Mr. Dieter Schmidt is a 48-year-old with a 2-year history of cervical spine injury that began after a motor vehicle

Mr. Dieter Schmidt is a 48-year-old with a 2-year history of cervical spine injury that began after a motor vehicle accident. Presenting symptoms were neck pain when turning his head, biceps weakness, and pain down the arm with tingling into the fingertips. He is unable to sit for extended periods or walk distances. Initially he received treatment with medication, TENS to the site, physical therapy, and cervical fusion. Despite trying all treatments available to him, including surgery, Mr. Schmidt continues to suffer chronic pain and fatigue. After prolonged suffering with no relief, he develops a cynical attitude toward healthcare. Mr. Schmidt begins missing scheduled appointments for physical therapy. He describes the stress he feels with an economic downturn affecting his land development business and fears bankruptcy. As a result, he has given up previous hobbies and most social activities. His relationships with his family and friends are increasingly strained as the pain persists over time.

THINKING

1. Theoretical Knowledge: What is the mechanism that explains how pain is transmitted in the spine?

2. Critical Thinking (Considering Alternatives, Deciding What to Do):

a. When planning care for Mr. Schmidt, what approach would you take in helping him to set goals for his rehabilitation?

b. Why do you think Mr. Schmidt displays a negative attitude and reduced compliance toward rehabilitative therapies?

DOING

3. Practical Knowledge:

a. Nursing Process (Assessment): What questions would you ask Mr. Schmidt to assess the impact of pain on his daily living and quality of life?

b. Nursing Process (Interventions): In addition to drug therapy, what other measures might you teach your patient to perform for controlling pain and promoting comfort?

CARING

4. Self-Knowledge: Have you experienced chronic pain, such as back pain, fibromyalgia, arthritis, migraines, or that associated with sports injuries? If so, how has it affected your daily life? Has your pain affected your relationships? Has it interfered with your job or recreational activities? What other ways would you say chronic pain has reduced the quality of your life?