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Module 4 (MedSurg 2) > Intervertebral Disc Disease/Back Pain > Flashcards

Intervertebral Disc Disease/Back Pain Flashcards

1
Q

Low Back PAIN AFFECTS

A

80% of adults in US
- MJR CONTRIBUTOR to missed work days
-disability

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2
Q

Patho of back pain

A

due to musculoskeletal problem

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3
Q

Radicular pain

A

Irritation of nerve root

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4
Q

Referred pain

A

The source of pain is another location

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5
Q

Lumbar region

A

Bears most weight*
Is most flexible
Contains nerve roots
Has poor biochemical structure

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6
Q

Risk Factors of Low Back Pain

A

Lack of muscle tone*
Excess body weight*
Poor posture*
Cigarette smoking
Prior compression fractures*
Congenital spinal problems - scoliosis
Family history of back pain

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7
Q

Occupational Risk Factors for back pain

A

Repetitive lifting – nurses, construction
Vibration = truck driver
Extended periods of sitting - school
Health care personnel engaged in patient care

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8
Q

Chronic low back pain

A

Lasts longer than 3 months
Involves repeated incapacitating episode
often progressive

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9
Q

Various Chronic low back pain

A

Degenerative or metabolic disease
Weakness from scar tissue
Chronic strain
Congenital spine problem

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10
Q

Spinal stenosis

A

Narrowing of spinal canal

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11
Q

Spinal stenosis : Acquired conditions

A

Osteoarthritis, RA, tumors, trauma

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12
Q

Spinal stenosis : Inherited conditions

A

Congenital spinal stenosis – narrow spinal canal
scoliosis

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13
Q

Spinal stenosis s/s

A

Pain in low back and radiates to buttocks and leg
↑with walking/prolonged standing
Numbness, tingling, weakness, heaviness in legs and buttocks
Pain ↓ when bends forward or sits down

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14
Q

Spondylosis

A

Structural defect, forward displacement, heredity

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15
Q

Spondylolisthesis

A

Vertebrae slides forward
Graded 1-4 severity

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16
Q

Low Back Pain Overall Goals

A

Satisfactory pain relief
Return to previous level of activity
Correct performance of exercises
Adequate coping
Adequate self-help management

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17
Q

Low Back Pain Health Promotion

A

Proper body mechanics
“Back School program” – specific therapy for back
Appropriate body weight
Proper sleep positioning
Firm mattress*
Stop smoking
Weight reduction
Sufficient rest periods
Local heat and cold application
Physical therapy
Exercise and activity throughout day
Complementary and alternative therapies

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18
Q

Treat as outpatient if back pain is not severe

A

NSAIDs, muscle relaxants
Massage
Back manipulation
Acupuncture
Cold and hot compresses

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19
Q

If they have severe low back pain

A

corticosteroids
opioids

20
Q

Low Back Pain Drug therapy

A

Mild analgesics
Antidepressants
Gabapentin (Neurontin)

21
Q

Minimally invasive therapy for low back pain

A

Epidural corticosteroid injections
Implanted devices to deliver analgesia

22
Q

Low Back Pain Nursing Dx

A

Acute pain
Impaired physical mobility
Ineffective coping
Ineffective health management

23
Q

Intervertebral Disc Disease Patho

A

Intervertebral discs separate vertebrae and help absorb shock
Disease involves deterioration, herniation, or other dysfunction
Involves all levels

24
Q

Degenerative Disc Disease Patho

A

Loss of elasticity, flexibility, & shock-absorbing capabilities
Disc becomes thinner as nucleus pulposus dries out → load shifted to annulus fibrosus → progressive destruction → pulposus seeps out (herniates)

25
Q

Radiculopathy

A

Radiating pain
Numbness
Tingling
↓ Strength and/or range of motion

26
Q

IDD S/S

A

Low back pain
Radicular pain
+Straight leg raise
↓ or absent reflexes
Paresthesia
Muscle weakness

27
Q

Multiple Nerve root compression s/s

A

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

28
Q

Cervical Disc Disease

A

Pain radiates to arms and hands
↓ reflexes and handgrip
May include shoulder pain and dysfunction

Higher the problem the more it affects the body

Check the strength before and after (better or worse)

29
Q

Dx of Disc Diseases

A

X-rays
Myelogram, MRI or CT
Epidural venogram or discogram
EMG

30
Q

Conservative Therapy

A

Start here 1st
Limitation of movement
Local heat or ice
Ultrasound and massage
Skin traction
Transcutaneous electrical nerve stimulation (TENS)
Back-strengthening exercises
Twice a day
Encouraged for a lifetime
Teach good body mechanics
Avoid extremes of flexion and torsion
Most patients heal in 6 months
Unless don’t follow lifestyle changes

31
Q

Drug Therapy for Disc Diseases

A

NSAIDs
Short-term corticosteroids
Opioids
Muscle relaxants
Antiseizure drugs, antidepressants
GABApentin
Epidural corticosteroids injections

32
Q

Surgery is indicated when IDD is debilitating

A

Conservative treatment fails
Radiculopathy worsens
Loss of bowel or bladder control
Constant pain
Persistent neurologic deficit

33
Q

Intradiscal electrothermoplasty (IDET)

A

Minimally invasive outpatient procedure
Denervates nerve fibers

34
Q

Radiofrequency discal nucleoplasty (coblation nucleoplasty

A

Needle inserted similar to IDET
Breaks up nucleus pulposus

35
Q

Interspinous process decompression system
(X Stop)

A

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

36
Q

Laminectomy

A

Surgically remove disc through excision of part of vertebra

37
Q

Discectomy

A

Surgically decompress nerve root
Microsurgical or percutaneous technique

38
Q

Artificial disc replacement

A

Charité or Prodisc-L disc for lumbar DDD
Prestige cervical disc system
Surgically placed in spine through small incision after damaged disc is removed
Allows for movement at level of implant

39
Q

Spinal fusion

A

Spine is stabilized by creating ankylosis (fusion) of contiguous vertebrae
Uses a bone graft from patient’s fibula or iliac crest or from donated cadaver bone
Metal fixation can add to stability
Bone morphogenetic protein (BMP) to
stimulate bone grown of graft

40
Q

Nursing Management after back surgery

A

Vital Signs** RN job
Wound Inspection
Motor strength
Urinary retention voiding
Positioning (logroll)**
Home Care

41
Q

PostOp spinal surgery

A

Opioids for 24-48 hours
Patient-controlled analgesia (PCA)
Switch to oral drugs when able
Muscle relaxants
Assess and document pain intensity and pain management effectiveness
Monitor GI and bowel function
Administer stool softeners**
Monitor and assist with bladder emptying
Loss of tone may indicate nerve damage
Notify surgeon immediately if bowel or bladder incontinence

42
Q

CSF leakage after spinal surgery

A

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

43
Q

Teaching Post-Op spinal surgery

A

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

44
Q

Baclofen (Lioresal)

A

used for spasticity

45
Q

Baclofen (Lioresal) MOA

A

acts within the spinal cord to suppress hyperactive reflexes with no direct effects on skeletal muscle

46
Q

Baclofen (Lioresal)
adverse effects

A

CNS effects, GI symptoms, urinary retention, *no antidote for overdose and withdrawal
also for severe MS

47
Q

During logroll, who counts off when to move

A

Head of the bed

Module 4 (MedSurg 2) (36 decks)

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