Exam (elaborations) NGR 6172 Case 01 Focused Exam Pain Management Results Completed Shadow Health

Exam (elaborations) NGR 6172 Case 01 Focused Exam Pain Management Results Completed Shadow Health Hello Tanner, my name is Tori. I am a nurse practitioner and will be taking care if you today. Hey. What brings you in today? I picked up this heavy box at work--with like, sound equipment and stuff in it--and ever since then, the pain in my lower back has been killing me. I think I need to be on opioids or something. oh, Im sorry to hear that you had to deal with that. Hey, thanks. You're welcome. I hope that through our discussion and today's exam that we can find a solution to help you and reduce your pain. (No matching questions found.) You're welcome. I hope that through our discussion and today's exam that we can find a solution to help you and reduce your pain. I appreciate your saying that. Approximately how heavy was the box you lifted at work when you initially hurt your back? (No matching questions found.) How heavy was the box you lifted at work when you initially hurt your back? (No matching questions found.) How heavy was the box you lifted at work when you initially hurt your back?? (No matching questions found.) How heavy was the box you lifted at work? Surprisingly heavy. I could tell immediately it was sound equipment and not scarves like I was expecting. How did you lift the box? I'm pretty sure I lifted it from my back. I wasn't really cognizant of proper lifting technique; I was expecting it to be like two pounds of costumes, but no. I feel pretty stupid. All Lines (127) Its not something to feel stupid about, its an easy mistake. Thanks for getting it. Its important to always practice proper lifting technique by lifting with your knees, not your back. I hadn't thought of that. Just something good to get in the habit of to help avoid accidents. OK. Got it. How would you describe the pain? The pain is sharp and burning, and it tingles sometimes. It's always in my lower back. Never really thought about being hurt at work, and now I've been laid up forever. So the pain is only in your lower back? Well, my lower back feels terrible. I just hurt it so bad picking up that box at work. I really need to be on opioids for the pain. Did you report the accident that occurred at work? (No matching questions found.) Did you report the accident at work? Yeah, I injured myself at work. Thirteen weeks ago, I picked up this box that was way heavier than I thought. Is the pain radiating anywhere? No, I'd more call it hot and burning. Sharp. It tingles, too. Does the pain spread anywhere, like to your legs? (Clarified to Does the pain radiate from your back?.) It only hurts in my lower back. (Clarified to if the pain radiates from my back.) You havent been able to work since the injury? I haven't been able to go to work since I got hurt. Doing anything physical just makes the pain worse. Directing plays is a pretty active job. Besides, even walking hurts right now. Im sorry to hear that, I imagine its been hard. Thanks. I think I really needed to hear that. So what makes your pain worse? Physical activity like walking or lifting things hurts really bad. The physical therapy exercises I tried at home hurt so much I haven't bothered with a therapist, even though they said to at the hospital. Does anything make your pain better? Sometimes just shifting around--changing the way I'm sitting or lying--can help a little. Rest helps a little bit, too. Drinking kind of worked, but I did have to go up to three drinks a day. Ibuprofen didn't work at all, but these opioids I tried--hydrocodone and acetaminophen--they actually stopped the pain. How often do you drink alcohol? Normally, I don't drink all that much, but I started drinking three times a day just to take the edge off of this back pain. Before this all started, I only drank once or twice a month. How many drinks do you have per sitting? (Clarified to How many drinks do you have in a day?.) When I was using alcohol for my back pain, I'd drink a tumbler of whiskey three times a day. Spread it evenly throughout the day. Sip it slowly. Tried to make it last. (Clarified to how many alcoholic drinks I have each day.) How big is the tumbler? (Clarified to What size are the drinks?.) I would drink three tumblers of whiskey a day. I'm not sure how many ounces that is. I don't think I ever got dependent on it, though. [AUDIO COMING SOON] (Clarified to what size the drinks are.) And when did you first start drinking alcohol? For my back pain, I started drinking around 11 weeks ago -- stopped the ibuprofen and started drinking, so as not to mix. But first time drinking ever? The normal story -- sip of wine when I was a kid; my early twenties, I had drink or two a month. Thats good you know not to mix substances, Thank you. Its important to realize that mixing opioids and alcohol is just as dangerous, if not more. Thank you. One more thing to think about, huh? When did you start taking opioids? So, the timeline's complicated. It goes, injury, thirteen weeks ago; took ibuprofen for two weeks, which did nothing, so I stopped; started drinking to