Course material

1. Community Nurse Assessment and care
Community Nurse Assessment and care Essay Case Scenario Option 2: Chronic Pain John
Ryan is a 66 year old male with a history of chronic back pain related to spinal stenosis, and
degeneration of the left hip. He has been reviewed in the Outpatient Pain Clinic on a
monthly basis for the past 4 months, after a sudden increase in pain and changes in his level
of activity. His pain specialist is concerned about his level of function at home and has
referred John to the community nursing service for an initial assessment and review.
Medical history “ John has spinal stenosis which was diagnosed in his early forties. He has
significant pain in his lower back and hip, slight (L) leg weakness and slight loss of sensation
in both his feet. He is generally fit, but slightly overweight. “ His most recent observations
are as follows: BP: 135/80¢ P: 60 bpm,¢ R: 18 bpm,¢ Height: 180 cm¢ Weight 95 kg.¢ “
Current medications: Ibuprofen 400 mg 6qh¢ Baclofen 20 mg BD¢ Diazepam 2.5mg “ 5mg
PRN¢ Social history: “ John is an engineer with a mining company who spends his time
equally between the mine in a remote location as a Fly In, Fly Out (FIFO) worker. He has an
office location in the CBD for his locally based work. John is married to Donna and they have
two adult children, both married. Donna works part time as office manager for a small
company and is hoping they can retire soon so they can travel and see more of their
grandchildren. Their daughter Jean (37 years) lives with her husband and three small
children in a large coastal community, 45 minutes drive from John and Donna’ s home.
Their son Robert (39 years) lives with his partner in another major interstate city. Current
Issue “ John reports being woken up by pain at night. During the day, he has pain if he sits
still for too long, but also if he walks or rides a bike for too long, and the time he can spend
on these activities varies. John states he is sick of the hours of focused exercise he needs to
do to keep his core muscles strong and to keep him mobile and flexible. He is also sick of
always having to take pain medications that have not been effective. In addition he reported
being ˜ fed up with being aware of my back and hip all the time and feeling limited because
of them’ . Recently, whilst playing with his four-year-old grandchild, swinging him through
the air, John experienced a significant flare in his level of pain. John has been alternating
between being angry about having ongoing pain, and being depressed because he is
increasingly unable to do the activities he has always done. He was a keen hiker and had
dreams of spending his retirement hiking in remote places. Now he can barely walk five
kilometers on level ground without pain. He was also a keen bicycle rider. Initially this
helped with his pain management. But increasingly, he is losing interest in riding as it also
causes increased pain. John has been seen by a physiotherapist on a regular basis over the

2. years, but he stopped going, because he felt they were not helping him, as he was
progressively experiencing more pain. He has increasing bilateral leg weakness, bilateral
muscle wasting and reduced sensation in both feet. He experiences blisters on his feet as a
result of pressure on his feet, which he ignores. The specialist at the Pain Clinic is also
concerned about John’ s level of medication adherence. Assessment Focus “ You are the
Registered Nurse from the Community Nursing Service. “ You will be undertaking an initial
visit to John’ s home. “ Prioritise and provide a rationale for the activities you will
undertake as part of this initial visit and identify two (2) priorities for your follow-up visit 1.
Identify 2 priorities of care for your follow-up visit; explain the reason why it is prioritized
more than the other treatment care. Give evidence to support your opinion(2-4 references
needed) a. Pain management priority b. Depression and anxiety management priority 2.
Identify and provide rationale for the activity that you commence during the visit as a
community nurse: (use ADPIE for initial assessment) a. Assessment i. Pain assessment
(priorities); exacerbation of his spinal stenosis; give evidence of why the pain gets worse
(references needed) ii. Based on A-G initial assessment, provide the proper assessment
according to John’ s condition. (not all A-G assessment is applicable for John); Give evidence
on why you provide those assessment for John? b. Diagnoses i. Based on current issues;
what other things that need to be diagnosed in order to improve John’ s living situation 1.
Back to A-G assessment, see what can you diagnose from the A-G result; e.g. (mobility issue,
wound, mental health,etc) 2. Link every possible issue to the Main issue; e.g. poor exercise
increase his pain level or poor diet decrease his strength to do exercise and lead to increase
in pain lvl. c. Planning i. Based on the diagnoses that you provide; provide each of the
treatment for the complication; remember you are Community nurse. 1. Symptom
management 2. Pain relief 3. Depression management 4. Mobility Management 5. Patient
education (meds and the importance of activity) 6. Issue with workplace 7. Issue with
family d. Implement