Case study of chronic pain

 

Option 2: Chronic Pain
John Ryan is a 66 year old male with a history of chronic back pain related to spinal stenosis, and degeneration of the left hip. He
has been reviewed in the Outpatient Pain Clinic on a monthly basis for the past 4 months, after a sudden increase in pain and
changes in his level of activity. His pain specialist is concerned about his level of function at home and has referred John to the
comm unity nursing service for an initial assessment and review.
Medical history
John has spinal stenosis which was diagnosed in his early forties. He has significant pain in his lower back and hip, slight {L} leg
weakness and slight loss of sensation in both his feet. He is generally fit, but slightly overweight.
His most recent observations are as follows:

o 8?: 135/80

0 P: 60 bpm,

o R: 18 bpm,

0 Height: 180 cm

a Weight 95 kg.
Current medications:

o ibuprofen 400 mg 6qh

o Baclofen 20 mg 80

o Oiazepam 25mg – 5mg PRN
Social history:
John is an engineer with a mining company who spends his time equally between the mine in a remote location as a Fly in, Fly
Out (FIFO) worker. He has an office location in the can for his locally based work.
John is married to Donna and they have two adult children, both married. Donna works part time as office manager for a small
company and is hoping they can retire soon so they can travel and see more of their grandchildren-
Their daughter Jean (37 years) lives with her husband and three small children in a large coastal community, 45 minutes drive
from John and Donna’s home. Their son Robert (39 years} lives with his partner in another major interstate city.
Current issue
John reports being woken up by pain at night. During the day, he has pain if he sits still for too long, but also if he walks or rides
a bike for too long, and the tune he can spend on these activities varies. John states he is sick of the hours of focused exercise he
needs to do to keep his core muscles strong and to keep him mobile and flexible. He Is also sick of always having to take pain
medications that have not been effective. in addition he reported being ‘fed up with being aware of my back and hip all the time
and feeling limited because of them‘. Recently. whilst playing with his four-year-old grandchild. swinging him through the air.
John experienced a significant flare in his level of pain.
John has been alternating between being angry about having ongoing pain. and being depressed because he is increasingly
unable to do the activities he has always done. lie was a keen hiker and had dreams of spending his retirement hiking in
NRSG366 Assessment task 1:
This assessment asks you to function in the role of the community nurse. It is asking you to provide a discussion of how you would plan and implement safe and effective strategies for meeting the needs of your client.
So you need to identify those needs – 2 of them.
You are required to identify issues related to the person and then provide a discussion regarding strategies to improve their health outcomes.
Don’t worry about the word “priorities” in the assessment description – this seems to be triggering the acute care focus of placing care in order of acuity. You can choose any issue from the scenario to discuss as long as it provides for a detailed discussion/argument.
Levett- Jones Clinical Reasoning Cycle – this is embedded in the discussion. You don’t need headings. The reader will see that you have: 1). Considered the pt 2). Collected information 3). Processed information 4) Identified problems/issues 5) Established goals.
Suggested Structure:
1. Introduction – overview of following paper
2. Discussion of initial visit including 1-5 of the clinical reasoning cycle. The purpose of this initial visit is so the community nurse can provide interventions for better health outcomes in consultation with the client. You already have the medical/social ‘handover’ and so this provides the opportunity to gain firsthand information from the client so that the interventions are going to be workable for the person (Jessica or John). If they are not manageable for the client then they won’t do them and you won’t therefore be supporting them to reach better health outcomes. If you need to do any assessment they would be done at this visit but they are only a springboard for you to then make your goals and so don’t waste too much of your word count on clinical assessments that are not related to the rest of your discussion. Detailed patho will also use your word count and is back ground – so use carefully and in context.
3. Issue 1: discussion/argument from many angles on how you can work with Jessica or John to improve their health based on the issue you have selected.
4. Issue 2: again – detailed discussion of the management of the issue.
5. Conclusion
You can build on the scenario – eg Jessica states difficulty with….and so in the planning phase this was considered and strategies included….
You don’t need to discuss evaluations unless you provide a plan and a discussion if that isn’t working then you would consider plan B.
Finally: “There is evidence of both depth and breadth of reading. A considered argument is presented, and is supported by adequate and appropriate evidence” 50%.
I will expect at least 1 reference per 200 words, peer reviewed journals or text books. ‘https’ are not part of this count and so are on top of the 8 expected.

If you choose to involve another health professional then you need to still identify the part the community nurse would play as well as that of the other professional – don’t just outsource.

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