Module 13A Back Problems - Study Module
The healthcare provider orders an MRI for a patient with continued back pain that is unrelieved with nonsteroidal anti-inflammatory drugs (NSAIDs). The patient asks the nurse, "What is an MRI?" Which response by the nurse answers this patient? "An MRI is a test of the blood flow to the back." "An MRI is an x-ray of the neck to find out what is causing your pain." "An MRI is a test of the muscles in the back." "An MRI is a technique used to create 3-D pictures of your spine."
"An MRI is a technique used to create 3-D pictures of your spine."
An occupational health nurse conducting an ergonomic assessment in the office observes a programmer who works long hours hunched over a computer. Which statement by the nurse is best? "I notice you hunched over your computer. Does your back or neck ever hurt?" "Bad posture can be a source of back pain. You should not hunch over your computer." "You should stretch on a regular basis and that will help your posture." "Sit up straight. Don't you know that you can do damage to your back sitting like that?"
"I notice you hunched over your computer. Does your back or neck ever hurt?" Opening the conversation with, "I notice you hunched over your computer. Does your back or neck hurt?" allows the person to be part of the conversation and solution. The other recommendations are worthwhile, but they are directives and do not encourage collaboration. As a result, the person may become defensive and less likely to implement ergonomic solutions.
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? "Wear it as much as you can, but there is not really a set time." "They say to wear it 12 - 23 hours a day, but you can probably get away with a lot less." "I understand why you don't want to do it, but if you wear the brace 13 hours a day and according to the directions, it will work that much faster." "I hope you're not thinking of taking this off when you're not supposed to. Your back will just get worse. You need to follow these instructions."
"I understand why you don't want to do it, but if you wear the brace 13 hours a day and according to the directions, it will work that much faster." 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. The success of correction increases with the daily amount of time spent wearing the brace. Telling the patient it is possible to get away with wearing the brace less than 13 hours is not appropriate. All the other responses are not therapeutic or appropriate for this patient. The thoracolumbar sacral orthosis is almost invisible underneath the clothing. In severe cases, halo traction may also be used to support the spine. Bedrest may be prescribed.
The nurse is counseling a pregnant woman who has scoliosis and rod placement about concerns during delivery. Which statement by the nurse is accurate? "Deep breathing will not be effective during your delivery." "You will not be able to receive nitrous oxide gas during labor." "It may not be possible for you to have an epidural during labor." "An episiotomy is not recommended during your delivery."
"It may not be possible for you to have an epidural during labor." A surgically placed rod may make it impossible to have an epidural during delivery. Back pain may increase during pregnancy. The physicians caring for the patient should be aware of the diagnosis and provide care collaboratively. The delivery should proceed with the typical deep breathing and pushing intermittently. An episiotomy (a cut in the area between the vagina and anus) may be necessary to facilitate birth. Nitrous oxide gas may be used to relieve pain.
The nurse is evaluating a patient's response to treatment for back pain. Which patient statement reflects a successful outcome of the treatment regimen? "My pain is decreasing, and I am able to walk for 30 minutes each day." "I am in less pain but am not able to stand for long periods of time." "I am unable to bend down to feed my cat." "I am having tingling in my left leg."
"My pain is decreasing, and I am able to walk for 30 minutes each day." Satisfactory progress will include a report of decreased pain, increased mobility, normal range of motion of joints, normal sensory perception, and lack of neurologic deficits.
An older adult patient diagnosed with secondary scoliosis asks, "Why do I need physical therapy?" Which statement by the nurse is accurate? "You will have to ask your doctor about that." "Physical therapy will train your muscles to maintain proper spine alignment." "We only use physical therapy to treat the most severe cases of scoliosis." "Physical therapy will completely correct your scoliosis."
"Physical therapy will train your muscles to maintain proper spine alignment." Scoliosis is treated by the most conservative method first. Physical therapy will assist in strengthening the back muscles to help maintain proper spinal alignment. The healthcare provider will also choose the treatment based on the Cobb angle. The Cobb angle refers to the angle of the spinal curvature viewed on a frontal plane x-ray. The smaller the angle, the more conservative the treatment. There is no guarantee that physical therapy will correct the scoliosis. There is also no reason for the nurse to defer that question to the doctor. Further teaching points include: It is rare but not impossible for scoliosis to occur in older adults. Myopathic deformity and secondary scoliosis are most probable.
