Nurb Test 2: Back pain

Question 0

Lack of muscle tone
Excess body weight
Poor posture-slouching
Cigarette smoking-lack of oxygen exchange with your tissues
Stress
Job related-heavy lifting, overhead Ex: construction workers

Answer 0

Risk Factors

Question 1

-Affects ~ 80% of adults at least once
=Second only to headache as the most common pain complaint
-In those < age 45 responsible for more lost working hours
-Tx doesn’t always work

Answer 1

back pain

Question 2

• pain in the muscle, acute onset, could become chronic if scar tissue develops
  Instability of bony mechanism-lost of muscle tone

Answer 2

Lumbosacral strain

Question 3

• over time wear and tear begins to deteriorate, shrinks, decrease shock absorption, loses elasticity

Answer 3

Degenerative disk disease

Question 4

• wear and tear, middle of disc has gel and outside is bone, overtime can build up pressure and push out of the bone
  Sx: pain, pressure, compression

Answer 4

1. Disk Herniation

Question 5

• slipped disk, over time wear and tear, disc pushed out over edge where it belongs
  Sx: compression= causing pain

Answer 5

2. Spondylolisthesis

Question 6

• narrowing around the spinal cord, pressing in on

Sx: pain

Answer 6

3. Spinal Stenosis

Question 7

-all spine in a simial way
Radicular pain-radiates, down the legs into siatic nerve 
Muscle spasm
Stiff, flexed  posture
Paresthesia-numbness, tingling
Decreased reflexes 
Muscle strength-pick one leg off floor, hold it, see if able to hold hips level=+ Trendelenburg test
Cauda Equina 
Decreased achilles or patellar reflex
Decreased ROM

Answer 7

CLINICAL MANIFESTATIONS

Question 8

• neurological sx, compression in lumbar section, could dev bowl and bladder incontinence, impedance

Answer 8

Cauda Equina

Question 9

-Usually lasts 4 weeks or less

Tx with conservative measures

Answer 9

Acute Back Pain

Question 10

-Lasts > 3mo. or repeated episodes

Answer 10

Chronic Back Pain

Question 11

Rest
Ice=1st 48 /Heat applications
Massage
Analgesics (NSAIDs)- try to avoid narcotics
Muscle relaxants – acute flare ups
cyclobenzaprine (Flexeril)
Epidural corticosteroid injections-decrease inflammation
Transcutaneous electrical nerve stimulation (TENS)-electrical current to stimulate the area, help repair injury, interfere with pain transmission
Brace, corset, or belt- help support, rest
Therapy- strengthen muscle, prevent another episode
Look at job, lifting, what helps, environmental modifications, on firm mattress
Don’t sleep in prone position

Answer 11

COLLABORATIVE CARE: Acute Back Pain conservative therapy

Question 12

Same as Acute
Weight reduction
Tricyclic antidepressants- will get relief
Serotonin reuptake inhibitors :sertraline (Zoloft)
Back Exercises

Answer 12

Collaborative care: Chronic Back Pain

Question 13

• use heat, take a cannula and inserting it into the disc where the nucleus is, melt away some of the jelly, used with disc herniation, decreases pressure

Answer 13

Nonsurgical Interventions

A. Intradiscal Electrothermoplasty (IDET

Question 14

• use electrical current to decrease the nucleus jelly

- usually 20 percent, outpatient, local anesthetic

Answer 14

nonsurgical intervention

B. Radiofrequency discal nucleoplasty

Question 15

Surgical Interventions- can do more than one
-Surgical excision of posterior arch of vertebra to remove protruding disk, back spinny portion of the spine, allows area to decompress

Answer 15

laminectomy

Question 16

-tradtional, surgical incision, remove a little bit of the lamnia, take a little portion of the disk so it doesn’t compress

Answer 16

B. Diskectomy

Question 17

laser and micro tools

endoscopic

Answer 17

C. Microdiskectomy

percutaneous lumbar diskectomy -

Question 18

• used for a disc replacement, artifical disk

Answer 18

E. CHARITÉ DISK

Question 19

• used for spinal stenosis, vertebra are coming in the thing expands the area to stop the compression

Answer 19

G. X Stop

Question 20

• Put together to give stability back, decrease compression, loose flexibility in the area that are put together, 3-5 vertebra used

Answer 20

H. Spinal Fusion

Question 21

• can use artificial, or pt use iliac crest/ need to know if used from patient have second incision

Answer 21

1. bone graft spinal fusion

Question 22

• sleep supine or on side, shoes, lifting mechanics, stregthening
  DO NOT: Lean forward without bending knees, Lift anything above level of elbows

Answer 22

NURSING MANAGEMENT:
1. Health Promotion
Teach Body Mechanics

Question 23

Have satisfactory pain relief
Avoid constipation secondary to medication and immobility
Learn back-sparing practices
Return to previous level of activity within prescribed restrictions

Answer 23

3. NURSING MANAGEMENT: PLANNING Overall goals

Question 24

1. Neurologic assessment=make sure no decreased function during surgery 2. Monitor VS- pulses in all extremities 3. Activity orders per MD-depends on where, no twisting, brace with getting up or 24 hours, 4. Positioning- log roll two ppl, one stabilize and the other place brace 5. Pain control-pca pump 1st 24, then narcotics, difficult to control bc already take meds 6. Inspect surgical site- drains, physician change dressing 1st time, then you replace once a day/ have someone learn how to take care of dressing and watch for infection 7. Assess for bowel function- incontinent, constipation, stool softener! Use as home, may send home without one 8. Assess bladder function- incontinent, trouble first time going, prn order for in and out cath=get up and try to get going on own 9. Assess bone graft site 10. Log roll, no trapeze, come up as one unit with sitting 11. 20-30 minutes in chair because all that pressure on spinal cord causing pain 12. May have leaking of spinal fluid- cause headache, halo on their dressing clear discharge then yellow on , Glucose strip if positive it is cerebral spinal fluid

Answer 24

NURSING MANAGEMENT: Postoperative Spinal Surgery

Question 25

May have collar-wear 24 hours, only able to move slightly, check for skin break down, check dressing, remove in bed to change dressing= have second person

Answer 25

Cervical surgery

Question 26

Thighs and knees should be used to absorb shock of activity Firm mattress or bed board Sleep in a side-lying position with knees and hips bent , supine, pillow long ways under leg= relieve pressure on lower back/ side lying pillow between leg/ don’t raise head of bed more than 30 degrees but check orders Lifting restrictions- no more than 5-10 lbs, not allowed to drive 4-6 weeks=can’t turn Weight reduction Exercises Brace

Answer 26

Pt education spin surgery

Question 27

- lay supine, have lift leg, pain= indicates herniation

Answer 27

+ Straight leg test