Module 13.A - Back Problems
The nurse is providing care to a client who is experiencing back pain. Which of the following items in the client's history is a known risk factor for disc herniation? A) 49 years of age B) Female gender C) Short stature D) Anorexia
A) 49 years of age The client's age is a known risk factor; herniated discs are most common between the ages of 30 and 50, because discs naturally degenerate with age. Other risk factors include male gender, tall height, and excess weight (which is extremely uncommon in clients with anorexia).
The mother of a preadolescent client meets with the school nurse to discuss the client's recent diagnosis of scoliosis. Which interventions would be appropriate for the nursing diagnosis of Disturbed Body Image related to deformity and brace? Select all that apply. A) Including the student and family in a meeting to elicit her feelings about scoliosis and wearing a brace B) Offering to arrange a meeting for the student with an 8th grader who has scoliosis C) Encouraging the student and family to register for home schooling to minimize the risk of ridicule D) Teaching the student and family about clothing that will hide the brace E) Suggesting that the pediatrician prescribe an anti-anxiety agent for the student
A) Including the student and family in a meeting to elicit her feelings about scoliosis and wearing a brace B) Offering to arrange a meeting for the student with an 8th grader who has scoliosis D) Teaching the student and family about clothing that will hide the brace In this scenario, important interventions related to a diagnosis of Disturbed Body Image include attentive listening, offering a support group or person, and teaching the student and family about clothes that will hide the brace. Avoiding other children and community encounters will increase the client's risk of social isolation. There is not enough information to indicate a problem that requires pharmacologic management.
The nurse is planning care for a client with acute back pain who is a single mother of two small children and works part-time as a receptionist. Based on this information, which nursing intervention is the highest priority? A) Instructing the client in appropriate body mechanics for lifting and ways to modify her work environment B) Suggesting that the client take time off from work until her back is healed C) Obtaining an order for nonsteroidal anti-inflammatory drugs (NSAIDs) from the client's healthcare provider D) Suggesting that the client's children be taken care of by an extended family member until the client's back is healed
A) Instructing the client in appropriate body mechanics for lifting and ways to modify her work environment The client is at risk for Ineffective Health Management, given that she has two small children who need care and a part-time job that is sedentary. To help the client better manage her health, the nurse should provide instruction on appropriate body mechanics for lifting and ways to modify her work environment. The client may or may not be prescribed NSAIDs. Suggesting that the client take time off from work or have extended family members care for her children may or may not be appropriate and should not be included in the plan of care.
A preadolescent client is recovering from spinal fusion surgery for scoliosis. Which nursing interventions should the nurse carry out to address comfort and mobility? Select all that apply. A) Reposition every 2 hours. B) Monitor intake and output. C) Encourage and assist with range of motion (ROM) exercises every 4 hours while awake. D) Administer pain medication around the clock. E) Encourage incentive spirometer use every 4 hours while awake.
A) Reposition every 2 hours. C) Encourage and assist with range of motion (ROM) exercises every 4 hours while awake. D) Administer pain medication around the clock. Interventions that address movement restrictions and/or pain in a preadolescent client recovering from spinal fusion include repositioning every 2 hours, encouraging and assisting with ROM exercises every 4 hours while awake, and administering pain medication around the clock. All of these interventions relate to a diagnosis of Impaired Physical Mobility. The use of an incentive spirometer may be appropriate after surgery, but it would relate to a diagnosis of Impaired Tissue Perfusion and not a diagnosis involving pain or restricted movement. Monitoring intake and output would be applicable for a diagnosis of Fluid Volume Excess or Fluid Volume Deficit.
The nurse is providing care to a client who returns to the medical-surgical unit after herniated disc surgery. The client's vitals are as follows: HR 100, RR 22, BP 130/86 mmHg, T 98.8°F, and pain rating of 7 on a scale of 0 to 10. Which nursing diagnosis is the highest priority for this client based on these assessment data? A) Impaired Physical Mobility B) Acute Pain C) Activity Intolerance D) Chronic Pain
B) Acute Pain The client is currently experiencing acute pain as evidenced by elevated vital signs and a pain rating of 7 on a 0-to-10 scale. Thus, the priority nursing diagnosis is Acute Pain. Impaired Physical Mobility and Activity Intolerance are appropriate diagnoses in light of the client's surgical procedure, but they are not the highest priority. The client was likely experiencing chronic pain prior to the surgery, and it probably contributed to the need for the procedure.
On the first postoperative day after spinal fusion, the nurse assesses a client and notes the following vital signs: T 39.2°C, BP 100/50 mmHg, HR 118, and RR 23. Drainage at the client's incision site is clear and tests positive for glucose. Which assessment parameter indicates the highest risk for surgical wound infection? A) Temperature B) Incisional drainage positive for glucose C) Heart rate 118 bpm D) Presence of incisional drainage
B) Incisional drainage positive for glucose Incisional drainage isn't necessarily problematic; however, the presence of glucose in this drainage is indicative of cerebrospinal fluid (CSF). A CSF leak increases the risk of infection of the surgical site and meninges. Temperature above 38°C is a fever. Fever may be a sign of infection anywhere in the body, not just at the surgical wound site. Similarly, the client's heart rate could be elevated for numerous reasons.
