Neurological Nursing Care

Unit X: Problems of Neurological FunctionChapter 46 : 

Unit X: Problems of Neurological FunctionChapter 46 Back Pain, Degenerative Disc Disease, and Laminectomy Pages 977-982

Back Pain: Acute versus Chronic : 

Elsevier items and derived items © 2006 by Elsevier Inc. Back Pain: Acute versus Chronic Acute Less than 3 months Chronic Persists longer than 3 months Causes include Degenerative disc disease Lack of physical exercise Prior injury Obesity Systemic diseases Structural and postural abnormalities

Etiology and Genetic Risk Back Pain (Page 978) : 

Elsevier items and derived items © 2006 by Elsevier Inc. Etiology and Genetic Risk Back Pain (Page 978) Trauma Obesity Smoking Congenital spinal conditions and scoliosis

Prevention of Low Back Pain and InjuryChart 46-2 Page 978 : 

Prevention of Low Back Pain and InjuryChart 46-2 Page 978 Regular exercise Proper body mechanics Do not wear high heeled shoes Good posture Assess the need for assistance with daily chores Avoid prolonged sitting or standing Keep weight down (within 10 % ideal body weight) and STOP SMOKING Elsevier items and derived items © 2006 by Elsevier Inc.

Anatomy : 

Elsevier items and derived items © 2006 by Elsevier Inc. Anatomy

Degenerative Disc Disease : 

Elsevier items and derived items © 2006 by Elsevier Inc. Degenerative Disc Disease Definition: The gradual deterioration of the disc between the vertebrae is referred to as Degenerative Disc Disease (DDD) Degeneration of the disc in Degenerative Disc Disease is also referred to as spondylosis The xray or MRI evidence is what confirms the diagnosis of Degenerative Disc Disease

Slide 7: 

Elsevier items and derived items © 2006 by Elsevier Inc.

HNP : 

Elsevier items and derived items © 2006 by Elsevier Inc. HNP

Spinal Stenosis : 

Elsevier items and derived items © 2006 by Elsevier Inc. Spinal Stenosis

Clinical Manifestations Sciatica : 

Elsevier items and derived items © 2006 by Elsevier Inc. Clinical Manifestations Sciatica

Clinical Manifestations : 

Elsevier items and derived items © 2006 by Elsevier Inc. Clinical Manifestations Continuous acute pain Sharp, burning thigh or calf pain that may radiate to the ankle or toes Walking with a limp or in a stiff, flexed state May be unable to bend at all Muscle spasm Paresthesia or numbness Decreased sensation Loss of bowel or bladder control from spinal nerve involvement

Diagnostic Assessment : 

Elsevier items and derived items © 2006 by Elsevier Inc. Diagnostic Assessment MRI CT scan EMG and nerve conduction studies Myelogram

Interventions/Nonsurgical Management : 

Elsevier items and derived items © 2006 by Elsevier Inc. Interventions/Nonsurgical Management Williams position Firm mattress, or backboard under soft mattress Exercise Drug therapy Heat and/or ice therapy Diet therapy (weight control to help reduce chronic back pain) (Continued)

Nonsurgical Management (Continued) : 

Elsevier items and derived items © 2006 by Elsevier Inc. Nonsurgical Management (Continued) Other pain relief measures (physical therapy) Complementary and alternative therapies (distraction, guided imagery and music therapy) Percutaneous laser disk decompression (draws the herniated portion away from the nerve root) Non-surgical 30 minute procedure MD prescribes 24 hours of bedrest after this procedure before beginning progressive ambulation

Surgical Management : 

Elsevier items and derived items © 2006 by Elsevier Inc. Surgical Management Laminectomy Diskectomy Spinal Fusion

Minimally Invasive Lumbar Procedures : 

Minimally Invasive Lumbar Procedures Percutaneous Lumbar Diskectomy Microdiskectomy Laser-assisted laparoscopic lumbar diskectomy Elsevier items and derived items © 2006 by Elsevier Inc.

Diskectomy : 

Elsevier items and derived items © 2006 by Elsevier Inc. Diskectomy

Slide 18: 

Elsevier items and derived items © 2006 by Elsevier Inc. .

: 

Elsevier items and derived items © 2006 by Elsevier Inc.

Surgical Management (continued) : 

Elsevier items and derived items © 2006 by Elsevier Inc. Surgical Management (continued) Foraminotomy Decompression

Slide 21: 

Elsevier items and derived items © 2006 by Elsevier Inc.

Slide 22: 

Elsevier items and derived items © 2006 by Elsevier Inc.

Postoperative Care (See Chart 46-4 Page 981) : 

Elsevier items and derived items © 2006 by Elsevier Inc. Postoperative Care (See Chart 46-4 Page 981) Prevention and assessment of complications Neurologic assessment; vital signs Q 4 hrs Client’s ability to void (inability to void may indicate damage to the sacral spinal nerves, which control the bladder) Pain control (PCA or IV morphine) 24-48 hours

Post-operative Care (continued) : 

Post-operative Care (continued) Wound care (inspect surgical dressing for blood or any other type of drainage, clear drainage may mean cerebrospinal fluid leakage). REPORT TO MD IMMEDIATELY Client positioning and mobility (log roll every 2 hours and keep back straight when getting out of bed)

Post-operative Care (continued) : 

Post-operative Care (continued) Neurovascular checks every 2-4 hours during the first 48 hours Paresthesias may not be relieved immediately after surgery Monitor bowel sounds for possible paralytic ileus Loss of sphincter tone or bladder tone may indicate nerve damage Elsevier items and derived items © 2006 by Elsevier Inc.

Post-operative care (continued) : 

Elsevier items and derived items © 2006 by Elsevier Inc. Post-operative care (continued) If spinal fusion performed in addition to laminectomy Patient stays on bedrest for 24 hours with nurse turning patient every 2 hours Brace is worn when client is out of bed Assess donor site of bone graft Posterior iliac crest (most common)