Nurb Test 2: Back pain Flashcards
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
Risk Factors
-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
back pain
- pain in the muscle, acute onset, could become chronic if scar tissue develops
Instability of bony mechanism-lost of muscle tone
Lumbosacral strain
- over time wear and tear begins to deteriorate, shrinks, decrease shock absorption, loses elasticity
Degenerative disk disease
- 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
- Disk Herniation
- slipped disk, over time wear and tear, disc pushed out over edge where it belongs
Sx: compression= causing pain
- Spondylolisthesis
- narrowing around the spinal cord, pressing in on
Sx: pain
- Spinal Stenosis
-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
CLINICAL MANIFESTATIONS
- neurological sx, compression in lumbar section, could dev bowl and bladder incontinence, impedance
Cauda Equina
-Usually lasts 4 weeks or less
Tx with conservative measures
Acute Back Pain
-Lasts > 3mo. or repeated episodes
Chronic Back Pain
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
COLLABORATIVE CARE: Acute Back Pain conservative therapy
Same as Acute
Weight reduction
Tricyclic antidepressants- will get relief
Serotonin reuptake inhibitors :sertraline (Zoloft)
Back Exercises
Collaborative care: Chronic Back Pain
- 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
Nonsurgical Interventions
A. Intradiscal Electrothermoplasty (IDET
- use electrical current to decrease the nucleus jelly
- usually 20 percent, outpatient, local anesthetic
nonsurgical intervention
B. Radiofrequency discal nucleoplasty
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
laminectomy
-tradtional, surgical incision, remove a little bit of the lamnia, take a little portion of the disk so it doesn’t compress
B. Diskectomy
laser and micro tools
endoscopic
C. Microdiskectomy
percutaneous lumbar diskectomy -
- used for a disc replacement, artifical disk
E. CHARITÉ DISK
- used for spinal stenosis, vertebra are coming in the thing expands the area to stop the compression
G. X Stop
- Put together to give stability back, decrease compression, loose flexibility in the area that are put together, 3-5 vertebra used
H. Spinal Fusion
- can use artificial, or pt use iliac crest/ need to know if used from patient have second incision
- bone graft spinal fusion
- sleep supine or on side, shoes, lifting mechanics, stregthening
DO NOT: Lean forward without bending knees, Lift anything above level of elbows
NURSING MANAGEMENT:
1. Health Promotion
Teach Body Mechanics
Have satisfactory pain relief
Avoid constipation secondary to medication and immobility
Learn back-sparing practices
Return to previous level of activity within prescribed restrictions
- NURSING MANAGEMENT: PLANNING Overall goals
- Neurologic assessment=make sure no decreased function during surgery
- Monitor VS- pulses in all extremities
- Activity orders per MD-depends on where, no twisting, brace with getting up or 24 hours,
- Positioning- log roll two ppl, one stabilize and the other place brace
- Pain control-pca pump 1st 24, then narcotics, difficult to control bc already take meds
- 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
- Assess for bowel function- incontinent, constipation, stool softener! Use as home, may send home without one
- Assess bladder function- incontinent, trouble first time going, prn order for in and out cath=get up and try to get going on own
- Assess bone graft site
- Log roll, no trapeze, come up as one unit with sitting
- 20-30 minutes in chair because all that pressure on spinal cord causing pain
- 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
NURSING MANAGEMENT: Postoperative Spinal Surgery
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
Cervical surgery
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
Pt education spin surgery
- lay supine, have lift leg, pain= indicates herniation
+ Straight leg test
