nursing 121: back problems (mod 13)set #11
A patient asks the nurse what causes sciatica. Which explanation by the nurse is corret? ANSWER "Sciatica is caused by irritation or compression of the sciatic nerve." "Sciatica is caused by a leakage of spinal fluid onto the sciatic nerve." "Sciatica is caused by a laceration of the sciatic nerve." "Sciatica is caused by meningitis."
"Sciatica is caused by irritation or compression of the sciatic nerve." Sciatica is caused by irritation or compression of all or part of the sciatic nerve in the L5-S1 location. Symptoms of sciatica include pain in the hip, lower back, posterolateral thigh, anterior leg, dorsal surface of the foot, and great toe. Leakage of spinal fluid would not exit the spinal cavity and cause irritation of the sciatic nerve. A laceration of the sciatic nerve would cause pain to cease, as innervation would be lost. Meningitis is an inflammation of the membranes that surround the brain and the spinal cord.
risk factors for scoliosis
-Adolescents at greatest risk ( from 9-15 specially woman) -Neuromuscular disorder ▪Cerebral palsy ▪Muscular dystrophy -Family history of scoliosis
Scoliosis Pathophysiology
-Curvature degrees classifications: ▪Mild scoliosis: 10-20 degrees ▪Moderate scoliosis: 20-40 degrees ▪Severe scoliosis: >40 degrees -scoliosis is Classified as: ▪Structural scoliosis: Deformities of bones in spinal column ▪Nonstructural scoliosis: Spine bends to compensate for poor posture, unequal leg lengths, tumors, pain, other physical conditions -Usually corrected by alleviating underlying cause
Nonpharmacologic Therapy for herniated disc
-Hot and cold packs ▪Individually or alternately -Maintain normal activities -Mild low-impact exercise to strengthen back -Collaboration with healthcare professional ▪Chiropractic therapy ▪Massage therapy
scoliosis etiology
-Idiopathic scoliosis ▪Unknown etiology Most often found between age 10. ▪result from abnormal force exerted on spine by surrounding connective tissues, muscles -Congenital scoliosis ▪Individual born with curved spine ▪Usually results from incomplete formation or separation from vertebrae -Neuromuscular scoliosis ▪Results of medical conditions that affect nerves and muscles -Cerebral palsy, muscular dystrophy, spinal cord injury (SCI) -Lateral curvature of spine causes structural changes to skeleton ▪Spinal discs narrowed on inside of curve, wider on outside of curve Creates asymmetric vertebral canal
nursing implementation
-Inpatient settings ▪Apply cervical collar as indicated, maintain spinal precautions as needed ▪Administer pain medication as ordered ▪Prepare patient for surgical procedure ▪Assess neurologic status after procedures ▪Provide postoperative assessments, instructions -prevent injurie: ▪Teach patient to -Avoid bending and twisting -Maintain body alignment that decreases stress on vertebral column -Place small pillow under the knees or neck to decrease pressure on nerve roots -Use a firm mattress to support spinal column ▪Assist patient with positioning and ambulation promote comfort: assess pain and give meds as order, reassess pain after pain meds. facilitate referrals to PT, OT. Provide preoperative care: pain meds. implement post op techniques: : -Logrolling -Incentive spirometer -Leg exercises -Bedpan -Eating while supine
herniated disc; pathophysiology
-Intervertebral discs are located btw vertebral the column, they do: ▪Cushioning ▪Shock absorption ▪Support for vertebrae -Herniation occurs when the Nucleus pulposus protrudes through compromised annulus fibrosus (basically the inner liquid go out of disc) • is More common in cervical, lumbar discs •is due to Rupture of cartilage surrounding disc •Herniation of thoracic disc is medical emergency it May result in paralysis
diagnostic tests
-Mobility tests ▪Straight-leg raise, gait tests, reflex tests, muscle strength tests -Imaging tests ▪CT scans: most common ▪MRI: in severe cases ▪Myelogram: die is injected into spinal fluid and visulaized by x-ray to identify pressure in spinal cord nerves due to herniated disc. ▪Electromyogram: measures electrical activity of muscle at rest and while contracting. -Blood tests ▪Test for inflammation, infection, arthritis ▪Compete blood count (CBC)
pharmacologic theraphy
-Nonsteroidal anti-inflammatory drugs (NSAIDs) ▪are the First-line therapy to reduce pain, swelling -Opioids for severe pain -Antispasmodics to reduce muscular spasms -Medications to treat neuropathic pain may also reduce pain related to nerve damage . they have Milder side effects than opioids -Epidural injections of cortisone/corticosteroids or anesthetics to reduce pain, inflammation
nursing assessment: pt interview and physical assessment
