Question

In: Nursing

linda is a 45 year old female with mild to moderate lumbar pain and knee pain...

linda is a 45 year old female with mild to moderate lumbar pain and knee pain that has persisted for more than six months. she has mild relief with rest and non- steroidal anti-inflammatory drugs. her pain worsens with exercise
what are the advantages/ disadvantages of the option
should she try one therapy or treatment option at a time or consider a combination approach why?
would she benefit from beginning her treatment with less invasive options? Are there downsides to this approach?

Solutions

Expert Solution

Linda have mild to moderate lumbar pain and knee pain that has persisted for more than six weeks . She has mild relief with rest and NSAIDs use.

Pain is aggravated by exercise.

Lower back pain or lumbar pain can have causes that are not due to underlying disease. Examples include overuse such as working out or lifting too much, prolonged sitting and laying down, sleeping in an uncomfortable position, wearing a poorly fitting backpack.

The causes of lumbar pain and knee pain is may be due to many reasons. It includes laboratory tests like X-ray, MRI, CT scan, etc.

The diagnosis may be -

Sciatica, herniated disc or slipped disc, muscle strain, arthritis, etc .

but as per case, pain is increasing by exercise, so , it might be herniated disc or sciatica.

Most people assume if they have knee pain, it is due to a problem with the knee joint. This is not always the case. While the discomfort can be due to a knee condition, it can also be the result of a disc protrusion or a pinched nerve in your lower back

** Herniated disc -

The vertebrae that form the spine in the back are cushioned by discs. These discs are round, like small pillows, with a tough, outer layer (annulus) that surrounds the nucleus. Located between each of the vertebra in the spinal column, discs act as shock absorbers for the spinal bones.

A herniated disc is a fragment of disc nucleus that is pushed out of the annulus (outer layer) into spinal canal through tear or rupture in the outer layer. Due to this displacement, the disc presses on spinal nerves, often producing pain.

A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.

Herniated disc cause knee pain also because the nerve roots act as telegraph lines to other parts of the body, a common complication of disc hernia took is that it can cause pain that is felt in other parts of the body.

A lumbar herniated disc or lumbar spinal stenosis that causes compression of the L3 nerve root in mid-back region may cause knee pain and weakness. One may also experience pain in the front of your thigh, side of hip, and the groin region.

** Sciatica

Knee pain that cannot be traced back to a physical injury may be caused by a problem in lower back. The muscles around knees are powered by nerves that originate in lower spine. Irritation or compression of these nerves at their spinal origin causes symptoms, commonly known as sciatica, which may include knee pain and/or weakness.

Knee pain and back pain are may be the symptoms of sciatica. Because of the compression of the L4 spinal nerve root, it could be the reason behind the knee pain.

Common causes of compression are spinal stenosis or herniated disc.

# Initial treatment includes conservative and non surgical treatment.

- Patient is advised to maintain a low, painless activity level for few weeks, as it may help in decreasing inflammation of spinal nerve. Bed rest is not recommended.

- Herniated disc is normally treated with NSAIDs if the pain is mild or moderate like paracetamol, strong pain killers like codeine or muscle relaxant like diazepam.

- An epidural steroid injection may be performed utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.

- Physical therapy is recommended. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises.

- Pain medication and muscle relaxants may also be beneficial in conjunction with physical therapy.

- SURGERY - Lumbar spine surgery.

Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc.

* It is performed through a small incision down the center of the back over the area of the herniated disc. During this procedure, a portion of the lamina may be removed. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. A small opening is made between the two vertebrae to gain access to the herniated disc. After the disc is removed through a discectomy, the spine may need to be stabilized. Spinal fusion often is performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed.

- Follow up -

* Specific instructions are given after surgery and pain killers are given. Some patients may benefit from supervised rehabilitation or physical therapy after surgery.
## She may get benefit from non invasive treatment but if she would not be if it from non invasive treatment then surgical treatment is required.


