Class Talk Fall 2016

What do you assess?

The nurse monitors the neurovascular status of the extremity every 2-4 hours and promptly reports any changes to the primary provider. Each pin site is assessed very 8-12 hrs for infection (redness, swelling, pain around the pin sites, warmth, and purulent drainage). Never adjust the clamps on the frame, this is the doctors responsibility.

Are there any limitations related to mobility?

When the swelling subsides, the nurse helps the patient become mobile within the prescribed weight-bearing limits. If activity is restricted, encouragement of isometric exercise is initiated to prevent complications.

What would your d/c teaching include?

Educating the patient or caregiver about pin site care according to the prescribed protocol and any signs of infection. The patient is also instructed to check the integrity of the fixator and report any lose pins.

ACUTE LOW BACK PAIN

by Jamaica Amurao, Audrey Guila, & Jose Perez

1. What do you assess for?

For acute low back pain, we would assess by using OLD CART, ask if the patient has had acute low back pain before, I’d also take the patient’s vital signs, ask if there are other parts of the body that are in pain alongside the lower back, and review the patient’s history to see if other diseases may be the cause. I’d ask the patient if they’ve participated in any activities recently, and if they are physically active. I’d ask the patient where they work and for how many hours a week.

2. Are there any limitations related to mobility?

Most patients need to alter their activity patterns to avoid aggravating the pain. They should avoid twisting, bending, lifting, and reaching, which stresses the back. Sitting should be limited to 20 – 50 minutes or as tolerated. ADLs are to be continued and bed rest is no recommended because extended periods of bed rest and inactivity are not effective and results in deconditioning. One of the goals is to improve physical mobility; this can be achieved through an exercise program with low-stress aerobic exercises such as walking and swimming.

3. What would your discharge teaching include?

• Encourage the patient to adhere to prescribed exercise program
• Avoid activities that cause lumbar strain or twisting, such as horseback riding and weight lifting.
• Use good body mechanics and good posture to avoid recurrence of back pain
• Provide the patient with lists of suggestions on how to stand, sit, lie, and lift
• Instruct patient to avoid lifting more than one-third of body weight.
• Avoid sitting on chairs that do not provide firm back support.

ACUTE LOW BACK PAIN

by Jamaica Amurao, Audrey Guila, & Jose Perez

1. What do you assess for?

For acute low back pain, we would assess by using OLD CART, ask if the patient has had acute low back pain before, I’d also take the patient’s vital signs, ask if there are other parts of the body that are in pain alongside the lower back, and review the patient’s history to see if other diseases may be the cause. I’d ask the patient if they’ve participated in any activities recently, and if they are physically active. I’d ask the patient where they work and for how many hours a week.

2. Are there any limitations related to mobility?

Most patients need to alter their activity patterns to avoid aggravating the pain. They should avoid twisting, bending, lifting, and reaching, which stresses the back. Sitting should be limited to 20 – 50 minutes or as tolerated. ADLs are to be continued and bed rest is no recommended because extended periods of bed rest and inactivity are not effective and results in deconditioning. One of the goals is to improve physical mobility; this can be achieved through an exercise program with low-stress aerobic exercises such as walking and swimming.

3. What would your discharge teaching include?

• Encourage the patient to adhere to prescribed exercise program
• Avoid activities that cause lumbar strain or twisting, such as horseback riding and weight lifting.
• Use good body mechanics and good posture to avoid recurrence of back pain
• Provide the patient with lists of suggestions on how to stand, sit, lie, and lift
• Instruct patient to avoid lifting more than one-third of body weight.
• Avoid sitting on chairs that do not provide firm back support.

ACUTE LOW BACK PAIN

by Jamaica Amurao, Audrey Guila, & Jose Perez

1. What do you assess for?

For acute low back pain, we would assess by using OLD CART, ask if the patient has had acute low back pain before, I’d also take the patient’s vital signs, ask if there are other parts of the body that are in pain alongside the lower back, and review the patient’s history to see if other diseases may be the cause. I’d ask the patient if they’ve participated in any activities recently, and if they are physically active. I’d ask the patient where they work and for how many hours a week.

