Problem
Joan is a 30-y.o. Caucasian female, registered nurse who works in transitional care. She presents to employee health, stating, "My back is killing me. I was helping to transfer a patient, and he moved. I thought he was going to fall, so I twisted around to grab onto him and wrenched my back. The pain is terrible, and I can barely walk." She further states that she is in so much pain that she cannot work and needs a work excuse.
Joan, is a healthy young adult, married with a 5-y.o. daughter. No significant family history. Past medical history of fractured coccyx as a teenager when she fell during cheerleading practice; no sequelae. Has smoked one-half pack of cigarettes a day since age 15 but is trying to quit. Denies alcohol or drug use. No known drug allergies. Denies any change in bowel/bladder habits.
Current meds:
Medroxyprogesterone acetate (Depo Provera) injection for birth control every 13 weeks. She is supposed to take calcium, but "I always forget, and it constipates me anyway."
Assessment
• What would your focused assessment include? Any "red flags" for potentially serious conditions related to her lower back pain?
• What would your initial differential diagnoses include?
Diagnosis
• Using current, evidence-based clinical guidelines, what diagnostic tests would you order at this time?
• What, if any, consults would you consider?
Plan
• What is your immediate plan of care? Include any pharmacological and nonpharmacological measures. Discuss the use of NSAIDs versus muscle relaxants.
• What patient education would you include for the immediate problem?