Gordon. Hoyle. & Doorenbos. 2015).

The nurse professional needs to evaluate the patient’s mood-fluctuations and frustrations as a result of his pain-related functional disabilities.

A patient’s use of pain management coping strategies will give information about the severity and extent of the unpleasantness he experiences (Stutts. Hirsh. George. & Robinson, 2010).

It is essential to evaluate the patient’s position, mobility, restlessness, daily activities, and cultural factors in order to subjectively assess his pain and the associated manifestations.

It is essential to determine the level of pain perception and assess the patient’s cultural background (Campbell & Edwards (2012)).

In order to validate the patient’s chronic pain pattern, it is recommended that a brief pain inventory be used (BPI).

The nurse professional would review the patient’s past medical history, and try to determine if there were any injuries or other conditions that could have contributed to the pain pattern.

The patient would have to draw a diagram of the location of his pain and give a self-rating of how severe it is.

BPI Assessment requires that the patient tracks his ongoing pain management medications as well as any factors that might increase or decrease pain intensity at any given time.

These factors can include the patient’s sleep pattern, sleeping patterns, walking, sitting, or any other general activities.

To track the impact of chronic pain on patient’s daily living activities and personal care, the nurse must use the Katz Basic Activity of Daily Living Scale (CSAT, 2012).

This tool is used to measure patient’s dependence while performing bathing activities.

The patient’s ability to bathe, dressing, toileting, transferring and continence is also evaluated. This assessment tool can be used to assess the level of self-dependence under chronic pain.

This tool evaluates the patient’s ability to perform daily activities, in light of their relationship with chronic pain.

McGill Pain Questionnaire will give a nurse professional insight into the quality of the patient’s multidimensional pain.

The MPQ intervention will help the nurse professional evaluate the pain dimensions.

The nurse professional will be able to determine whether the pain feels mild, uncomfortable, distressing or horrible.

The nurse professional may also use Chronic Pain Acceptance Questionnaire, (CPAQ), to determine the impact of chronic pain on the overall quality of life as well as behavioural outcomes. CSAT, 2012.

For the purpose of assessing the severity of pain related adversities that the patient is experiencing in his daily life, the nurse professional will ask multiple questions.

The subjective questions will require the patient to respond in numerical order from 1-6. This will allow the nurse professional to assess the truthfulness of the statements made by the patient in his daily life.

This questionnaire will give the nurse professional insight into the patient’s priority to keep the pain intensity under control, while still completing daily tasks.

The CPAQ questionnaire will help in the identification of pain control strategies that are needed for the patient being treated.

This questionnaire will highlight the patient’s perceptions as well as their impact on chronic pain.

The questionnaire will give insight into the patient’s perceptions, fears and anxieties as well as the outcomes.

Part B (Type of Pain)

Fred is suffering from sciatica nerve pain in the current clinical scenario.

Sciatica can also be called a “slipped disk” and the current patient experienced it after an accidental fall from a ladder (IQWiG (2014)).

Sciatica is characterized by radiating (low back) pain that radiates from any lower extremities to any lower back.

Sciatica pain is most common in people older than 30 years. It can also cause restriction of movement (IQWiG (2014)).

Sciatica may be associated with numbness or tingling and high-intensity, as well as impaired bladder function.

Fred’s scenario clearly shows that most of these clinical manifestations can be confirmed as sciatica.

He could develop a degenerative syndrome due to his sciatica pain (Wheeler 2016,).

Endplate segregation could result from radial strains in the annular fibrils due to trauma or torsional loads.

These events could eventually result in nerve root compression.

A lack of bone growth or facets-hypertrophy can lead to foraminal canal stenosis (Wheeler 2016,).

Insufficient peripheral blood supply will result in chronic nociception, which can have adverse consequences (Wheeler 2016).

Section 2 Part B (Pain Management).

A nurse professional must encourage the patient to do the best possible rest and to change position in order for the systematic elevation of lumbarflexion.

To reduce lumbar tension and achieve the desired results, the nurse must also show relaxation techniques to the patient.

In the current situation, an acupuncture practitioner might be able to help with the reduction of chronic low back discomfort.

In collaboration with the physiotherapist, a nurse professional needs to instruct the patient in stretching exercises, with the goal of decreasing the severity of the lumbar sprain. (Kamioka et al. 2011, 2011).

Massage therapy can be administered to help reduce muscle spasms and improve the patient’s vascular circulation.

The nurse practitioner must encourage the patient to improve mobility patterns and reduce tension in the affected area.

Lower back.

It is important to implement shared decision-making with the goal of increasing patient compliance to the recommended treatment intervention. Hofstede et. al., 2013.

To minimize errors in treatment and improve the clinical environment for patients’ psychosocial outcomes, the nurse professional must work in collaboration with other healthcare professionals.

With the goal of increasing patient trust in the recommended treatment options, it is important to have a good therapeutic relationship with the nurse professional.

This is the best way to identify the patient’s problems and understand his cultural beliefs, ideology, and pain perception (Kourkouta& Papathanasiou (2014)).

For the treatment of chronic pain, the nurse must administer cognitive behavioural therapy. This is a way to affect the patient’s emotion, cognition, behaviour, and ultimately his pain intensity (Roditi & Roinson 2011, 2011).

CBT helps patients to increase their problem solving skills and coping abilities, while also restructuring their cognitive capacities for achieving desired behavioral outcomes.

Acceptance-based interventions are also used to increase the patient’s self-perception and improve his quality of life in order to manage chronic pain.

To reduce the intensity of sciatica pain and its psychosocial effects, the patient should also learn relaxation techniques, diaphragmatic breath, autogenic training, visualization imagery, and diaphragmatic breathing.

Deep breathing and muscle relaxation exercises can help release muscle tension, as well as increase oxygen intake.

This causes a systematic decrease in pain perceptions in the patients (Roditi & Roinson (2011)).

A holistic, person-centred, individualized approach to patient care is also used. This allows the patient to determine the weight management that is necessary for managing chronic back pain.

Refer to

Ethnic differences in pain management.

Pain Management, 2(3). doi:10.2217/pmt.12.7

Assessment Tools and Resources.

The management of chronic pain in adults with or recovering from substance use disorders.

USA: Substance Abuse and Mental Health Services Administration.

Validation and validation of a short pain inventory for Brazilian pain patients.

Validation and validation of the McGill pain questionnaire-2 short form in cancer pain patients aged between 18 and 59 years.

Qualitative study on barriers and facilitators in implementing shared decision-making in multidisciplinary sciatica management:

Implementation Science.

(2014 October 9).

Overview.

Systematic Review and Metaanalysis of the Efficacy Of Acupuncture in Sciatica Treatment:

Evidence-Based Complementary or Alternative Medicine.

A pilot study evaluating the effectiveness of low-back pain interventions for female caregivers in nursing home settings: A multicenter randomization-based pilot study.

Communication in Nursing Practice.

An evaluation of the Iconic Pain Assessment Tool was done by a diverse group of pain professionals.

Pain Research and Management (16(1), 13-18.

Psychological interventions and chronic pain management: The role of psychological interventions.

Evaluation of Evidence Based Nursing Pain Management Practice.

The use of virtual human technology to investigate patient characteristics for pain assessment.

Wheeler A. H. (2016 Feb 03).

Sciatica and low back pain.