help the pain a little; stopped drinking a week ago to try the opioids. So you havent been combining any substances for the pain? (No matching questions found.) So you havent been taking substances simultaneously? (No matching questions found.) Why did you resort to opioids? (No matching questions found.) Why did you start taking opioids? It was kind of perfect how it worked out -- my friend says he has some hydrocodone leftover from a surgery and didn't need them, knowing I did. I was desperate to get some relief. How much hydrocodone are you taking? I take a pill morning and night; the pill has I believe 5 milligrams of hydrocodone in it and 325 of acetaminophen. That combination is called Percocet and is very strong. Yeah, I guess that makes sense. It can be very dangerous to take someone elses prescription medication. Good to know. Do you smoke tobacco? Ooh, yuck. A lot of my theatre crew smokes, but I never touch the stuff. Use any nicotine products? Ooh, yuck. A lot of my theatre crew smokes, but I never touch the stuff. Do you use any other illicit drugs? I've never used any recreational drugs. [AUDIO COMING SOON] How do you rate your pain on a scale of 1 to 10, with 10 being the worse pain youve ever experienced? At its worst, I'm probably at a 7 out of 10. It can get down to a 0 to 2 if I'm taking opioids, though. When was the last time you took the opioid? I ran out of opioids this morning. Before that, I stopped taking the ibuprofen cause it wasn't working, and I wanted to try just straight alcohol. That kind of worked, but I stopped it so I could safely take opioids. Which worked. How much ibuprofen were you taking? When I was taking ibuprofen, I was doing two 200 mg pills every four hours. Waste of time. With an injury such as yours, it would be beneficial to take a higher dose of ibuprofen to provide more pain relief. Yeah, I guess that makes sense. Well thats what you're here for today, We'll figure this out together, I appreciate your saying that. When did you go to the hospital for your injury? Yeah, my stagehand friend took me to the ER right after it happened. What did the hospital say? (Clarified to What did the hospital discover?.) The ER did an MRI, but they can't tell me what's actually wrong with my back. My coworker drove me all the way out to the hospital the day I hurt myself, and there's not a whole lot to show for it. (Clarified to what the hospital discovered.) What did the hospital recommend? All they did was tell me to take ibuprofen and do physical therapy. They couldn't even tell me what was wrong, even after an MRI. It turned up nothing. Im sorry, I imagine that situation was frustrating. Thanks. I think I really needed to hear that. What prescription of ibuprofen did the hospital recommend? All they did was tell me to take ibuprofen and do physical therapy. They couldn't even tell me what was wrong, even after an MRI. It turned up nothing. How much ibuprofen did the hospital recommend you take? When I was taking ibuprofen, I was doing two 200 mg pills every four hours. Waste of time. What physical therapy did the hospital recommenced? I tried some yoga-type stretches I found online -- cat-camel, plank, arm and leg raising -- and it all hurt my back even more, so I kinda gave up on it. Why didnt you followup with a therapist? (No matching questions found.) Did you followup with anyone after the hospital? (No matching questions found.) Has your back pain gotten any better or worse since the accident? My back pain hasn't gotten better at all. I feel like I've been in pain forever. I need it to stop. How often do you experience pain during day? The pain starts when I wake up in the morning. It does fade away for a little bit during the day, but it's not a reliable thing and it always comes back. How long does your pain last? My pain goes in and out during the day, but I always know it will be there tomorrow. Hasn't improved any way whatsoever. Has the pain affected your quality of life? I have been very sedentary pretty much all day every day since I hurt my back at work. Even walking around makes the pain worse, not to mention bending my back or lifting something. Shifting around a little bit when I'm sitting or lying down can make the pain a little better for a while. How does the pain make you feel? The opioids felt good . . . not like a high, but they decreased my pain from like a 6 to a 2. Opioids are effective at reducing pain but they can be addictive. Thank you. One more thing to think about, huh? How often do you experience pain throughout the day? The pain starts when I wake up in the morning. It does fade away for a little bit during the day, but it's not a reliable thing and it always comes back. Do you feel reliant on the opioids? (No matching questions found.) And you dont have any more symptoms? (No matching questions found.) Do you have any other symptoms? No other health issues, no disorders, no other symptoms. Just excruciating lower back pain. Any pertinent family history? (No matching questions found.) What is your family history? My dad's fine. My mom's an alcoholic with depression, so she's got it pretty rough. Do you fear