iHuman Case Study: Tina
Williams, 41Yrs Old Female
Cc: Low Back Pain
J.C. is a 41-year-old man who comes to the ED (emergency department)
C/O 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. He admits to having had several episodes of
similar back pain each year over the past 10 years. In the past the pain
has been treated by diazepam, codeine, NSAIDs, and several weeks of
bed rest. J.C. has a past medical history (PMH) of a peptic ulcer. He is 6
ft tall, weighs 265 pounds, and has a prominent "potbelly." The ED
admitting clerk calls J.C.'s insurance company to
authorize payment for treatment at your facility. J.C.'s health
maintenance organization (HMO) has identified him as a consumer of
"high-cost care" with poor prior outcome. The ED is authorized to
perform emergency treatment only and the case manager will make a
, home visit within 24 hours to devise a treatment plan. The ED - ANS-J.C.
is a 41-year-old man who comes to the ED (emergency department)
C/O 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. He admits to having had several episodes of
similar back pain each year over the past 10 years. In the past the pain
has been treated by diazepam, codeine, NSAIDs, and several weeks of
bed rest. J.C. has a past medical history (PMH) of a peptic ulcer. He is 6
ft tall, weighs 265 pounds, and has a prominent "potbelly." The ED
admitting clerk calls J.C.'s insurance company to
authorize payment for treatment at your facility. J.C.'s health
maintenance organization (HMO) has identified him as a consumer of
"high-cost care" with poor prior outcome. The ED is authorized to
perform emergency treatment only and the case manager will make a
home visit within 24 hours to devise a treatment plan. The ED physician
diagnoses muscular strain of the lower back and orders the following:
cyclobenzaprene (Flexeril) 10 mg qid, celecoxib (Celebrex) 200 mg qd;
bed rest for 2 days then gradually increase activity; ice packs to the
lower back 30 minutes out of every hour. You are a case manager RN
working for Grubabuck HMO and make the initial visit to J.C.'s
residence. His wife lets you in and you find J.C. lying on the sofa with his
knees flexed and watching videos.
Obtain a clear chronologic narrative of problem onset, setting,
manifestation, and treatment.
Principal symptoms should be described.
Location: Where does it hurt?
Williams, 41Yrs Old Female
Cc: Low Back Pain
J.C. is a 41-year-old man who comes to the ED (emergency department)
C/O 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. He admits to having had several episodes of
similar back pain each year over the past 10 years. In the past the pain
has been treated by diazepam, codeine, NSAIDs, and several weeks of
bed rest. J.C. has a past medical history (PMH) of a peptic ulcer. He is 6
ft tall, weighs 265 pounds, and has a prominent "potbelly." The ED
admitting clerk calls J.C.'s insurance company to
authorize payment for treatment at your facility. J.C.'s health
maintenance organization (HMO) has identified him as a consumer of
"high-cost care" with poor prior outcome. The ED is authorized to
perform emergency treatment only and the case manager will make a
, home visit within 24 hours to devise a treatment plan. The ED - ANS-J.C.
is a 41-year-old man who comes to the ED (emergency department)
C/O 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. He admits to having had several episodes of
similar back pain each year over the past 10 years. In the past the pain
has been treated by diazepam, codeine, NSAIDs, and several weeks of
bed rest. J.C. has a past medical history (PMH) of a peptic ulcer. He is 6
ft tall, weighs 265 pounds, and has a prominent "potbelly." The ED
admitting clerk calls J.C.'s insurance company to
authorize payment for treatment at your facility. J.C.'s health
maintenance organization (HMO) has identified him as a consumer of
"high-cost care" with poor prior outcome. The ED is authorized to
perform emergency treatment only and the case manager will make a
home visit within 24 hours to devise a treatment plan. The ED physician
diagnoses muscular strain of the lower back and orders the following:
cyclobenzaprene (Flexeril) 10 mg qid, celecoxib (Celebrex) 200 mg qd;
bed rest for 2 days then gradually increase activity; ice packs to the
lower back 30 minutes out of every hour. You are a case manager RN
working for Grubabuck HMO and make the initial visit to J.C.'s
residence. His wife lets you in and you find J.C. lying on the sofa with his
knees flexed and watching videos.
Obtain a clear chronologic narrative of problem onset, setting,
manifestation, and treatment.
Principal symptoms should be described.
Location: Where does it hurt?
