1. A Four Letter Word BACK PAIN Bianca Moses Spring 2013

2. SPINAL ANATOMY

3. Vertebra

4. SPINAL ANATOMY Lumbar Spine Vertebra

5. SPINAL ANATOMY Lumbar Spine Vertebra

6. SPINAL ANATOMY Lumbar Spine Vertebra

7. SPINAL ANATOMY Lumbar Spine Spinal Cord Vertebra

8. SPINAL ANATOMY Lumbar Spine Nerve Root Spinal Cord Vertebra

9. SPINAL ANATOMY Lumbar Spine Nerve Root Spinal Cord Lumbar Disc Vertebra

10. SPINAL ANATOMY Lumbar Spine Nerve Root Spinal Cord Lumbar Disc Nucleus Vertebra

11. SPINAL ANATOMY Lumbar Spine Nerve Root Spinal Cord Lumbar Disc Nucleus Annula Vertebra

12. ANATOMY OF MOVEMENT

26. ANATOMY OF INFLAMMATION

27. Disc itself can cause pain “Discogenic pain”

28. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain”

29. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain” Most pain comes from inflammation which puts pressure on spinal cord thus transmitting pain down nerves

30. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain” Most pain comes from inflammation which puts pressure on spinal cord thus transmitting pain down nerves

31. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain” Most pain comes from inflammation which puts pressure on spinal cord thus transmitting pain down nerves Enough pressure on spinal cord causes no signal transmission down spinal cord and results in numbness

32. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain” Most pain comes from inflammation which puts pressure on spinal cord thus transmitting pain down nerves Enough pressure on spinal cord causes no signal transmission down spinal cord and results in numbness X

33. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain” Most pain comes from inflammation which puts pressure on spinal cord thus transmitting pain down nerves Enough pressure on spinal cord causes no signal transmission down spinal cord and results in numbness X

34. ANATOMY OF INFLAMMATION Disc itself can cause pain “Discogenic pain” Most pain comes from inflammation which puts pressure on spinal cord thus transmitting pain down nerves Enough pressure on spinal cord causes no signal transmission down spinal cord and results in numbness Where you feel pain or lack thereof, depends on the location of the injury X

35. ANATOMY OF DERMATOMES Disc itself can cause pain “Discogenic pain” Where you feel pain or lack thereof, depends on the location of the injury

36. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

37. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

38. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

39. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

40. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

41. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

42. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury

43. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury S1

44. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury S1

45. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury L5

46. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury L5

47. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury L4

48. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury L4

49. ANATOMY OF DERMATOMES Where you feel pain or lack thereof, depends on the location of the injury L3

50. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES

51. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES

52. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES S1, S2

53. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES S1, S2

54. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES L4, L5

55. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES L4, L5

56. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES L3, L4

57. Where you feel pain or lack thereof, depends on the location of the injury ANATOMY OF DERMATOMES L3, L4

58. RESULT ON VERTEBRAE

76. Nerve Root Impingement

77. RESULT ON VERTEBRAE Nerve Root Impingement

78. RESULT ON VERTEBRAE Osteoarthritis

79. RESULT ON VERTEBRAE Osteoarthritis

80. RESULT ON VERTEBRAE Osteoarthritis

81. RESULT ON VERTEBRAE

105. WHAT CAN A NURSE DO?

106. Teach proper body mechanics

107. WHAT CAN A NURSE DO? Teach proper body mechanics

108. WHAT CAN A NURSE DO? 25 lbs of force on spinal disc Teach proper body mechanics

109. WHAT CAN A NURSE DO? 75 lbs of force on spinal disc Teach proper body mechanics

110. WHAT CAN A NURSE DO? 100 lbs of force on spinal disc Teach proper body mechanics

111. WHAT CAN A NURSE DO? 150 lbs of force on spinal disc Teach proper body mechanics

112. WHAT CAN A NURSE DO? 220 lbs of force on spinal disc Teach proper body mechanics

113. WHAT CAN A NURSE DO? 220 lbs of force on spinal disc Teach proper body mechanics ???? lbs of force on spinal disc

114. WHAT CAN A NURSE DO? 220 lbs of force on spinal disc Teach proper body mechanics Weight loss ???? lbs of force on spinal disc