Which condition or symptom is most common in clients with a herniated cervical disc? A) Sciatica B) Stiff neck and shoulder pain C) Changes in knee and ankle reflexes D) Cauda equina syndrome
B) Stiff neck and shoulder pain Sciatica, cauda equina syndrome, and changes in knee and ankle reflexes are all symptoms associated with lumbar disc herniation. Herniation of the cervical discs is more commonly associated with numbness, tingling, muscle spasms, and weakness in the upper body, as well as stiff neck and shoulder pain that radiates to the arms and fingers.
Which of the clients described below are at increased risk for back problems? Select all that apply. A) A 45-year-old man who has played golf three times a week for the past 20 years B) An 18-year-old woman who has been a distance runner since middle school C) A 62-year-old man who is a heavy truck mechanic and has a body mass index (BMI) of 30 D) A 12-year-old boy who has a history of cerebral palsy and a current BMI of 21 E) A 78-year-old man with a 40 pack-year smoking history who was recently widowed
C) A 62-year-old man who is a heavy truck mechanic and has a body mass index (BMI) of 30 D) A 12-year-old boy who has a history of cerebral palsy and a current BMI of 21 E) A 78-year-old man with a 40 pack-year smoking history who was recently widowed Factors that increase the risk of herniated intervertebral discs include male gender, age (clients over 30 are at higher risk), obesity, history of smoking, and regularly engaging in heavy lifting. This means both the 62-year-old client and the 78-year-old client have multiple traits that put them at elevated risk of disc herniation. Risk factors for scoliosis include age of between 9 and 15 and history of cerebral palsy; thus, the 12-year-old client is at elevated risk for this condition. Neither playing golf nor running track causes a high risk of back problems.
The nurse is documenting the interdisciplinary team report on an adolescent client who has a 35-degree Cobb angle confirmed by x-ray. What interventions should the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply. A) Obtaining a physical therapy consult prior to surgical intervention B) Maintaining the existing curvature with no increase C) Bracing for 12-23 hours per day and providing a support group referral D) Administering nonopioid analgesics and a TLSO or Milwaukee brace E) Instructing the client on exercises and appropriate support groups
C) Bracing for 12-23 hours per day and providing a support group referral D) Administering nonopioid analgesics and a TLSO or Milwaukee brace E) Instructing the client on exercises and appropriate support groups Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.
The nurse is planning care for the client with chronic pain from herniated intervertebral discs who is also experiencing constipation. Which intervention should the nurse carry out to address constipation? A) Restrict foods high in fiber. B) Avoid the use of stool softeners. C) Encourage fluid intake of 2500-3000 mL each day. D) Medicate for pain around the clock.
C) Encourage fluid intake of 2500-3000 mL each day. A client with a herniated intervertebral disc could have problems with constipation because of reduced mobility. Interventions to alleviate and prevent constipation include encouraging fluid intake of 2500-3000 mL each day, encouraging foods high in fiber, and administering stool softeners to clients who cannot tolerate a high-fiber diet. Medicating for pain around the clock should be avoided if possible, because most pain medications have constipation as a side effect.
Which region of the spine is the most common location of herniated discs? A) Cervical region B) Thoracic region C) Lumbar region D) Sacral region
C) Lumbar region The most common location of herniated discs is the lumbar region (L4-L5 and L5-S1), followed by the cervical region (C5-C6 and C6-C7).
The nurse is planning care for a client who is 1 day postoperative after spinal fusion surgery. Which of the following is an appropriate outcome for this client? A) The client will remain in prone position. B) The client will maintain urine output at 20 mL per hour. C) The client will use the incentive spirometer every 2 hours. D) The client will void 12 hours after surgery.
C) The client will use the incentive spirometer every 2 hours. An appropriate outcome for this client is the use of an incentive spirometer every 2 hours. The client is not expected to remain in a prone position, urine output should be at least 30 mL per hour, and the client should void within 8 hours of surgery.
An adolescent client with scoliosis has a Cobb angle of 32 degrees. Given this information, what treatment will the nurse likely need to prepare the client for? A) This client will not need specific treatment. B) The nurse will prepare the client for physical therapy. C) The nurse will prepare the client for wearing a brace. D) The nurse will prepare the client for undergoing spinal fusion surgery.
C) The nurse will prepare the client for wearing a brace. Typically, clients with Cobb angles less than 15 degrees do not require treatment. Clients with Cobb angles of 15 to 25 degrees are treated conservatively with physical therapy, whereas clients with Cobb angles between 25 and 40 degrees are advised to wear a corrective brace. For clients with Cobb angles in excess of 40 degrees, spinal fusion surgery is the most effective option.
During a home care visit, an older adult client begins to cry softly when asked about coping with back pain. The client states, "My back hurts bad all the time. I am so confused about all these tests and scared that the doctor wants me to have surgery." In this scenario, which of the following nursing interventions is the highest priority? A) Asking the client to rate the pain on a scale of 0 to 10 B) Explaining potential procedures in a way the client will understand C) Administering all pain medication as ordered D) Attentively listening to the client's thoughts and fears
D) Attentively listening to the client's thoughts and fears The priority nursing intervention for a client who is ready to disclose emotions is to attentively listen to the client's thoughts and fears. If the nurse is asking about coping, a general back pain assessment and medication administration has already likely been completed. Explaining potential procedures will be done after the assessment is complete and the plan of care is set in place.