Which statement by the nurse reflects an understanding of a lifestyle habit linked to back problems? "There is no need to change your diet to prevent back problems." "There is no need to quit smoking to prevent back problems." "Poor posture has been shown to cause back problems." "Heavy lifting has not been shown to cause back problems."
"Poor posture has been shown to cause back problems." Back problems are linked to certain lifestyle habits such as bad posture, low fitness level, smoking, athletic injuries, and occupational hazards. Exercise is a habit that helps to prevent back problems. Poor nutrition is not directly related to back problems, although it can lead to obesity and excess strain on the back. Lifting using the muscles of the legs is better than lifting with the muscles of the back.
The nurse is assessing the risk factors for an obese female patient, a programmer by profession, who is complaining of increasing back pain. Which statement best demonstrates the nurse's ability to provide appropriate patient teaching? "Regular exercise will help to strengthen your back." "You should exercise to lose that weight." "You need to lose weight." "You need to change jobs to get better."
"Regular exercise will help to strengthen your back." Excess weight can cause extra pressure on the back and lead to irritation. Regular exercise, especially walking, is good to strengthen the back and can lead to weight loss. Telling the patient what to do in a noncollaborative way will only cause the patient to go on the defensive.
A patient asks the nurse what causes sciatica. Which explanation by the nurse is corret? "Sciatica is caused by meningitis." "Sciatica is caused by irritation or compression of the sciatic nerve." "Sciatica is caused by a laceration of the sciatic nerve." "Sciatica is caused by a leakage of spinal fluid onto the sciatic nerve."
"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.
The nurse is providing discharge teaching for smoking cessation for a patient hospitalized after spinal surgery. The patient asks, "What does smoking have to do with my back?" Which response by the nurse is appropriate? "You know you need to quit smoking regardless of your back. It will kill you." "It is important to cover every part of these teaching materials before you go home." "You haven't smoked the whole time you were in the hospital. You may as well quit now." "Smoking affects every system in the body and is known to increase the risk of herniated discs."
"Smoking affects every system in the body and is known to increase the risk of herniated discs." The response that indicates the effects of smoking on the body and how it increases the patient's risk for herniated discs is the appropriate response to the patient's question. The other responses are vague, threatening, or do not answer the patient's question.
The nurse is caring for a patient who was recently diagnosed with a herniated disc. Which statement by the nurse best describes the teaching required for this patient? "I want to go over with you what you need to do before surgery." "The doctor has asked me to show you how to apply a cervical collar." "I want you to go right home and get into bed. You are to stay in bed for the next 2 weeks." "Today I would like to talk to you about the medications you were prescribed."
"Today I would like to talk to you about the medications you were prescribed." Most patients with back pain related to a herniated disc take some type of medication for pain. Not all herniated discs require use of a cervical collar or surgery. To adequately recover from a herniated disc, the patient requires regular exercise, especially walking. In all settings, the nurse will provide: Medication teaching. Information about diagnostic procedures. Teaching related to any physical restrictions.
The nurse is preparing a presentation to community members on risk factors associated with back pain. Which patient should the nurse identify as being most at risk for herniated disks? A short-statured 25-year-old woman who walks regularly A 45-year-old man who works for a shipping company A normal-weight 18-year-old man who swims competitively A 35-year-old woman with no family history of bone disorders
A 45-year-old man who works for a shipping company A 45-year-old male patient who is overweight and works at a shipping company is most at risk for a herniated disc. Herniated discs are most common between the ages of 30 and 50 and can be exacerbated by excess weight and regular heavy lifting, bending, and twisting, activity that would be common among workers at a shipping company. Genetic factors such as male gender, tall height, and bone disorders also contribute to increased risk of herniated discs, so the other individuals would be less likely to experience herniated discs.
Diagnostic tests for scoliosis include:
Adam forward-bend test. X-rays. Cobb method. MRI. CT scan. Bone scans.
Risk factors for herniated discs include:
Ages 30-50 years. Excess weight. Regular heavy lifting, bending, and twisting. Previous back problems. Smoking.