-Patient interview ▪Primary complaint ▪Health history -Description of pain -Previous back injuries or surgeries -Current medications -Risk factors for back pain -Type of employment -Typical recreational activities -Physical assessment ▪Tests of muscle strength, coordination, gait and posture, sensation, reflexes ▪5 P's neurologic assessment to determine neurovascular status (pain, pallor, pulse, paresthesia, and paralysis)
surgery to fix herniated disc
-Reserved for most severe cases ▪Laminectomy: remove lamina layer oround vertebra to allow more space for nerve and relieve pain. ▪Discectomy: remove all or part of herniated disc ▪Spinal fusion: use screws to join 2 or more vertebral discs together to reduce motion and as outcome to reduce pain. ▪Artificial disc surgery: replace original for artificial disc. it will help relieveing pain and maintain flexibility. ▪Laser surgery
lumbar and cervical disc herniations
-Sciatica: irritation or compression of all or part of sciatic nerve ▪Sciatic nerve -Originates in lower back -Longest nerve in body -Two branches travel through pelvis, deep into buttock, down leg -if irritated will show: ▪Pain, burning, tingling, numbness radiating from buttock to leg, foot ▪Usually affects only one side of body -Cauda equina syndrome ▪massive Compression of nerve roots of cauda equina ▪May result in permanent neurologic impairment ▪Medical emergency, requiring immediate surgery, since it can cause urinary incontinence and paralysis. cervical disc herniations shows by: ▪Numbness, tingling, muscle spasms ▪Stiff neck ▪Neck and shoulder pain that shoots into arm, fingers ▪If spinal cord is compressed instead of nerve root
scoliosis clinical manifestatiosn
-Spinal curvature to one side -Uneven shoulders, hips -Differences in leg length -Back pain, pain radiating down legs more common in adults in adults can develop from: ▪Degenerative changes of spine ▪Osteoporosis ▪Fractures ▪Spondylolisthesis ▪Infections ▪Tumors
surgery for scoliosis
-Surgical correction of scoliosis ▪Severe scoliosis: curvature >40 degrees medications for all scoliosis: jsut opioids and otc meds for pain
A patient presents with scoliosis and is scheduled for surgery. Which assessment data should the nurse consider consistent with this treatment? ANSWER Cobb angle greater than 50 degrees Active growth Noncompliance with conservative therapy Age greater than 16 years
ACobb angle greater than 50 degrees patient exhibiting a Cobb angle greater than 50 degrees is a candidate for surgical intervention. The Cobb angle refers to the angle of the spinal curvature viewed on a frontal plane x-ray. Age is not a factor. To need a surgical intervention, the patient must be beyond the age when active growth occurs, and the scoliosis needs to have been proven unresponsive to proper conservative therapy.
A patient is admitted to the hospital to rule out cauda equine syndrome. The nurse should assess the patient for which complication? ANSWER Loss of bladder control Upper lumbar pain Numbness isolated to toes Pain radiating up back
Loss of bladder control The spinal cord does not extend through the entire spinal canal; rather, at approximately L1-L2, it branches into a bundle of free-flowing nerve roots. Because this portion of the spinal cord resembles a horse's tail, it is called the cauda equina, which means "horse's tail" in Latin. Compression of the nerve roots of the cauda equina can lead to cauda equina syndrome, which may result in permanent neurologic impairment, including urinary incontinence and paralysis. Pain would not radiate up the back or be in the upper lumbar region. Any pain would be below the area of injury. Any numbness or impaired sensation would be below the level of injury.
The nurse is caring for a patient with a herniated disc. Which condition should the nurse recognize as the cause of the pain? ANSWER Nerve compression Disc herniation Myelitis Fascitis
Nerve compression If nerve compression is present, clinical manifestations may be pain in the lower back, buttocks, thigh, and leg; numbness and tingling; and muscle weakness. If nerve compression is not present, the patient may be asymptomatic. Myelitis involves the infection or the inflammation of the white matter or gray matter of the spinal cord. Fascitis is an inflammation of the fascia.
A 12-year-old student diagnosed with moderate scoliosis is prescribed a thoracolumbar sacral orthosis (TLSO) brace. The orthopedic nurse is teaching the patient and mother about the therapy, but the patient is upset and reluctant to put the brace on. Which response by the nurse is the appropriate?
Providing the patient with accurate information regarding the length of time the brace will be worn and acknowledging the patient's feelings is the best response in this situation. Braces should be worn between 12 and 23 hours per day.
