Question

Lori a patient with no previous medical and a 19 year old, 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 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 400mg of ibuprofen every 6 hours and 5mg cyclobenzoprine (flexeril) 3 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. 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 for the ibuprofen and muscle relaxer. c. what are the expected patient outcomes for the patient in this case study?

Answer 1

a.Usually after an injury the muscles and ligaments are damaged ,if the damage occurs there is fluid collection in it causing edema and swelling. To prevent further discomfort and inflammation the blood supply should be ceased this is possible by application of cold compress which restricts the blood flow .

After 48 hours the swelling will settle down making the muscle to spasm due to decreased blood supply hence to prevent this the circulation has yo be enhanced whivh is possible by hot application.

b.Ibuprofen is a non steroidal anti inflammatory drug which blocks the enzyme cycloxygenase and reducing or preventing the pain.

Muscle relaxant are used to relax the muscle contracture , rigidity and spasm

c.The expected patient outcomes innthis patient are

• Relief from pain
• Able to do daily activity by self
• Able to mobilise freely without any support after discharge
• Has knowledge about the body techniques ,sitting posture etc.,
• Has knowledge about the action and effects of medication