2. Are there any limitations related to mobility?

Most patients need to alter their activity patterns to avoid aggravating the pain. They should avoid twisting, bending, lifting, and reaching, which stresses the back. Sitting should be limited to 20 – 50 minutes or as tolerated. ADLs are to be continued and bed rest is no recommended because extended periods of bed rest and inactivity are not effective and results in deconditioning. One of the goals is to improve physical mobility; this can be achieved through an exercise program with low-stress aerobic exercises such as walking and swimming.

3. What would your discharge teaching include?

• Encourage the patient to adhere to prescribed exercise program
• Avoid activities that cause lumbar strain or twisting, such as horseback riding and weight lifting.
• Use good body mechanics and good posture to avoid recurrence of back pain
• Provide the patient with lists of suggestions on how to stand, sit, lie, and lift
• Instruct patient to avoid lifting more than one-third of body weight.
• Avoid sitting on chairs that do not provide firm back support.

ACUTE LOW BACK PAIN

by Jamaica Amurao, Audrey Guila, & Jose Perez

1. What do you assess for?

For acute low back pain, we would assess by using OLD CART, ask if the patient has had acute low back pain before, I’d also take the patient’s vital signs, ask if there are other parts of the body that are in pain alongside the lower back, and review the patient’s history to see if other diseases may be the cause. I’d ask the patient if they’ve participated in any activities recently, and if they are physically active. I’d ask the patient where they work and for how many hours a week.

2. Are there any limitations related to mobility?

Most patients need to alter their activity patterns to avoid aggravating the pain. They should avoid twisting, bending, lifting, and reaching, which stresses the back. Sitting should be limited to 20 – 50 minutes or as tolerated. ADLs are to be continued and bed rest is no recommended because extended periods of bed rest and inactivity are not effective and results in deconditioning. One of the goals is to improve physical mobility; this can be achieved through an exercise program with low-stress aerobic exercises such as walking and swimming.

3. What would your discharge teaching include?

• Encourage the patient to adhere to prescribed exercise program
• Avoid activities that cause lumbar strain or twisting, such as horseback riding and weight lifting.
• Use good body mechanics and good posture to avoid recurrence of back pain
• Provide the patient with lists of suggestions on how to stand, sit, lie, and lift
• Instruct patient to avoid lifting more than one-third of body weight.
• Avoid sitting on chairs that do not provide firm back support.

ACUTE LOW BACK PAIN

by Jamaica Amurao, Audrey Guila, & Jose Perez

1. What do you assess for?

For acute low back pain, we would assess by using OLD CART, ask if the patient has had acute low back pain before, I’d also take the patient’s vital signs, ask if there are other parts of the body that are in pain alongside the lower back, and review the patient’s history to see if other diseases may be the cause. I’d ask the patient if they’ve participated in any activities recently, and if they are physically active. I’d ask the patient where they work and for how many hours a week.

2. Are there any limitations related to mobility?

Most patients need to alter their activity patterns to avoid aggravating the pain. They should avoid twisting, bending, lifting, and reaching, which stresses the back. Sitting should be limited to 20 – 50 minutes or as tolerated. ADLs are to be continued and bed rest is no recommended because extended periods of bed rest and inactivity are not effective and results in deconditioning. One of the goals is to improve physical mobility; this can be achieved through an exercise program with low-stress aerobic exercises such as walking and swimming.

3. What would your discharge teaching include?

• Encourage the patient to adhere to prescribed exercise program
• Avoid activities that cause lumbar strain or twisting, such as horseback riding and weight lifting.
• Use good body mechanics and good posture to avoid recurrence of back pain
• Provide the patient with lists of suggestions on how to stand, sit, lie, and lift
• Instruct patient to avoid lifting more than one-third of body weight.
• Avoid sitting on chairs that do not provide firm back support.

What do you assess: focused hx & physical exam; neurologic testing, discomfort/pain (OLDCART), previous successful pain control methods, work/recreational activities, environmental variables, posture, position changes, gait, spinal curve, leg length, pelvic crest & shoulder symmetry, paraspinal muscles, nerves (DTR’s, sensations, muscle strength).

Limitations in mobility: not to remain on bed rest (result in deconditioning), avoid prone positioning, avoid twisting, lifting above waste level, lumbar strain and forward flexion position. As comfort is achieved, an exercise program is gradually initiated.

D/C teaching: good body mechanics & posture; teach how to sit, stand, lie, lift properly; provide list of suggestions to make long term changes; role-related responsibility modifications; weight reduction if obese; *chart 42-2