A patient with chronic back pain due to multiple herniated discs visits the clinic seeking long-term relief from the pain. Which treatment should the nurse expect the healthcare provider to prescribe? ANSWER Steroid injection Nonsteroidal anti-inflammatory drug (NSAID) Muscle relaxant Anticonvulsant
Steroid injection A steroid injection can reduce pain and inflammation over a longer time. A nonsteroidal anti-inflammatory drug (NSAID) is effective to reduce pain and inflammation for short periods. If the patient is experiencing chronic pain from multiple herniated discs, the steroid injection will be more effective in providing pain relief. A muscle relaxant is effective to reduce pain for short periods. An anticonvulsant is useful in reducing nerve pain and may have fewer side effects than opioids.
herniated intervertebral disk
also called -Slipped disc -Herniated nucleus pulposus • a Rupture in a spinal disc Allows fluids to leak out of spinal disc and irritate nearby nerves Causing a decrease in ability of disc to cushion the joints of the vertebrae, causing pain and limiting mobility
back problems
are one of most common alterations of mobility -Typically attributed to activity, movement -Often result of years of improper bending, lifting, standing -Linked to certain lifestyle habits ▪Bad posture ▪Low fitness level ▪Smoking ▪Athletic injuries ▪Occupational risk factors
clinical manifestation of herniated disk
lumbar and cervical regions are the most herniated disc are more common in younger adult than older. common places for herniated discs -If disc is not compressing a nerve, may be asymptomatic -If disc is compressing a nerve ▪Pain in lower back, buttock, thighs, leg ▪Numbness and tingling ▪Muscle weakness -If disc leaks ▪May irritate nerves, cause pain
risk factors and prevention for herniated disc
risk factors: -ages 30 and 50 -Excess weight -Regular heavy lifting, bending, twisting -Previous back problems -Smoking -Genetic factors ▪Male gender ▪Tall height ▪Degenerative disc disorders •Prevention ▪Good posture for sitting and standing ▪Exercising regularly -Weight-bearing exercises ▪Maintaining healthy weight
herniated disc ethiology
with aging: ▪Disc shrinks ▪ Decreased ability to absorb shock ▪Increased risk of herniation gradual herniation is due to: ▪Osteoarthritis or ankylosing spondylitis ▪is Slow onset of pain, with neurologic symptoms such as weakness, tingling sudden herniation is due to: ▪Heavy lifting or motor vehicle crash ▪ has to do with Nerve root compression, causing severe pain, muscle spasms
Which nonpharmacologic option for back pain relief would be most appropriate for the nurse to discuss with a client? (Select all that apply.) A. Massage therapy Your answer is correct. B. Acupuncture Your answer is correct. C. Hydrotherapy Your answer is correct. D. Bedrest E. Weight lifting
ABC Rationale: Clients with pain may want to seek out nonpharmacologic methods of pain relief. The nurse may discuss acupuncture, massage therapy, hydrotherapy, and other methods of pain relief. Bedrest and weight lifting would be contraindicated
Which is a type of scoliosis identified as occurring in individuals? (Select all that apply.) A. Congenital B. Neuromuscular C. Idiopathic D. Familial E. Pathologic
ABCD Rationale: Idiopathic scoliosis is scoliosis of unknown etiology, congenital scoliosis occurs when the individual is born with a spinal curvature, and neuromuscular scoliosis occurs when a medical condition affecting nerves and muscles leads to curvature of the spine. Pathologic and familial are not types of scoliosis.
Which pharmacologic therapy should the nurse expect to be prescribed for a client diagnosed with a herniated disc? (Select all that apply.) A. Anticonvulsants B. Epidural injection with corticosteroids C. Antispasmodics D. Opioids E. Transcutaneous electrical nerve stimulation (TENS)
ABCD Rationale: Appropriate pharmacologic therapy for a client with a herniated disc includes opioids for pain, antispasmodics for muscle spasm, an anticonvulsant for neuropathic pain, and epidural injection with corticosteroids to decrease inflammation. TENS is not considered a pharmacologic therapy for a herniated disc.
The nurse is preparing educational materials concerning back injuries and herniated discs for a health fair at a local community center. Which information should the nurse include in the educational materials? (Select all that apply.) A. Ruptured discs are the most common cause of back pain. Your answer is correct. B. Avoid lifting objects with a twisting motion. Your answer is correct. C. A herniated disc can affect both sensory and motor function. Your answer is correct. D. Those between the ages of 20 and 30 are most at risk. E. The injury occurs most commonly in the lower back.
ABCE Rationale: Lifting heavy objects with a twisting motion can cause rupture of the nucleus pulposus and painful muscle spasms. Improper lifting technique is a common cause of herniated discs. The most common sites for herniated discs are in the lower lumbar area and upper sacrum. These areas are located in the lower back. A herniated disc can affect sensory as well as motor nerves. The client can have issues with sensation as well as problems with walking and mobility. A ruptured disc is the most common cause of low back pain. This occurs in as many as two-thirds of the population. Although herniated discs can occur at any age, the most common occurrence is in men between the age of 30 and 50 years.
