Lower back pain Ch. 63, question well explained 2023/2024.

Low Back Pain - answers- Affects ~80% of adults in United States at least once - Second only to headache as most common pain complaint - Leading cause of job-related disability - Major contributor to missed work days Etiology and Pathophys - answers- Most often due to musculoskeletal problem - localized: soreness/discomfort when a specific area of the lower back is palpated/pressed - diffused: occurs over a larger area and comes from deep tissue - Radicular pain: caused by irritation of a nerve root - Referred Pain: source of pain is another location Radicular pain - answers- caused by irritation of a nerve root. Radicular pain is not typically isolated to a single location, but instead radiates or moves along a nerve distribution. Sciatica is an example of radicular pain. Referred Pain - answers- "felt" or perceived in the lower back, but the source of the pain is another location (e.g., kidneys, lower abdomen). Low back pain common because lumbar region - answers-Bears most of body weight -Is most flexible -Contains nerve roots -Has poor biomechanical structure Risk factors associated with low back pain include: - answers- lack of muscle tone and excess body weight, pregnancy, stress, poor posture, cigarette smoking, prior compression fractures of the spine, spinal problems since birth, and a family history of back pain. Occupational risk factors - answers-Jobs that require repetitive heavy lifting, vibration (such as a jackhammer operator), and extended periods of sitting are also associated with low back pain. -Health care personnel who perform direct patient care activities are at high risk for the development of low back pain. -Lifting and moving patients, excessive bending or leaning position, and frequent twisting can result in low back pain that causes lost time and productivity and/or disability. The causes of low back pain of musculoskeletal origin include: - answers(1) acute lumbosacral strain, (2) instability of the lumbosacral bony mechanism (3) osteoarthritis of the lumbosacral vertebrae (4) degenerative disc disease, and (5) herniation of an intervertebral disc. Acute low back pain - answers-Lasts 4 weeks or less -Caused by trauma or undue stress -Symptoms usually appear within 24 hours -Muscle ache to shooting/stabbing pain -Limited flexibility/ROM -Inability to stand upright Few definitive diagnostic abnormalities - answers-Straight-leg raising test -Positive for disc herniation when radicular pain occurs -MRI and CT scan only for trauma or suspected systemic disease Nursing Assessment:Objective Data - answers-Guarded movement -Depressed or absent Achilles tendon or patellar reflex + Straight leg raise test + Crossover straight leg test + Trendelenburg test -Tense, tight paravertebral muscles -↓ Range of motion in spine Possible Diagnostic Findings - answers-Lesion or disorder on myelogram, CT scan, or MRI -Nerve root impingement on electromyography (EMG) overall goals - answers-Satisfactory pain relief (<4 on 10 point scale) -Return to previous level of activity -Correct performance of exercises -Adequate coping -Adequate self-help management Health promotion - answers-Proper body mechanics -"Back School" -Appropriate body weight -Proper sleep positioning -Firm mattress Stop smoking Treat as outpatient if not severe.. - answers-NSAIDs, muscle relaxants -Massage -Back manipulation -Acupuncture -Cold and hot compresses -Severe pain: corticosteroids, opioids - answers-Some people may need a brief period (1 to 2 days) of rest at home, but should avoid prolonged bed rest. -Most patients do better if they continue their regular activities.