addiction? I wouldn't say I've ever been addicted to anything. What medications do you take? I'm taking testosterone enanthate right now. For my back, I've tried ibuprofen and this hydrocodone-acetaminophen combo pill. I think I really need an opioid like that for this pain. Im sorry to hear that about your mother, it must be hard. Thanks for getting it. Addiction can run in families so its important to be aware of your habits. Good to know. What do you take testosterone for? I take the testosterone for gender-affirmation therapy. Most trans guys do. How long have you been taking testosterone? I've been injecting testosterone weekly for two years. How much testosterone do you inject weekly? I inject 100 mg of testosterone per week. How do you inject the testosterone? (Clarified to Where on your body do you inject testosterone?.) Right in the deltoid. (Clarified to where on my body I inject testosterone.) How do you inject the testosterone? (Clarified to When do you take the testosterone?.) I get my 100 mg testosterone shots weekly. Have been for the last two years. (Clarified to when I take testosterone.) Do you self inject the testosterone? (No matching questions found.) Do you inject the testosterone yourself? (Clarified to When was your last testosterone injection?.) Yesterday was shot day. (Clarified to when my last testosterone shot was.) Do you take any supplements? Uh, no, I don't really take anything like that. Do you take any herbs? Uh, no, I don't really take anything like that. Do you have any allergies? I don't have allergies. No medication allergies? I'm not allergic to any meds. Do you have any environmental allergies? No seasonal or environmental allergies. No food allergies? I'm not allergic to any food. No allergies to latex? (Clarified to Do you have a latex allergy?.) Latex is fine. (Clarified to if I have a latex allergy.) Were you hospitalized for your back injury? (Clarified to Have you been hospitalized for your injury?.) Yeah, my stagehand friend took me to the ER right after it happened. (Clarified to if I have been hospitalized for my injury.) Have you tried ice or heat for your pain? No . . . it didn't really occur to me. Do you have any mental health history? I've never had a mental illness. I've got my issues, but nothing at a disorder level. What issues do you speak of? (No matching questions found.) Where did you get the ibuprofen? (No matching questions found.) Where did you buy the ibuprofen? The opioids? My friend gave them to me -- he was prescribed them for a surgery, but he had leftovers, and he knew I was in pain. They did help, and I definitely need more. Did you get a prescription for ibuprofen? The ER gave me a prescription for ibuprofen. It's such a hassle to fill that stuff though, so I got the over-the-counter stuff. It's all the same. Its important to fill the prescriptions provided by medical staff. The prescription of ibuprofen is stronger then over the counter. I hadn't thought of that. Have you missed any medication doses? I've been in way too much pain to miss doses. im sorry to hear that. Hey, thanks. What is your income level? I make around 25 grand a year from the theatre -- it's mostly enough, but I need to be super careful with spending. What is your job? I have a full time job as a theater director, but I haven't been working for months. The pay isn't the best, but it's good work, and steady. What is your gender identity? I'm male. Use "he" and "him" pronouns. I understand and respect that. Thank you. Can you tell me more about your transition? Thirteen weeks ago, I really messed myself up picking up this box at work. It hurt right away, and one of my theater buddies took me to the hospital. They couldn't figure out what was wrong with my back. They just knew it was back pain. And I was like yeah, thanks, I could tell. What else have you done to feel masculine? Oh, man. I feel like I've tried everything. Sometimes shifting positions makes the pain ease up a little, and resting helps. I mean, it doesn't help much, but it helps. Drinking actually helps more. I'm not a drinker, but I upped my intake just to give my back some relief. The only thing that's worked really well, though, were these opioids I took. What do you do to feel male? Yeah, I'm trans -- female to male. What have you done to your appearance? (Clarified to What do you do to masculinize your appearance?.) Besides taking testosterone, I wear a binder. (Clarified to how I masculinize my appearance.) Does wearing a binder hurt you physically? (Clarified to Does your binder hurt your back?.) No, not at all. (Clarified to if my binder hurts my back.) Are you involved in any risky behavior? (Clarified to Do you ever do risky things when drunk?.) Nothing like that, no. I rarely even get drunk anyway. (Clarified to if I do risky things when drunk.) Are you involved un any risky behavior? (No matching questions found.) Are you involved in any risky behavior? (Clarified to Has your alcohol consumption put you in danger?.) If you mean like, drinking at work or something, no, I'd never. I've just been at home. (Clarified to if I have done risky things while drinking.