13-1.1Demonstrate understanding of the concept of mobility in the care of a patient with back problems. Question 1, Study Plan 13-1.1.1 1 correct Points: 1 of 1 Close The nurse is assessing a client who is scheduled for a surgical correction of scoliosis. Which manifestation should the nurse assess? (Select all that apply.) A. One shoulder higher than the other Your answer is correct. B. Asymmetric scapulae Your answer is correct. C. Difference in length of legs Your answer is correct. D. Curve of the thoracic spine when viewed from the side, or hunchback appearance E. Prominence of thoracic ribs on bending forward
ABCE Rationale: Musculoskeletal manifestations in scoliosis include one shoulder higher than the other, uneven hips, a prominent scapula, asymmetry of the shoulders and scapula, differences in leg length, prominence of the thoracic ribs or paravertebral muscles on forward bending, and lateral curvature and vertebral rotation on posteroanterior x-rays. Increased curvature of the thoracic spine as viewed from the side, or a hunchback appearance, is a manifestation of kyphosis. Scoliosis is a lateral curvature of the thoracic or lumbar spine (or both).
Which collaborative therapy should the nurse expect for a client newly diagnosed with sciatica? (Select all that apply.) A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Epidural injections C. Surgery D. Antispasmodics E. Physical therapy
ABDE Rationale: When treating a client newly diagnosed with sciatica, the healthcare provider will want to reserve surgery as a last resort. NSAIDs or other analgesics, antispasmodics, epidural injections of cortisone, and physical therapy are first-line treatment options.
Which symptom indicates gradual herniation of a disc? (Select all that apply.) A. Weakness B. Fast onset of pain C. Tingling D. Slow onset of pain E. Muscle spasm
ACD Rationale: Abrupt herniation is associated with root compression, severe pain, and muscle spasms. Gradual herniation is usually associated with a gradual onset of pain and may be associated with neurologic symptoms such as tingling and weakness.
Which diagnostic test is associated with the diagnosis of scoliosis? A. Magnetic resonance imaging (MRI) scan B. X-ray Your answer is correct. C. Positron emission tomography (PET) scan D. Computerized tomography (CT) scan
B Rationale: X-rays are most commonly used in imaging to definitively diagnose scoliosis. With an x-ray of the spine, the healthcare provider can use the Cobb method of determining the curvature of the spine. MRI, CT scan, and PET scan are not commonly used in the diagnosis of scoliosis.
Which instruction should the nurse include in teaching for clients diagnosed with a herniated disc? (Select all that apply.) A. Application of a cervical collar B. Information about diagnostic testing Your answer is correct. C. Medication teaching Your answer is correct. D. Physical restrictions Your answer is correct. E. Implementation of weight lifting exercises
BCD Rationale: All clients with a diagnosis of a herniated disc will require medication teaching relating to pain control, information about any physical restrictions, and information about upcoming diagnostic testing. Weight training is contraindicated in a client with a herniated disc. As cervical disc herniation is rare, it would be unlikely the healthcare provider would prescribe a cervical collar.
The nurse is teaching a client with back pain about the medications prescribed. Which information should the nurse include? (Select all that apply.) A. Where to purchase medication B. Possible side effects Your answer is correct. C. Safe administration Your answer is correct. D. Expected response Your answer is correct. E. Adverse reactions
BCDE Rationale: The nurse teaches the client about the purpose of the medications, expected response, possible side effects, and adverse reactions, as well as safe administration. The nurse would not advise on where to purchase the medication.
The nurse caring for a client with a herniated disc should place the client in which position? A. Side-lying B. Prone, with pillow under chest C. Knee-chest D. Supine, with a small pillow under the knees
D Rationale: The nurse should encourage the client to maintain body alignment that decreases stress on the vertebral column, such as in the supine position with a small pillow under the knees. If side-lying, a small pillow between the knees would maintain alignment. The prone position causes too much pressure on the vertebral column. The knee-chest position is commonly used only for procedures.
scoliosis
•ateral curve of the spine >10 degrees -C-shaped or S-shaped -Evident during growth spurt before puberty -Most cases are mild -Severe cases can cause spine rotation ▪Deformities and disabilities
lifespan consideration older adult with herniated disk
▪Age-related changes make discs less likely to herniate ▪Most experience recovery similar to younger adults with nonsurgical interventions
Lifespan Considerations: adults and Older Adults
▪Myopathic deformity and secondary scoliosis may develop in adulthood ▪Treatment -Begins with conservative measures •Physical therapy (PT), exercise, braces
nursing process: primary goal
▪Relieving pain ▪Healing involved disc ▪Regaining mobility -other Goals may include that patient will ▪Develop no motor or sensory deficits ▪Remain free from infection ▪Demonstrate normal bowel/urinary function ▪Verbalize proper use of medications ▪Report diminished pain to allow activities of daily living (ADLs) ▪Correctly verbalize proper use of medications ▪Verbalize emotions and concerns related to all treatments ▪Perform job responsibilities without work absences