A patient presents to the clinic with back pain and is being assessed for a herniated disc. Which independent nursing intervention should the nurse implement? Preoperative training Weight-lifting training Obtaining informed consent from the patient for any treatments Assessing the patient's knowledge of the diagnosis and treatment
Assessing the patient's knowledge of the diagnosis and treatment The nurse in an outpatient setting should assess the patient's knowledge of the diagnosis and understanding of the treatment regimen. Surgery is a last resort and would not be a first-line treatment option. Informed consent for any procedure is obtained by the doctor; the nurse is only a witness to the patient's signature. Weight lifting is contraindicated in the patient with back pain and suspected herniated disc. Actions by the nurse in the outpatient setting include: Assessment of the patient's neurologic and mobility status. Assessment of the patient's knowledge of the diagnosis and understanding of the treatment regimen. Assessment of the patient's response to the treatment regimen and stress and coping mechanisms.
Diagnostic tests for a herniated disc include:
CT scan. MRI. Myelogram.
Possible causes of back pain include:
Children are at risk of back strain due to heavy backpacks. Pregnancy is also a source of increasing back pain due to anterior weight.
A patient presents with scoliosis and is scheduled for surgery. Which assessment data should the nurse consider consistent with this treatment? Active growth Cobb angle greater than 50 degrees Age greater than 16 years Noncompliance with conservative therapy
Cobb angle greater than 50 degrees A 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 being treated for a herniated disc. Which assessment finding indicates successful treatment? Decreased pain Decreased mobility Decreased sensation Partial range of motion
Decreased pain Satisfactory progress includes a report of decreased pain, increased mobility, normal range of motion of joints, normal sensory perception, and lack of neurologic deficits.
Health history necessary for a patient with a herniated disc includes:
Description of pain. Previous back injuries or surgeries. Current medications. Risk factors for pain. Type of employment. Typical recreational activities.
The nurse is preparing a pregnant woman who has scoliosis and a rod placement for delivery. Which treatment is the nurse least likely to expect during the delivery? Nitrous oxide gas Deep breathing and pushing Epidural block Episiotomy
Epidural block A surgically placed rod may make it impossible to have an epidural during delivery. Back pain may increase during pregnancy. The physicians caring for the patient should be aware of the diagnosis and provide care collaboratively. The delivery should proceed with the typical deep breathing and pushing intermittently. An episiotomy (a cut in the area between the vagina and anus) may be necessary to facilitate birth. Nitrous oxide gas may be used to relieve pain.
A patient presents with severe left-sided back pain starting near their tail bone and radiating down the leg, accompanied by numbness and tingling in the left calf and heel. Which pathologic process should the nurse suspect is causing the patient's symptoms? Scoliosis Herniated disc in the L4-L5 region Cervical herniated disc Herniated disc in the L5-S1 region
Herniated disc in the L5-S1 region The patient has described the symptoms of a herniated disc between L5 and S1. Symptoms of herniation between L4 and L5 include pain in the hip, lower back, posterolateral thigh, anterior leg, dorsal surface of the foot, and great toe. Leg pain is not present in herniation of cervical discs. Pain is not generally associated with scoliosis, which is usually diagnosed in childhood.
A patient at a preoperative consultation for a lumbar laminectomy has been taking prescription nonsteroidal anti-inflammatory drugs (NSAIDs) and occasional opioids when the pain is severe. Which additional information is most important for the nurse to obtain? Patient's preference for a date and time of surgery History of other back injuries Patient's activity level at work Patient's ability to afford the medications needed at discharge
History of other back injuries All of this is important information for the nurse to obtain. The information that is most important preoperatively is a history of other back injuries, as it has a direct impact on the surgeon's plan for the procedure. Additional health history assessment should include: Risk factors for back pain. Recreational activities.
Alternative therapies for herniated disc/back pain include:
Hot and cold packs. Mild low-impact exercise. Physical therapy. Chiropractic treatment. Massage therapy.
A pregnant woman who is in her third trimester reports back pain. The nurse should associate this pain with which condition? Spinal stenosis Herniated disc Increased anterior weight Fracture of the lumbar vertebrae
Increased anterior weight Back pain during pregnancy is usually caused by changes in posture to compensate for the increase in anterior weight. A herniated disc is rare—1 in about 10,000 pregnancies. Most often, symptoms resolve after the pregnancy ends. Spinal stenosis is a degenerative condition that causes a narrowing of spaces of the spine. A fracture of the lumbar vertebrae mostly is caused by traumatic injury to the back. Nearly half of women complain of back pain during pregnancy. Approximately 70% of women qualify the pain as severe, and about 9% complain of complete disability.
