Week 7: Herniated Disk and Spinal Cord Tumors Flashcards
Function of disc is to?
allow for mobility of the spine and act as a shock absorber
Herniated disk
-herniated nucleus pulposus, (HNP) slipped disc, ruptured disk
-HNP- annulus becomes weakened/torn and the nucleus pulposus herniates through it
Risk factors: standing erect, aging changes, poor body mechanics, overweight, trauma
Common manifestations/complications of herniated disk
- sensory root or nerve usually affected: pain, parenthesis, or loss of sensation
- motor root or nerve may be affected: paresis or paralysis
- Manifestations: depend on what nerve root, spinal nerve is being compressed-which dermatomes
- radiculopathy: pathology of the nerve root
symptoms of lumbar HNP
- postural changes
- urinary.male sexual function changes
- paresis or paralysis
- paresthesisa
- numbness
- muscle spasms
- absent cord relexes
Cervical HNP manifestations/complications
- pain-neck, shoulder, anterior upper arm to thumb
- absent/diminished reflexes to the arm
- motor changes-paresis or paralysis
- sensory- paresthesias or pain
- muscle spasms
treatment: conservative
- Bed rest with firm mattress: log roll, side lying position with knees bent and pillow between legs to support legs
- avoid flexion of the spine: brace/corset, cervical collar to provide support
- medication: non-narcotic analgesiscs, anti-inflammatory, muscle relaxants, antispasmodics, tranquilizers
- heat and cold, massage therapy
- weight loss
- TENS units
Laminectomy
remove portion of the lamina to relieve pressure to get the herniated nucleus puplosus that is protruding
foraminotomy
enlargement of the bony overgrowth at the opening which is compressing the nerve
microdiskectomy
use of electron microscope through a small incision to remove a portion of the HNP that is displaced
prevention of HNP
- education on causes (obesity, improper body mechanics, aging, etc.)
- exercise and strengthen leg and abd. muscles
- changes in lifestyle
Post op assessment for HNP
- sensory/motor assessment -care not to injure op site
- assess for csf drainage or bleeding from op site
- encourage turn (log roll, cough, deep breathe)
- assess for postural hypotension: especially if client was on bed rest for several days/weeks prior to surgery
Anterior cervical: assess injury to carotid, esophagus, trachea, laryngeal nerve, respiration, neck size, swallowing and speech
Lumbar: asses bowel sounds, voiding, minimize stress of post op site: glat with pillow between knees, log rolling, etc.
Nursing Problem/intervention acute Pain
- post surgery the individual may have similar pain as pre-op due to lack of resiliency of the spinal nerves to ‘bounce’ back quickly
- donor site (iliac crest) may cause more pain than laminectomy
- individual may be in pain-spasm-pain cycle, therefore may need both antispasmodic as well as analgesic
Home care nursing problem/intervention
- when riding in a car, take frequent stops to move and stretch
- prevention-back school approach
- may have to deal with pain as a chronic condition
- may need to make life/job changes
intermedullary
arise from neural tissues of the spinal cord
extramedullary
arise from tissues outside the spinal cord may be benign or malignant
