J.C. asks, "What is Celebrex? I hope it won't do what that Feldene did to me years ago."Why do you think it was prescribed for J.C., considering his gastrointestinal (GI) history?

Question

It has been over 5 years since his last episode of GI bleeding. Are there any other conditions
that you need to assess for before J.C. begins to take the celecoxib? Explain.

Why would the NP prescribe an NSAID rather than acetaminophen for J.C.'s pain?

A physical therapist teaches J.C. maintenance exercises he can do on his own to promote
back health. Identify two common exercises that would be included.

In addition to learning exercises, J.C. needs to learn proper body mechanics for lifting
and performing day-to-day activities. Which statement by J.C. indicates a need for further
instruction?
a. "I will bend my knees when I lean forward."
b. "When lifting heavy boxes, I will bend at the waist."
c. "I will not lift anything above the level of my elbows."
d. "I will avoid standing in one position for a long period of time."

Answer 1

It was prescribed to reduce the chronic inflammatory processes causing his back pain. Celecoxib
(Celebrex) is a cyclooxygenase-2 (COX-2) inhibitor that selectively inhibits prostaglandins
responsible for joint pain. It is a newer member of the NSAIDs and has fewer GI adverse effects
in comparison with older NSAIDs because of its COX-2 selectivity. However, GI toxicity is still a
possibility, and, especially with his history, he needs to be very careful to watch for GI bleeding.

The FDA has issued a Black Box Warning for all NSAIDs. This warning includes information that
patients with cardiovascular disease or risk factors for cardiovascular disease might be at greater risk
for serious cardiovascular events such as thrombotic events, myocardial infarction (MI), and stroke.
J.C.'s cardiovascular status and risk factors need to be assessed closely.

Although it is frequently used for chronic joint pain, acetaminophen is an analgesic and antipyretic
but lacks anti-inflammatory properties and does not stop the damage caused by chronic
inflammatory processes.

Single knee-to-chest: Lie on the back with the knees bent at 90-degree angle and feet flat on the floor.
Clasp the hands behind one knee at a time and gently pull toward the chest; hold 5 to 10 seconds.
Alternate knees. Complete 6 to 10 repetitions at least twice a day. This can also be done from a
seated position; as you lean forward, extend your arms and touch the floor.

Abdominal curl: Lie on the back with the knees flexed and feet flat on the floor, with arms extended
beside the knees. Inhale deeply. Tuck chin and exhale while slowly lifting the shoulders from the
floor. Hold this position for 5 seconds, continuing to exhale and inhale while slowly returning to
resting position.
Pelvic tilt: Lie on the back with the knees flexed and feet flat on the floor. Inhale deeply. Exhale
slowly as you tighten the buttocks and abdomen, pressing back into the floor and tilting your
pelvis toward the ceiling. Hold for 5 to 10 seconds while exhaling, then relax. Complete 6 to 10
repetitions at least twice a day.
Hamstring stretch: Sit with one leg extended on the bed and the other leg off the side of the bed.
Bend forward, reaching the hands toward the foot of the extended leg, and hold 10 to 30 seconds,
then relax. Turn around and repeat with the other leg outstretched. Repeat 6 to 10 times at least
twice daily.

Answer: b
When lifting a heavy object, it is important to bend at the knees, not the waist, and stand up
slowly while holding the object close to the body.