Back Pain And Intervertebral Disc Disease Flashcards
Radicular pain
Irritation of nerve root
Referred pain
Source of pain is another location
Lumbar region
Low back pain
Bears most weight
Most flexible
Contains nerve roots
Has poor biochemical structure
Risk factors
Lack of muscle tone
Excess body weight
Poor posture
Cigarette smoking
Prior compression fractures
Congenital al problems
Family history o back pain
Occupational risk factors
Repetitive lifting
Vibration
Extended periods of sitting
Health care personnel engaged in pt care
Chronic low back pain
Last longer than 3 months
Spinal stenosis
Narrowing spinal canal
Acquired conditions
Osteoarthritis RA tumors and trauma
Inherited: congenital spinal stenosis
Spinal stenosis manifestations
Pain in low back radiates to buttocks and leg
INCREASES with walking
When you bend forward it decreases pain
Spondylolysis
Structural defect , forward displacement , heredity
Spondylolisthesis
Vertebrae slides forward
(Grades not for us )
Low back pain goals
Satisfactory pain relief
Return to previous level of activity
Correct performances of excercise
Adequate coping
Adequate self help management
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
Back school program
A specific therapy for back pain
What medications can help with back pain
NSAIDS , muscle relaxants
Severe- corticosteroids , opioids
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
Other forms of care
Massage
Back manipulation
Acupuncture
Cold and hot compresses
Drug therapy
Mild analgesics-nsaids
Antidepressants
Gabapentin (neuropathy)
Baclafin for spasm
Deladid
Nursing diagnosis
Acute pain
Impaired physical mobility
Ineffective coping
Ineffective health management
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)