Related Solutions

J.A., a 68-year-old female with a herniated lumbar disc at L4, is scheduled to have an...
J.A., a 68-year-old female with a herniated lumbar disc at L4, is scheduled to have an L4 lumbar laminectomy using a posterior approach. She has a history of low back pain, osteoarthritis in the left hip, and hypertension. She is taking the following medications: Metoprolol 50 mg PO BID; last dose last night Ibuprofen 600 mg TID; last dose yesterday morning Garlic supplement daily; last dose yesterday morning Subjective Data Has low back pain that radiates down her right leg...
A 48-year-old woman presents with a chief complaint of knee pain, with aching and stiffness on...
A 48-year-old woman presents with a chief complaint of knee pain, with aching and stiffness on arising but easing up during the day. She does not engage in any type of exercise or activity. She is a grava 4, para 4 with a 10-year history of hypertension and a diagnosis of diabetes in the past 2 years. She calls it “sugar” and states that this condition is controlled with diet. She recently began working at a local Wal-Mart and has...
Linda Shaw is a 56-year-old female who was brought to the hospital by EMS on December...
Linda Shaw is a 56-year-old female who was brought to the hospital by EMS on December 23, 2019. She presented to the emergency department with complaints of shortness of breath. She has had a productive cough for 3 days with a fever. She is admitted to the hospital with pneumonia and septicemia. She has a history of cellulitis, iron deficiency, high cholesterol and hypertension. She has an allergy to penicillin and vancomycin. She is taking ramipril 10mg daily, atorvastatin 20...
A 56-year-old Asian patient comes to the outpatient clinic with complaints of mild chest pain. When...
A 56-year-old Asian patient comes to the outpatient clinic with complaints of mild chest pain. When assessing this patient, the nurse must take into account the cultural characteristics of people of Asian descent. What are three culturally mediated characteristics that are important in caring for adults of various cultures?
Fatima is a 36-year-old female with a megaloblastic anemia. An initial diagnosis of moderate anemia, jaundice,...
Fatima is a 36-year-old female with a megaloblastic anemia. An initial diagnosis of moderate anemia, jaundice, and neurological complications was made. Based on the patient’s laboratory test results, she was diagnosed as having a vitamin B12 deficiency. Her CBC results showed MCV of 87 fl. The Schilling test demonstrated that the deficiency was due to the absence of intrinsic factor. This patient can be diagnosed with a megaloblastic anemia due to a lack of intrinsic factor. The patient is suffering...
nursing care plan for Linda Pittmon, a 74 -year old female patient who is a noncompliant...
nursing care plan for Linda Pittmon, a 74 -year old female patient who is a noncompliant diabetic, and frequently stays at the local homeless shelter. She has been admitted to the floor with complaints of numbness in her right foot and ankle. Mrs. Pittmon states she has had numbness for years but “now I can’t feel it at all, and my toes don’t look the right color.”. The care plan must have 5 priority nursing diagnosis.
The patient in this case is a 57 year old female that has experienced joint pain...
The patient in this case is a 57 year old female that has experienced joint pain for ~ 5 years. Her joints are becoming progressively deformed with swelling. Her physician decides to order a synovial fluid analysis, including a cell count, differential, RF, protein, glucose, LDH, and crystal analysis if indicated. He also orders blood work: Rheumatoid Factor and glucose level. Her results are as follows: Synovial Fluid Analysis Serum Results Appearance Yellow/Cloudy Protein 3.7 g/dL Glucose 81 mg/dL 100...
A 2-year-old female with spinal muscular atrophy type 1 presented to the emergency department in moderate...
A 2-year-old female with spinal muscular atrophy type 1 presented to the emergency department in moderate respiratory distress. Physical assessment showed a bell-shaped configuration of thorax and ribs, and moderate intercostal and substernal retractions. The patient was receiving bilevel positive airway pressure (BiPAP) at home with the following settings: spontaneous mode, pressure 18/10 cm H2O, room air, with 4-hour sprints twice a day. BiPAP was initiated on the following settings: spontaneous/timed mode rate of 22, pressure 20/10 cm H2O, and...
A 45-year-old male presents with a chief complaint of pain in the abdominal area. The patient...
A 45-year-old male presents with a chief complaint of pain in the abdominal area. The patient had pain with palpation of the abdomen and standard x-rays were negative. What other types of radiographic, diagnostic studies can be performed? What are the advantages of these studies over standard x-rays and is one study best?
Nursing Care Plan ) Case Study Linda Shaw is a 56-year-old female who was brought to...
Nursing Care Plan ) Case Study Linda Shaw is a 56-year-old female who was brought to the hospital by EMS on December 23, 2019. She presented to the emergency department with complaints of shortness of breath. She has had a productive cough for 3 days with a fever. She is admitted to the hospital with pneumonia and septicemia. She has a history of cellulitis, iron deficiency, high cholesterol and hypertension. She has an allergy to penicillin and vancomycin. She is...
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT