Primary Nursing Diagnosis

Pain (acute) related to inflammation and compression

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom severity

INTERVENTIONS. Analgesic administration; Anxiety reduction; Environmental management: Comfort; Pain management; Medication management

H PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. Pharmacologic measures are often used to manage symptoms. Physical therapy includes various passive modalities of treatment, such as heat, ice, massage, ultrasound, and electrogalvanic stimulation, often directed by a physical therapist, and exercises to stretch and strengthen the spine and supporting musculature. Spinal adjustments performed by osteopathic or chiropractic physicians can also relieve symptoms. Chemonucleolysis may be used by injecting the enzyme chymopapain into the nucleus pulposus. Ask if the patient is allergic to meat tenderizers, since such an allergy contraindicates the use of chymopapain in the procedure.

SURGICAL. When the medical and pharmacologic treatments are not successful, or if the symptoms become debilitating, then surgery is considered. Surgery involves removal of the disk using a microscope. A microdiskectomy removes fragments of the nucleus pulpolsus. More common is a laminectomy, which removes the protruding disk and a portion of the lamina. A spinal fusion of the bony tissues may be performed if there is evidence that the disk herniation is accompanied by instability of the surrounding tissues. Surgical treatment is usually successful but may involve a prolonged recovery time, especially with more involved procedures.

Postoperatively, enforce bedrest and monitor dressings for excessive drainage. Position the patient depending on the type of surgery performed. Teach the patient who has undergone spinal fusion how to wear a brace. Teach the patient proper body mechanics. Encourage the patient to lie down when she or he is tired and to sleep on her or his side, using an extra firm mattress or bed board. Caution the patient to maintain proper weight, since obesity can cause lordosis. Ongoing assessments are important if the patient requires surgery. Monitor the patient for signs of weakness, pain, changes in circulation, and numbness in the extremities. Assess the cardiovascular status of the patient's legs by observing for color, temperature, and motion. Assess the degree of pain in terms of intensity, location, and character.

Pharmacologic Highlights

Medication or

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