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.
b. Explain the rationale for the administration of the ibuprofen and muscle relaxer.
c. What are the expected patient outcomes for the patient in this case study?
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?
b. What nursing interventions should the nurse provide the patient?
