Introduction
In the case under analysis, Mr. X is a 42-year-old patient with low back pain as his major complaint. This chronic pain has not disappeared since his skiing accident ten years ago. Still, the last 24 hours are characterized by increased pain because the patient moved some boxed and felt a pulling sensation three days ago. At the moment of his examination, the pain level is 3-4 out of 10; the straight leg lift test is negative, but he has difficulty getting onto the table. He also has type 2 diabetes controlled by metformin (1000 mg daily) and a deep vein thrombosis (DVT) history controlled by Coumadin. Other critical issues of the patient’s history include his 15-year-old smoking history, taking over-the-counter (OTC) medications for anxiety, and being overweight. This paper aims to discuss the patient’s diagnosis, treatment, OTC products’ use, and education to predict negative health outcomes and help the man manage his pain.
Diagnosis
The evaluation of the patient with low back pain should be based on the results of his physical examination and history. The diagnosis that can be given to the patient regarding his current complaints and medical history is muscle sprains or cramps. This condition is a common musculoskeletal injury associated with physical activity in patients older than 40 (Alzahrani et al., 2019). Another rationale for this diagnosis is that the patient has diabetes, with an HGA1c of 5.6. It is necessary to check the vitamin D level because its insufficiency provokes severe symptoms such as muscle cramps and back pain (Hu et al., 2021). Muscle cramps in diabetic patients are usually sudden and painful due to a “rapid penetrative firing of motor unit action potential” at a higher rate than needed (Roy, 2019, p. 311). His DVT history proves the possibility of peripheral vascular disease, buts there are no blood clotting problems. Still, there was a particular event when the man felt a pulling sensation, after which acute back pain emerged.
The problems with nerve roots and radiculopathy can be excluded because the patient’s straight leg test is negative, deep tendon reflexes are normal, and other systems are within normal limits. No information about radiation from or to other body parts and no history of cancer is identified, which makes it possible to reject tumor-related diagnosis. Attention should also be paid to the patient’s decision to take several OTC products for his anxiety (not professionally diagnosed) and Coenzyme Q10 (CoQ10) for unknown reasons (advised by a friend). Although no adverse effects have been reported about the use of CoQ10 as supplementation for type 2 diabetes, the dosage and doctor’s consultation are required (Zhang et al., 2018). The patient’s condition, history, and the absence of specific lab tests prove the diagnosis of muscle cramps (sprains).
Treatment Plan
The main idea of treatment in the case of muscle cramps in a diabetic patient is to address the underlying cause of the condition. Heavy lifting and sudden movement cause strains, which means the patient should consider both pharmacological and non-pharmacological methods of treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics are highly recommended to manage pain (Hung et al., 2018). The combination of NSAIDs (400 mg of ibuprofen) and paracetamol (1000 mg maximum) can help diabetic patients achieve 50% of pain relief without complications (Hung et al., 2018). Muscle relaxations have no adverse effects on diabetes and provoke the required muscle relaxation and pain relief. Taking CoQ10 is highly recommended as a part of idiopathic etiology because it helps increase plasma glucose levels and HbA1C and reduce muscle symptoms (Roy, 2019). Thus, the chosen self-medication in combination with NSAIDs and ibuprofen introduces the major part of a pharmacological treatment plan.
In addition, the patient needs to follow several non-pharmacological recommendations to predict new cases of low back pain. Most symptoms should relieve with rest, and it is important to predict the episodes of daytime fatigue (Roy, 2019). Yoga, meditation, and increased physical movements are encouraged as a part of alternative medicine without overdoing it. Muscles should be regularly stretched because sedentary lifestyles provoke chronic pain and an increased number of spasms and cramps. Other lifestyle changes are stress reduction, normal breathing, and smoking cessation (Roy, 2019). Massage will allow for managing overworked muscles and the overall stabilization of the organism. There are many other ways to relieve low back pain in diabetes, but the current patient should be overloaded with recommendations and follow such steps as taking NSAIDs, paracetamol, and CoQ10 (pharmacology) and lifestyle changes (rest mixed up with physical activities, meditation, stress reduction, and smoking cessation at least for some period).
The Use of OTC Products
The patient takes two OTC products at the moment: kava kava to manage his anxiety and CoQ10 to manage his diabetes as per the friend’s recommendation. Following his doctor, metformin and coumadin are regularly taken to control his diabetes and DVT history. CoQ10 is a lipid-soluble nutrient and antioxidant that plays an important role in diabetes pathogenesis (Zhang et al., 2018). It is a natural source that protects cells from damage, strengthens human metabolism, improves oxidative stress-induced abnormalities, and substitutes cholesterol enzymes (Zhang et al., 2018). Kava kava is a perennial shrub (herbal remedy) known for its relaxing qualities (Bian et al., 2020). The interactions between these OTC products and metformin are poorly discussed, and no serious complications are usually observed in patients. However, it is always required to consult a healthcare provider for further usage. The effects of natural supplements chosen by Mr. X on coumadin are also insignificant, and there are no severe restrictions between these medications.
On the contrary, the interaction between metformin and coumadin is critical because this combination may reduce coumadin dynamics and provoke new blood clots, vision problems, and pain. Both drugs are completely absorbed and reach the plasma within the next two hours. The kinetics of these oral medications helps control blood glucose levels and increase hepatic tissue (metformin) and vitamin K concentration (coumadin). Thus, it is important to check the levels of sugar and vitamins D and K in the blood to ensure all drug-drug interactions and side effects are well-managed within the offered treatment plan.
Education Plan
Nurses and doctors are responsible for developing a special education plan for every patient and addressing the principles of therapeutic communication. In this case, interpersonal interactions are based on identifying the specific needs of the patient, including his diabetes, DVT history, and acute back pain. The goals also cover the importance of developing the patient’s correct perception of the problem and following the doctor’s recommendations precisely. The principles of communication are listening, interaction, personal attitudes, confidentiality, and no judgments about his behavior. There are four main areas of patient education: the basics of type 2 diabetes, health risks of obesity, diabetes-related pain symptoms, and lifestyle changes.
Discussing the basics of diabetes, the nurse should inform the patient about the necessity of regularly monitoring his vital signs and glucose levels in the blood. The man’s BMI is 27, which is close to being overweight. It means he needs additional education about his dietary habits, focusing on low-carbohydrate and low-glycemic food (vegetables, beans, or grains) and proteins (fish, chicken, and nuts). Back pain can be provoked by increased glucose levels and insulin imbalance, which proves similar controlling activities and interventions. The patient has to be educated about the importance of a healthy lifestyle, no smoking, and increased physical activity, together with rest and relaxation. Finally, the man has already made a decision to take several medications without the doctor’s prescription, which is not recommended for patients of his age. OTC medications can do a lot of harm to human health, and the nurse should underline the worth of communication with healthcare providers before independent decision-making. Even if the drug is properly chosen, its dosage and duration should be individually discussed.
Conclusion
In the case under consideration, the patient proves that OTC medications are commonly used by people for different reasons. However, when a patient has a severe chronic disease like diabetes, the combination of drugs has to be thoroughly examined. Mr. X has low back pain complaints and informs about taking kava kava and CoQ10 without a prescription. His diagnosis of muscle spasms has to be treated with the help of pharmacological methods (NSAIDs and paracetamol) and non-pharmacological interventions (physical activities and lifestyle changes). The patient’s education is a nurse’s responsibility to ensure the man does not repeat his mistakes and contributes to his well-being.
References
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