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
NRSG366 Partnerships in Chronicity
Assessment 1: Information Sheet and Case Scenarios
For this assessment you are given a choice between two (2) case scenarios. The scenarios are your referral
Information and no additional information is available.
Each student is to select one (1) scenario on which to base their assessment. The completed assessment is
to be submitted through the appropriate turn-it-in drop box on the NRSG366 LEO site. The Assessment
One marking criteria in the unit outline is to be used to guide the preparation of this assessment.
When submitting your assessment, please do not use the scenario as part of your response.
The purpose of this essay is for students to present a
comprehensive discussion linking the health issues they identify
through a client assessment to the impact they have on the client
and their level of function in the community setting. It requires the
student to prioritise the health issues and to show analysis of the
complexity of care provision demonstrating critical reflection on
THIS ASSESSSMENT REQUIRES APA REFERENCE SYSTEM
8 REFERENCES BOOKS
5 JOURNAL ARTICLES .
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.
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.
- Ibuprofen 400 mg 6qh
- Baclofen 20 mg BD
- Diazepam 2.5mg – 5mg PRN
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.
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 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.
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