Topic 4: Workplace Injury – Back Pain

Answer

 Topic 4: Workplace Injury – Back Pain

Question 1

Outline the context and a brief description of the health issues of the case study?

My Response

Occupational back injury seems to have resulted in both physical and psychological implications. The key physical impact in this case is the back pain. On the other hand, back pain and other additional issues such as being forced to stay out of work for 4 months and being unable to carry out activities of daily living as well as sleep difficulties may have resulted in psychological implications. The patient should be assessed for depression due to newly observed behavior in which she tends to avoid socialization or her refusal to access services. Alternation of meloxicam and panadol therapy seems to be ineffective in this case, since she has been experiencing constant back pain for four month regardless of taking the above medications. The patient requires counseling services to help her cope with the changes and its implications. Lastly, but not the least, the extent and the nature of the sustained back injury should be properly investigated to inform proper treatment.

Question 2

Describe the underlying pathophysiology and symptomatology the person may experience due to the chronic condition?

My Response

Chronic back pain due to back injury and other implications seems to have contributed to development of depression. The patient may have experienced spinal cord injury since she presents with telltale symptoms such as constant back pain and the inability to conduct her activities of daily living. Spinal cord injury causes various symptoms such as bowel incontinence, bladder incontinence, paralysis of the upper and/or lower limbs, and chronic pain. The above symptoms of spinal cord injury may have significant social and psychological effects, which may affect the functioning of the affected person, which in this case may have caused depression and social self-interest (Fuseini, Aniteye, & Alhassan, 2019). Stress due to inability to carry out activities of daily living and having to stay out of work may have contributed to development of depression (Wang et al., 2014). Depression may as well be attributed to the use of meloxicam. Meloxicam may cause side effects such as depression, confusion, dizziness, insomnia, back pain, and anxiety (Prescribers’ Digital Reference (PDR), 2019). Apart from stopping for use of Meloxicam therapy due to the potential side effects, paracetamol (panadol) should be stopped due to risks associated with its long term use. Paracetamol may cause fatal brain, kidney, and liver damage. In addition, paracetamol may cause cognitive effects such as sleepiness or euphoria; which have important implications in this case (Sharma & Mehta, 2014).

Question 3

Outline the 'KEY' assessment criteria (data) you would include for the person i.e. what information/ data is necessary in order to develop a plan of care for the person within the context outlined in the case scenario (be specific to the case scenario).

My Response

            Key assessment criteria should focus on assessment of the nature of back injury, possibility of depression and appropriateness of the current medications, which are meloxicam and panadol. Chronic back pain may be due to conditions such as osteoporosis, osteoarthritis, ruptured or bulging disks, muscle strain, or ligament strain. Hence, the above conditions should be included in the differential diagnosis for the patient.  Osteoporosis is associated with the development of compression fractures in the spinal vertebrae resulting in nerve compression; hence, chronic back pain. Osteoathritis leads to spinal stenosis or narrowing of the space round the spinal cord thus resulting in chronic lower back pain. Ruptured or bulged disks result in nerve compression chronic back pain.  Strained back muscles or ligaments is associated with a sudden awkward movement or repeated heavy lifting that can lead to painful muscle spasms. Symptoms such as tingling sensations, numbness or weakness in booth or one leg may indicate possibility of nerve compression (Zoladz, 2018). The nurse should evaluate whether the patient presents with depression telltale symptoms such as loss of enjoyment and interest in usual activities, depressed mood, and decreased activity and reduced energy (American Psychiatric Association (APA), 2015).  

Question 4

Include in your discussion a brief outline of the relevant diagnostic and ongoing tests (including biochemistry, hematology, cytology etc.) associated with the chronic disease.

