J.C. is a 41-year-old man who comes to the emergency department with complaints of acute low back pain
He states that he did some heavy lifting yesterday, went to bed with a mild backache, and awoke
this morning with terrible back pain, which he rates as a 10 on a 1-to-10 scale. He admits to having had
a similar episode of back pain years ago "after I lifted something heavy at work." J.C. has a past medical
history of peptic ulcer disease (Pud) related to nonsteroidal anti-inflammatory drug (NSAId) use. He is 6
feet tall, weighs 265 pounds, and has a prominent "potbelly."
What questions would be appropriate to ask J.C. in evaluating the extent of his back pain and
injury?
What observable characteristic does J.C. have that makes him highly susceptible to low back
injury?
J.C. used to take piroxicam (Feldene) 20 mg until he developed his duodenal ulcer. What is
the relationship between the two? What signs and symptoms (S/S) would you expect if an
ulcer developed?
Obtain a clear chronologic narrative of problem onset, setting, manifestation, and past medical
treatment. Principal symptoms should be described. Use the COLDERRA mnemonic to guide
questions (COLDERRA: Characteristics, Onset, Location, Duration, Exacerbation, Radiation, Relief,
Associated signs and symptoms [S/S]).
His potbelly puts undue strain on the lumbar joints, muscles, and tendons in his low back.
Piroxicam, like other NSAIDs, can precipitate peptic ulceration and gastrointestinal (GI) bleeding,
especially if taken on an empty stomach. S/S of GI bleeding include abdominal pain or other GI
discomfort and tarry, maroon, or bloody stools.
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An appropriate goal when teaching a patient who has diarrhea is that the patient
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