Bob, a 67-year-old school janitor presented to his GP with lower back pain. He informed his GP that he has been generally active, walking and cycling regularly but his lower back pain has started to restrict these activities lately, in addition to affecting his daily job. Upon questioning, Bob related that the lower pain has been there for the last 2 months and has gradually become more severe. On physical examination, there was acute tenderness over T12–L1. There were no other clinical signs. The GP was unsure of the origin of the lower back pain and prescribed a non-steroidal anti-inflammatory medication to be taken when he experienced pain. Bob saw his GP one week later and complained of worsening pain. The GP referred him to a rheumatologist. The rheumatologist advised Bob to have magnetic resonance imaging (MRI) of the spine. Two weeks later MRI scan was done, and the report showed metastatic lesions in thoracic and lumbar vertebrae. Bob received a call from the clinic to come for an immediate consultation.
Please answer the following TWO questions:
1. What happens to pain threshold and behavioural response to pain in the older people and discuss briefly the effectiveness of NSAIDS for pain management in elderly. (150 words approx.)
2. Following the MRI report, and the pain being persistent, which analgesics should be prescribed to Bob? Support your answer with evidence. (250 words approx.)
NUR231 Assessment 2: Case Study Bob, a 67-year-old school janitor presented to his GP with lower back pain. He informed his GP that he has been generally active, walking and cycling regularly but his lower back pain has started to restrict these activities lately, in addition to affecting his daily job. Upon questioning, Bob related that the lower pain has been there for the last 2 months and has gradually become more severe. On physical examination, there was acute tenderness over T12–L1. There were no other clinical signs. The GP was unsure of the origin of the lower back pain and prescribed a non-steroidal anti-inflammatory medication to be taken when he experienced pain. Bob saw his GP one week later and complained of worsening pain. The GP referred him to a rheumatologist. The rheumatologist advised Bob to have magnetic resonance imaging (MRI) of the spine. Two weeks later MRI scan was done, and the report showed metastatic lesions in thoracic and lumbar vertebrae. Bob received a call from the clinic to come for an immediate consultation. Please answer the following TWO questions: 1. What happens to pain threshold and behavioural response to pain in the older people and discuss briefly the effectiveness of NSAIDS for pain management in elderly. (150 words approx.) 2. Following the MRI report, and the pain being persistent, which analgesics should be prescribed to Bob? Support your answer with evidence. (250 words approx.) GENERAL GUIDELINES ON HOW TO WRITE YOUR ASSIGNMENT 1. The maximum word limit for this assignment is 400, this does not include references. 2. This assignment must be submitted via safe assign on Learnline. 3. No other form of submission is acceptable including email, hand delivery or post. 4. It is advised to have a foot note on your assessment containing your name, student number and unit code. No COVER SHEET REQUIRED for Safe assign submission as per CDU policy. 5. Please click on assessment details where it says, “click on the above link to submit your assignment”. Please note there is NO DRAFT SUBMISSION for this assignment. Once you upload your file and click submit, it will be submitted for grading. 6. I will not be able to check and let you know if I have received your assignment or not. 7. All the information about the assignment is available on Learnline; please take time to locate the necessary documents prior to sending an email to me enquiring about the assignment details. 8. Proof reading or feedback of any kind of ASSIGNMENT QUESTIONS will not be provided prior to submission. 9. Please contact the Learnline technical support if you have problems submitting the assignment. FORMAT: 1. Font size 12; Font Type: preferably Calibri or Arial; 2. Line space 1.5 to 2. REFERENCING: Please use APA referencing style (7th edition). Number of references: between 5-10. EXTENSION: You will have to submit an official extension request with supporting documents at least 5 days before the deadline. ASSIGNMENT MARKS RELEASE: It is expected to take around 2 weeks or more to get your assignment marks being released after submission. Levels of Achievement Criteria Novice Just Competent Competent Proficient Overall Presentation (including formatting and grammar) 0 Points Work is illegible, poor use of English. Presentation does not meet the criteria required. 4 Points Work is clearly presented with good use of English. Presentation meets the criteria. 7 Points Presentation of work is excellent, grammatically correct with highly commendable writing style. 10 Points Presentation of work is excellent, grammatically correct with highly commendable writing style. Proper use of Literature 0 Points Failure to use appropriate citation or incomplete or inappropriate referencing. 10 Points Adequate evidence of supportive reading without the use of argument and discussion. Some inaccuracies in citation of research/literature. External sources may be used but of low quality (wiki, web pages); attempt at referencing in text, attempt at constructing a reference list. 20 Points Presents work that draws on relevant research/literature to support rational arguments and discussions. Accurate and coherent use of relevant research and literature. Small problems with formatting but able to identify sources used. 30 Points Critical analysis of a wide range of relevant literature. 5-10 External sources of information included and well-integrated into report. Reference list complete and well formatted (according to latest APA guidelines). Demonstration of comprehension, knowledge and analysis 0 Points Content lacks relevance. Professional focus is not understood or explained. Theoretical concepts and frameworks inappropriately selected. 10 Points Content demonstrates relevance. Adequate understanding/explanation of professional focus. Identifies and addresses key aspects of a minimum acceptable level. Limited evidence of analytical thinking. 20 Points Content demonstrates relevance. Very good understanding/explanation of professional focus. Thorough understanding of facts and theories to support arguments. Demonstrates creative use of material. Evidence of critical thinking in a realistic logical manner. 30 Points Analytical content demonstrates excellent critical thinking skills, knowledge and comprehension, able to synthesise learning and apply to field of study. Demonstrates ability to critically evaluate. Interpretation and application 0 Points Wrong interpretation of the assessment questions. No application of the learnt materials. 10 Points Interprets brief correctly. Evidence of being able to evaluate a situation in a logical way, identifying aspects of problem. Able to set own experiences within a wider context and take an objective stance. 20 Points Interpret brief correctly. Evidence of being able to examine and evaluate critically using appropriate theoretical frameworks. Points raised re applied and fully integrated into the discussion. 30 Points Able to critically evaluate and make judgments, which are realistic, creative and original.