My Response

            Physical assessment should include testing of the range of motion to zero in the problem area and identify involved nerves.  Spine X-ray is indicated to assess the potential cause of the back pain. Spinal X-ray will help rule-in or rule-out differential diagnoses such as osteoporosis, osteoarthritis, ruptured or bulging disks, muscle strain, or ligament strain, which may be the cause of chronic back pain. Biochemical tests include detection of pro-inflammatory and anti-inflammatory cytokines. Pro-inflammatory cytokines include TNF-α which indicates spinal cord injury, chronic constriction injury, and rheumatoid arthritis.  Other pro-inflammatory cytokines such as IL-1 (general) indicates rheumatoid arthritis, IL-1 α (spinal cord injury or rheumatoid arthritis), IL-1β (spinal cord injury, gouty arthritis, intervertebral disc degeneration, and rheumatoid arthritis), and TGF- β that may indicate complex regional pain syndrome. Detection of anti-inflammatory cytokines such as IL-11 may indicate inflammatory arthritis, IL-13 may indicate rheumatoid arthritis, IL-4 may indicate spinal cord injury and/or rheumatoid arthritis. Other anti-inflammatory cytokines including IL-6 (intervertebral disc degeneration or rheumatoid arthritis) and IL-10 (excitotoxic spinal cord injury, intervertebral disc degeneration, rheumatoid arthritis, and/or complex pain syndrome) are also important biochemical determinants of diagnosing the cause of back pain (Kaufman & Carl, 2013).  Urine test (biochemical test) and blood test (haematological tests) to rule-out of other suspect issues such as kidney infection or kidney stones, which may cause back pain. Magnetic resonance imaging and computed tomography scan are also indicated to assess for soft tissue damage such as back ligament or muscle strain. In addition, an electromyogram may be necessary to assess muscle and nerve damage (Fritz, 2017). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria by the APA (2015) should be used to evaluate whether the patient has depression or not.

Question 5

Outline briefly the developmental considerations for the person. You will need to review developmental theory such as Erikson in your Fundamentals text from first year.

My Response

            With reference to Erikson’s (1975) stages of psychosocial development theory the nurse falls within the early middle adulthood (range 40 to 50 years of age).  Developmental considerations for the patient include career needs and associated issues, whether she support her old parents or not, and her family life. Reproductive health issues should also be taken into consideration. Her reproductive health needs will be determined by whether she at pre-menopausal stage or have reached menopause stage.  Besides, she is premenopausal stage hence the increased risk of osteoporosis (Erikson, 1975; Fritz, 2017). The patient may be experiencing menstrual irregularities as an indication of progression towards menopause. Many demands appropriate for her age including career life, family life, and to support old parents may be increasingly stressful and may predispose her to depression (Chung, 2018).

Question 6

Identify and explain nursing management (Physical, psychological, social). Also, three key nursing interventions, management approach (i.e. education) , self-management to  assist the patient. Evidence based approaches, nurse’s role in the provision for optimal outcome.

My Response

            Physical management for back injury for the patient include regular exercises to improve endurance level and physical strength. They include abdominal and back muscle exercises to improve flexibility and build muscle strength, and help maintain a healthy weight (Zoladz, 2018).  Indicated psychological management include use of interpersonal psychotherapy and cognitive behavioural therapy to foster treatment of depression. The patient is also in need of social support from co-workers and the husband to reduce the risk of or to manage depression (World Health Organization, 2018). Three nursing interventions for managing chronic back pain increase physical exercises, pharmacotherapy, and weight loss.  Pharmacotherapeutic interventions may include use of tricyclic antidepressants and selective serotonin reuptake inhibitors should also be considered for proper management of depression (World Health Organization, 2018). Patient education is a management approach that is important to help her avoid movements that may strain or twist her back (Zoladz, 2018).  The patient’s self-care ability should be improved to help he cope with changes as well as manage chronic back pain and depression.

Question 7

Potential problems associated with the chronic condition and cues ( signs + symptoms) the nurse would assess and observe for.

My Response

Back pain may gradually improve with self-care and home treatment. However, no sign of improvement can be seen despite having stayed at home for four months, which is alarming. Urgent care is necessary since back pain may signal serious potential problems such as bladder and bowel problems; especially bladder and bowel incontinence, and lower body paralysis (Fritz, 2017). In addition, depression may lead to other life threatening effects such as suicidal ideation, suicidal attempts, or suicide (Wang et al., 2014). The nurse should also assess on whether observed depression, dizziness, insomnia, back pain, and anxiety are side effects of meloxicam use (PDR, 2019). In addition, the nurse should assess whether use of panadol may have caused side effects such as fatal brain, kidney, liver damage, sleepiness and/or euphoria (Sharma & Mehta, 2014).