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NURS 347 EXAM 6 > Intervertebral Disc Disease ; Problems > Flashcards

Intervertebral Disc Disease ; Problems Flashcards

1
Q

Intervertebral discs separate vertebrae and help absorb ?

A

Shock

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2
Q

Intervertebral disc disease involves (3)

Involves cervical, thoracic, lumbar spine

A

Deterioration
Herniation
Dysfunction of discs

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3
Q

Degenerative disc disease is the?

A

Loss of fluid leads to loss of elasticity, flexibility and shock absorbing capabilities ; normal process of aging unless also have pain

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4
Q

Degenerative disc disease
Disc become ??

A

Thinner as nucleus pulposus dries out

Load shifted to annulus fibrosis resulting in progressive destruction as the nucleus pulposus seeps out ( herniated or slipped disc )

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5
Q

Etiology (3)

A

Age related degeneration
Repeated stress & trauma
Spinal stenosis

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6
Q

Notes
Most common sites for this is?
L4-5, L5-S1, C5-6, C6-7

A
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7
Q

How does DDD happen ?
And results in?

A

Herniated discs pinch nerves that emerge through the intervertebral foramen

resulting in radiculopathy and radiating pain, numbness, tingling, decreased strength and ROM

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8
Q

How does osteoarthritis affected DDD?

A

Bone spurs form from damaged cartilage

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9
Q

Notes
Clinical manifestations

Low back pain
Radicular pain follows sciatic nerve
Positive straight leg raise
Decreased reflexes
Paresthesia !!
Muscular weakness
Compression of multiple nerve roots !!
( cause equine syndrome !! )

  • severe low back pain
  • progressive weakness
  • increased pain
  • bowel and bladder incontinece
  • saddle anesthesia

May develop slowly and suddenly
( medical energy that requires immediate surgical decompression to prevent paralysis )

Pain radiates to arm and hands following the nerve

Decreased flexes and hand grip

May include shoulder pain and dysfunction

A
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10
Q

What are the 4 diagnostic studies?

A

X ray
Myelogram, MRI, CT
Epidural venogran, discogram
EMG

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11
Q

What is some conservative therapy we can do?

Don’t over think it, similar to back pain

A

Limitation of spinal movement
Local heat or ice
Ultrasound and massage
Skin traction
TENS
( transcutaneous electrical nerve stimulation )

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12
Q

Drug therapy we can give are?

Don’t overthink
Same as low back pain

A

NSAIDS
Short term corticosteroids
Opioids
Muscle relaxtants !!
Anti seizure drugs
Antidepressants

Epidural corticosteroid injections

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13
Q

It’s important to teach patients back strengthening exercises
- how many times a day?
It’s encouraged for a lifetime

We want to teach good body mechanics

Avoid extreme Flexion and torsion

Most patients heal within how many months ??

A

Twice a day

6

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14
Q

Surgical therapy
Indication is needed when? (5)

A

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

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15
Q

What are the 7 surges for intervertebral disc disease?

A

Intradiscal electrothermoplastly (IDET)
Radiofrequency fiscal nucleoplasty ( Coablation nucleoplasty )

Interspinous process decompression system

Laminectomy

Discectomy

Artificial disc replacement

Spinal fusion

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16
Q

Intradiscal electrothermoplastly

It’s minimally invasive

How does it work ?

And body will produces?

A

Needle inserted into affected disc
Wire threaded into disc and heated which destroyed nerve fibers

New reinforcing proteins and fibers of the annulus

17
Q

Radiofrequency fiscal nucleoplasty
( coablation nucleoplasty )

Needles inserted similar to IDET

How does it work?

Up to 20% of nucleus is removed

And it decompressed disc

A

Probe generates energy that breaks up nucleus pulposus

18
Q

Notes
Interspinous process decompressions system ( X stop )

Titanium : fits into mouth placed on vertebrae

To treat lumbar spinal stenosis

Lifts vertebrae off pinched nerve

A
19
Q

What is laminectomy ?

A

Surgically excise protruding disc through of part of vertebra ( lamina )

20
Q

Notes
Discectomy
Surgically decompressed nerve root by removing damaged part

Micro surgical - microscope
Percutaneous - uses fluoroscopy and laser

Artificial disc replacements goals
Restore movement and elimated pain
- surgically placed in spine through small incision after damaged disc is removed
- allows for movement at level of implant

A
21
Q

What is a spinal fusion?

Used a bone graft from a patients __
Or donated cadaver bone (allograft )

Metal fixation can added stability and ___ motion

Bone morphogenetic protein will help stimulate ___

A

Stabilized by creating an ankylosis ( fusion ) of contiguous vertebrae

Fibula or iliac crest

Decreased

Bone growth of graft

22
Q

Notes
Nursing management post surgery

Maintain proper alignment
Postoperative activity varies
Lumbar fusion
- pillows under thighs when supine
- between legs when side lying
- log roll to change position

Reassure patient

Opioids for 24-48 hours
PCA
Switch to oral when able
Muscule relaxtans
Assess and document pain

A
23
Q

Potential for cerebrospinal fluid (CSF) LEAKAGE after spinal surgery

How will you do this? (2)

Noting amount, color, characteristics

A

Yellow drainage ( halo sign )
Positive glucose

24
Q

Assess peripheral neurologic status how?

How long?
Compare to what?

A

Movement and sensations
- report new weakness or Paresthesia

Every 2-4 hours for 48 hours
Baseline ( preoperative status )

25
Q

Assess circulation how post op? (3)

A

Temperature
Capillary refill
Pulses

26
Q

Monitor for GI and Bowel function
And administer ?

Monitor and assist bladder emptying
Loss of tone may indict ___
May require ??

Notify surgeon immediacy if bladder or bowel incontinece for nerve damage !!

A

Constiparion
Stool softeners and laxative

Nerve damage
Catherization

27
Q

Notes
Nursing management
Spinal fusion
Post op

Prolonged healing time and extended activity limited

Rigid orthosis ( chair back brace )
- teach preferred method to apply and remove

Cervical spine
- observe for spinal cord edema
- respiratory distressed and decreased neurologic donation of upper extremities

Immobilize neck hard or soft collar

Assess surgical site
Asses bone graft donor site
- iliac or fibula
- most painful
- pressure dressing
- neurovascular assessment

A
28
Q

Notes
Teaching spinal fusion
Proper body mechanics
Avoid prolonged sitting or standing
Encourage walking Lying down
Avoid lifting, twisting, bending, stooping

Use thighs and knees to absorb shock

Firm mattress or bed board

A

NURS 347 EXAM 6 (17 decks)

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