35 year old white male presents to the ER with low back pain for two weeks with increasing severity. He had a normal Lumbar spine X-ray and had a normal CBC and blood chemistry. A urinalyisis was done to look for signs of nephrolithiasis and showed no white cells or red blood cells but large protein and no bacteria. He had a slight fever and was in such pain that IV morphine did not even touch it. Examination was difficult as he could not even get into a comfortable position to lessen his pain. Internet searches on the local state pain medication abuse systems did not show him to be drug seeking but the ER doctor considers him drug seeking and wants him out of his ER. You are called as the nurse practitioner helping the nighttime hospitalist admit new patients to the hospital and you are paged to consult as your physician is busy with another admission on the floor with an MI. You question this young man and find him to be in terrible pain and barely able to answer your questions, he looks well-developed and well-nourished and yells when you palpate around L3 and L4 lumbars. You decide to admit him to the hospital as you have no other choice and decide to do a urine protein analysis after seeing the urinalysis. The analysis comes in with high levels of M-proteins and you also ordered an MRI of his lumbar spine and find that he has lytic lesions through out the lumbar spine in the early stages. What is your diagnosis? What is his treatment? Are you glad you admitted this patient and did not send him home as the ER doctor wanted? What is his overall prognosis? Use what you have read to answer these questions. Must have initial post by Friday and two responses to fellow students by Tuesday night.
35 year old white male presents to the ER with low back pain for two weeks with increasing severity. He had a normal Lumbar spine X-ray and had a normal CBC and blood chemistry. A urinalyisis was done to look for signs of nephrolithiasis and showed no white cells or red blood cells but large protein and no bacteria. He had a slight fever and was in such pain that IV morphine did not even touch it. Examination was difficult as he could not even get into a comfortable position to lessen his pain. Internet searches on the local state pain medication abuse systems did not show him to be drug seeking but the ER doctor considers him drug seeking and wants him out of his ER. You are called as the nurse practitioner helping the nighttime hospitalist admit new patients to the hospital and you are paged to consult as your physician is busy with another admission on the floor with an MI. You question this young man and find him to be in terrible pain and barely able to answer your questions, he looks well-developed and well-nourished and yells when you palpate around L3 and L4 lumbars. You decide to admit him to the hospital as you have no other choice and decide to do a urine protein analysis after seeing the urinalysis. The analysis comes in with high levels of M-proteins and you also ordered an MRI of his lumbar spine and find that he has lytic lesions through out the lumbar spine in the early stages. What is your diagnosis? What is his treatment? Are you glad you admitted this patient and did not send him home as the ER doctor wanted? What is his overall prognosis? Use what you have read to answer these questions. Must have initial post by Friday and two responses to fellow students by Tuesday night.
Trending now
This is a popular solution!
Step by step
Solved in 5 steps
