Lower  back pain (LPB) is frequently encountered by advanced-practice nurses  in various healthcare settings. Diagnosing the cause of back pain  requires advanced practice nurses to conduct a thorough history and  physical exam.  Proper diagnostics and treatments are pivotal in  treating LBP. The main focus for LBP includes effective therapies,  proper patient education, and rehabilitation in treatment (Hong et al.,  2022). Patients play a major role in preventing LBP by using proper body  mechanics and self-care. Research conducted by Hong et al. (2022 shows  no significant evidence that bed rest and modified work assignments  improve lower back pain. It actually benefits the patient to move as  much as possible in a safe and modest way. If left untreated, lower back  pain can be very debilitating.
      Discuss the Mr. Payne’s history that would be pertinent to his  genitourinary problem. Include chief complaint, HPI, Social, Family and  Past medical history that would be important to know. 
                  Mr. Payne comes into the clinic today and complains of having two weeks  of sharp, stabbing pain at level 7 after lifting a 10-pound box. He  said the pain is shooting down his left leg to his ankle, and it  improved but got worse after playing softball with his daughter. . He  reports no issues with his bladder or bowels and is continent. He denies  any fever, chills, nausea, or vomiting. He has a history of  hypertension and hyperlipidemia, no surgeries, and no known drug  allergies. Mr. Payne works as a truck driver, lifts 20–35-pound  packages, quit smoking two years ago, and drinks one to two beers on the  weekend. He denies using illicit drugs and had sex with an HIV-positive  person about two years ago. Mr. Payne takes PrEP as a prophylaxis for  pre-exposure to HIV. He takes the following medications: chlorthalidone  50 mg daily by mouth, lisinopril 40 mg daily by mouth, simvastatin 40 mg  daily by mouth, and tenofovir disoproxil fumarate/emtricitabine  (TDF/FTC). He also took 400 mg of ibuprofen every six hours for three  days and 250mg of naproxen for five days for his back pain. He says his  pain is worse when he moves or sits for a long time. He denies any  numbness, weakness, or tingling in his legs. 
Describe  the physical exam and diagnostic tools to be used for Mr. Payne. Are  there any additional you would have liked to be included that were not? 
The  physical exam is very important and provides insightful information  about the patient’s present state. Mr. Payne’s vital signs are as  follows: blood pressure is 130/82 mmHg, temperature is 98.6 F, pulse is  80 beats/minute, respiratory rate is 12 breaths/minute, weight is 170  lbs., and BMI is 24. For his back pain, a three-fold exam is conducted:  standing, sitting, and supine back exams. Mr. Payne’s standing back exam  was normal except for some tenderness on the left lumber muscles and  pain with movement. He is able to walk normally, has no issues with  range of motion, and still has pain when he squats. Mr. Payne has no  pain, reflexes are present in his ankles and knees, and his motor  strength is 5/5 in his legs. His heart rate and rhythm are normal, and  his lung sounds are clear. His abdominal and neurology exams are within  normal limits. The supine position exam is also normal, and the FABER  (flexion, abduction, and external rotation) test is negative. His  passive straight leg raised (SLR) test (SLR) is positive at sixty  degrees.

Please  list 3 differential diagnoses for Mr. Payne and explain why you chose  them.  What was your final diagnosis and how did you make the  determination?

Disc Herniation Mr.  Payne is experiencing pain with movement, pain radiating down his left  leg, and has a positive SLR on the left. These symptoms indicate a  diagnosis of disc herniation. 
Lumbar Strain A  very common back problem many adults face is back strain. This type of  pain is normally caused by an injury or performing a strenuous activity  like heavy lifting, and Mr. Payne says his pain began after lifting a  10-pound box.

Sciatic The  lower back pain Mr. Payne is having is also a sign of sciatica.  According to Cash 2023, some of the symptoms of sciatica are pain on one  side, a positive SLR test, and difficulty moving. Also, his age and  occupation as a truck driver increase his risk for sciatica (Cash,  2023). The diagnosis of herniated discs is closely related to sciatica. 

What  plan of care will Mr. Payne be given at this visit, include drug  therapy and treatments; what is the patient education and follow-up? 
The  initial plan of care for Mr. Payne is to take over-the-counter naproxen  500mg twice a day, use heat wraps, and go to physical therapy. The plan  of care also includes patient education about proper lifting, how to  recognize symptoms, and how to return if pain worsens or new symptoms  appear. At the follow-up visit four weeks later, his symptoms had not  fully improved, and there were no neurological symptoms. The new plan of  care involves prescribing a stronger NSAID, meloxicam, and requesting  to see an osteopathic physician for spine manipulation. A follow-up call  was made two weeks later with Mr. Payne, and he stated his symptoms had  improved with physical therapy, meloxicam, and spinal manipulation.