Back Pain And Intervertebral Disc Disease Flashcards by Elizabeth Gausin

Radicular pain

Irritation of nerve root

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Referred pain

Source of pain is another location

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Lumbar region

Low back pain
Bears most weight
Most flexible
Contains nerve roots
Has poor biochemical structure

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Risk factors

Lack of muscle tone
Excess body weight
Poor posture
Cigarette smoking
Prior compression fractures
Congenital al problems
Family history o back pain

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Occupational risk factors

Repetitive lifting
Vibration
Extended periods of sitting
Health care personnel engaged in pt care

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Chronic low back pain

Last longer than 3 months

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Spinal stenosis

Narrowing spinal canal
Acquired conditions

Osteoarthritis RA tumors and trauma
Inherited: congenital spinal stenosis

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Spinal stenosis manifestations

Pain in low back radiates to buttocks and leg
INCREASES with walking
When you bend forward it decreases pain

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Spondylolysis

Structural defect , forward displacement , heredity

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Spondylolisthesis

Vertebrae slides forward
(Grades not for us )

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Low back pain goals

Satisfactory pain relief
Return to previous level of activity
Correct performances of excercise
Adequate coping
Adequate self help management

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Health promotion for low back pain

Proper body. Mechanics
“Back school program”
Appropriate body weight
Proper sleep positioning
Firm mattress (change 8-10 years and rotate mattress)
Stop smoking
Weight reduction
Sufficient rest periods
Local hear and cold app
PT
Excercise and activity through out the day complementary and alternative therapies

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Back school program

A specific therapy for back pain

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What medications can help with back pain

NSAIDS , muscle relaxants

Severe- corticosteroids , opioids

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What can we tell truck drivers if that’s how they make a living

Frequent excercise (back school)
Drive shorter time
Get in town Job

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Other forms of care

Massage
Back manipulation
Acupuncture
Cold and hot compresses

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Drug therapy

Mild analgesics-nsaids
Antidepressants
Gabapentin (neuropathy)
Baclafin for spasm
Deladid

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Nursing diagnosis

Acute pain
Impaired physical mobility
Ineffective coping
Ineffective health management

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Intervertebral ray disc disease

Intervertebral disc seperate vertebrae and help absorb shock
Deterioration herniation or other dysfunction
Involves all levels(cervical thoracic or lumbar)

Patho of intervertebral disc disease

Loss of elasticity , flexibility and shock absorbing capabilities
Disc becomes thinner

Radiculopathy from intervertebral disc disease

Radiating pain
Numbness
Tingling
Strength
Decrease strength and or ROM

Clinical manifestations of disc disease

Low back pain
Radicular pain
Straight leg raise
Decrease or absent reflexes
Parenthesis
Muscle weakness

Thinning disc

Causes bone on bone

Disc degeneration with osteophyte formation

From osteoarthritis or RA

Multiple nerve root( (cauda equina). Compression ——clinical manifestation of disc disease)

Severe low back pain Progressive weakness Increased pain Bowel and bladder incontinence Medical emergency

More clinical manifestations

Pain radiated to arms and hands Decreases reflexes and hand grip May include shoulder pain and. Dysfunction

Diagnostic studies for disc disease

X-ray Myelogram, MRI or CT scan Epidural venogram or disco gram EMG

Conservative therapy for disc disease

Limitation of movement Local heat or ice Ultrasounds and massage Skin traction Transcutaneous electrical nerve stimulation

Back strengthening excercises for disc disease

2x a day Encourage for a lifetime Teach good body mechanics Avoid extremes of FLEXION and torsion Most pt heal in 6 months

Drug therapy for disc disease

NsaIDs Short term corticcosteriods Opioids Muscle relaxants Antisiezure drugs anti depressant (Gabapentin ) Epidural corticosteroid injections

Surgical therapy disc disease

Indicated only when conservative treatment fails Radiculopathy worsens Loss of bowel or bladder control Constant pain Persistent neuro deficit

IDET Intradiscal electrothermoplasty

Surgical treatment Minimal invasive treatment Denervates nerve fibers

X stop /interspinous process decompression system surgical

To treat lumbar stenosis Titanium fits into mount placed on vertebrae Lifts vertebrae off pinched nerve

Laminectomy

Most common seen Surgically remove disc through excision of part of vertebra

Discectomy

Most common Surgically decompress nerve root Microsurgical or. Percutaneous technique

How do you move pt after surgery

Log roll technique Person at head of the bed to count and call out turn

Artificially disc replacement

Charite or prodisc-l disc for lumbar ddd Allows for movement at level of implant

Spinal fusion surgical technique

Metal fixation can add stability BMP to stimulate bone growth to graft

Nursing management

Vital signs - ICU only nurse Wound inspection Motor strength Urinary retention Positioning Logroll Home care

From baseline if it gets worse

Inform physician

Post op management spinal surgery)

Opioids for 24-48 hours PCA Switch oral drugs when able Muscle relaxants Assess and document pain intensity and pain management effectiveness

What should you never do

Administer meds thru PCA

What to assess post op spinal surgery

Potential for CSF leakage Monitor for and report severe headache or leakage of CSF (Clear or slightly yellow drainage on dressing and for glucose Frequently assess for peripheral neuro signs

Monitor GI and bowel function post op spinal surgery

Administer stool softeners

Monitor and assist with bladder emptying post op spine surgery

Loss of tone may indicate nerve damage Notify surgeon immediately if bowel or bladder incontinence

Nursing managment post op

Teaching regarding activity Proper body mechanics Avoid prolonged sitting/standing Encourage walking,lying down, shifting weight No lifting and twisting Use thighsn and knees to absorb shock Firm mattress or bed board

Baclofen

Also for MS and severe back problems (spasms)