115. WHAT CAN A NURSE DO? 220 lbs of force on spinal disc Teach proper body mechanics Weight loss ???? lbs of force on spinal disc Every extra pound of body weight Adds 5-10 lbs of pressure on your spine

116. WHAT CAN A NURSE DO? 220 lbs of force on spinal disc Teach proper body mechanics Weight loss Low impact exercise ???? lbs of force on spinal disc Every extra pound of body weight Adds 5-10 lbs of pressure on your spine

117. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise ???? lbs of force on spinal disc

118. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection

119. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection Ergonomics

120. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection Ergonomics Sleep on side with knees flexed and a pillow between knees

121. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection Ergonomics Sleep on side with knees flexed and a pillow between knees Sleep on back with roll under knees to flex hips

122. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection Ergonomics Sleep on side with knees flexed and a pillow between knees Sleep on back with roll under knees to flex hips Teach avoidance of pro-inflammatory foods Sugar Oils Trans Fats Dairy Grain Fed Meats Red Meat/Processed meat Refined Grains MSG

123. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection Ergonomics Sleep on side with knees flexed and a pillow between knees Sleep on back with roll under knees to flex hips Teach avoidance of pro-inflammatory foods Cold (acute) or Heat (after 24 hrs)

124. WHAT CAN A NURSE DO? Teach proper body mechanics Weight loss Low impact exercise Shoe selection Ergonomics Sleep on side with knees flexed and a pillow between knees Sleep on back with roll under knees to flex hips Teach avoidance of pro-inflammatory foods Cold (acute) or Heat (after 24 hrs) Med Teaching

125. PATIENT: SUBJECTIVE INFO

126. “Woken up at 3am by the pain”

127. PATIENT: SUBJECTIVE INFO “Woken up at 3am by the pain” “Excruciating pain in lower back”

128. PATIENT: SUBJECTIVE INFO “I can’t move bit without in any direction, even a little horrible pain” “Woken up at 3am by the pain” “Excruciating pain in lower back”

129. PATIENT: SUBJECTIVE INFO “I can’t move bit without “I can’t bend I can’t lie in any direction, even a little horrible pain” or move at all…I can’t sit, I down, I can’t do anything” “Woken up at 3am by the pain” “Excruciating pain in lower back”

130. PATIENT: SUBJECTIVE INFO “I can’t move bit without “I can’t bend I can’t lie in any direction, even a little horrible pain” or move at all…I can’t sit, I down, I can’t do anything” “Woken up at 3am by the pain” “Excruciating pain in lower back” “When lifting a bucket of ice at work yesterday, I had a feeling of ‘release’ in my lower back, but it didn’t hurt, it just felt weird, like a ‘give’”

131. PATIENT: OBJECTIVE INFO

132. Physically fit 20 yo female, BMI 22, no previous health Hx

133. PATIENT: OBJECTIVE INFO Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic

134. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic

135. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt

136. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk

137. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10

138. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion

139. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex

140. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex

141. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex

142. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex

143. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex

144. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex

145. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+)

146. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+)

147. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+)

148. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+)

149. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+)

150. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+)

151. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+)

152. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+)

153. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+), trendellenburg test (+)

154. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+), trendellenburg test (+) (-)(+) Not Good

155. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+), trendellenburg test (+)

156. PATIENT: OBJECTIVE INFO Employed as a waitress; full time student Physically fit 20 yo female, BMI 22, no previous health Hx Seeking attention at urgent care clinic Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk Pain is 9/10 out of 10 Movement is guarded, limited range of motion Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+), trendellenburg test (+)

157. SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO

158. “I have a difficult time getting comfortable in bed” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO

159. “I have a difficult time getting comfortable in bed” “Sitting, standing or laying in the same position for longer than a few minutes causes pain” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO

160. “When its bad, sitting is just sneezing, coughing or just lifting a foot while sitting causes too much pain to bear” “I have a difficult time getting comfortable in bed” “Sitting, standing or laying in the same position for longer than a few minutes causes pain” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO

161. “When its bad, sitting is just “Ibuprofen will bad, it can’t even sneezing, coughing or just lifting a foot while sitting causes too much pain to bear” “I have a difficult time getting comfortable in bed” “Sitting, standing or laying in the same position for longer than a few minutes causes pain” touch the pain. The pain is always there.” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO sometimes help, but when the pain is really

162. “When its bad, sitting is just “Ibuprofen will bad, it can’t even sneezing, coughing or just lifting a foot while sitting causes too much pain to bear” “I have a difficult time getting comfortable in bed” “Sitting, standing or laying in the same position for longer than a few minutes causes pain” touch the pain. The pain is always there.” “My leg gets hot spots that burn or intense itching that can’t be soothed or scratched” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO sometimes help, but when the pain is really

163. “When its bad, sitting is just “Ibuprofen will bad, it can’t even sneezing, coughing or just lifting a foot while sitting causes too much pain to bear” “I have a difficult time getting comfortable in bed” “Sitting, standing or laying in the same position for longer than a few minutes causes pain” touch the pain. The pain is always there.” “My leg gets hot spots that burn or intense itching that can’t be soothed or scratched” “Some parts of my leg or butt cheek go numb or feel like static on TV” Patient is uninsured” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO sometimes help, but when the pain is really

164. “When its bad, sitting is just “Ibuprofen will bad, it can’t even sneezing, coughing or just lifting a foot while sitting causes too much pain to bear” “I have a difficult time getting comfortable in bed” “Sitting, standing or laying in the same position for longer than a few minutes causes pain” touch the pain. The pain is always there.” “My leg gets hot spots that burn or intense itching that can’t be soothed or scratched” “Some parts of my leg or butt cheek go numb or feel like static on TV” Patient is uninsured” “Sometimes if feels like a knitting needle being pushed through my heel” SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO sometimes help, but when the pain is really

165. SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

166. 30yo female, BMI 22, moderately active SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

167. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

168. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

169. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms Reports trauma from 10 years ago and frequently “throws back out” SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

170. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms Reports trauma from 10 years ago and frequently “throws back out” Significant weakness in right leg AEB falls to right when walking on toes or heels SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

171. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms Reports trauma from 10 years ago and frequently “throws back out” Significant weakness in right leg AEB falls to right when walking on toes or heels Full time employment with no physical demands SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

172. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms Reports trauma from 10 years ago and frequently “throws back out” Significant weakness in right leg AEB falls to right when walking on toes or heels Full time employment with no physical demands Pain is currently 3/10 or 4/10, but during flare ups pain is 8/10 SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

173. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms Reports trauma from 10 years ago and frequently “throws back out” Significant weakness in right leg AEB falls to right when walking on toes or heels Full time employment with no physical demands Pain is currently 3/10 or 4/10, but during flare ups pain is 8/10 Depressed achilles reflex, positive patellar tendon reflex SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

174. 30yo female, BMI 22, moderately active Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain Hx of chronic lumbar back pain, foot pain, muscle spasms Reports trauma from 10 years ago and frequently “throws back out” Significant weakness in right leg AEB falls to right when walking on toes or heels Full time employment with no physical demands Pain is currently 3/10 or 4/10, but during flare ups pain is 8/10 Depressed achilles reflex, positive patellar tendon reflex Straight leg raise (+), crossover straight leg (+), trendellenburg test (+) SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

175. POSSIBLE NURSING DIAGNOSES Acute pain r/t physical injury Chronic pain r/t central or peripheral nerve injury Impaired walking related to musculoskeletal impairment Ineffective role performance related to physical symptoms of pain Bathing self care deficit r/t musculoskeletal impairment Dressing self care deficit r/t musculoskeletal impairment Deficient knowledge r/t lack of exposure Impaired physical mobility r/t musculoskeletal impairment Fear r/t innate origins of acute pain Risk for falls r/t: difficulty with gait, impaired balance, impaired physical mobility Impaired comfort r/t to acute pain