A patient is admitted to the hospital to rule out cauda equine syndrome. The nurse should assess the patient for which complication? Loss of bladder control Numbness isolated to toes Pain radiating up back Upper lumbar pain
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. When the nerves are not completely compressed, any of the symptoms may be observed. When compression is complete, the presence of all of these symptoms is common.
A 40-year-old patient presents with continued back pain. The patient has seen the doctor twice in the last 2 months and has been taking nonsteroidal anti-inflammatory drugs (NSAIDs). Which diagnostic test should the nurse expect the healthcare provider to order? Arteriogram Myogram Cervical x-rays MRI
MRI Considering the patient has been experiencing back pain for an extended period, the healthcare provider would take the next step and order an MRI to determine the actual cause of the back pain. Cervical x-rays would only provide information about the neck region. A myogram is a graphic representation of muscle contractions and would not be relevant in this case. An arteriogram produces images of the arteries and is not relevant. X-rays don't detect herniated discs, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues, or a broken bone.
A patient presents with back pain. The healthcare provider has asked the nurse to discuss nonpharmacologic therapies for pain relief. Which nonpharmacologic therapy should the nurse include? Low-phosphorus diet Meditation Leg-press exercises Massage therapy
Massage therapy Massage therapy may relieve muscle tension, stiffness, and muscle spasms, improving mobility and range of motion. Meditation, diet other than that directly related to weight loss, and leg-press exercises are not included in a nonpharmacologic care regimen for back pain. Weight-bearing exercise may increase the risk for further back injury if not practiced with professional supervision.
A patient presents with back pain. The healthcare provider has asked the nurse to discuss nonpharmacologic therapies for pain relief. Which nonpharmacologic therapy should the nurse include? Meditation Leg-press exercises Low-phosphorus diet Massage therapy
Massage therapy Massage therapy may relieve muscle tension, stiffness, and muscle spasms, improving mobility and range of motion. Meditation, diet other than that directly related to weight loss, and leg-press exercises are not included in a nonpharmacologic care regimen for back pain. Weight-bearing exercise may increase the risk for further back injury if not practiced with professional supervision.
A patient presents with a suspected herniated disc. Which diagnostic test should the nurse expect to be ordered? Mobility testing Lumbar puncture Myelogram Brain scan
Mobility testing Tests for a herniated disc might include mobility testing, imaging, and blood tests. Mobility tests will include straight-leg raises, gait testing, reflex testing, and muscle strength tests. A myelogram can be used to identify areas of pressure on the spinal cord or nerves due to a herniated disc; a brain scan would only reflect what is happening in the brain. Lumbar puncture is used to diagnose meningitis.
Physical assessment for herniated disc should cover:
Muscle coordination. Strength. Gait. Posture. Sensation. Reflexes.
Commonly used medications for herniated disc include:
NSAIDS. Gabapentin (Neurontin). Pregabalin (Lyrica). Duloxetine (Cymbalta). Tramadol (Ultram). Epidural injection of cortisone.
The nurse is caring for a patient with a herniated disc. Which condition should the nurse recognize as the cause of the pain? 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. The discs contain a jelly-like substance; if the substance leaks, it may irritate the nerves and cause pain. The location of the symptoms depends on the area innervated by the compressed nerve.
Which focused assessment should the nurse implement for a patient with chronic back problems who has been taking opioids for pain? Neurologic assessment Cardiovascular assessment Sensory assessment Gastrointestinal assessment
Neurologic assessment A patient with back pain who has been taking opioids will require a neurologic assessment to determine responses to both verbal and physical cues. Cardiovascular, sensory, and gastrointestinal assessments would not provide relevant information to better understand the patient's condition.
Clinical therapies for sciatica include:
Nonsteroidal anti-inflammatory drugs or other analgesics. Antispasmodics. Epidural cortisone injections. Surgery. Physical therapy.
The nurse is conducting a 5 Ps neurovascular assessment for a patient. Which assessments will the nurse document? Pain, pulses, pallor, paresthesia, and paralysis/paresis Pain, pulses, prattle, paresthesia, and paralysis/paresis Pain, patterns, pallor, paresthesia, and paralysis/paresis Pain, pulses, pallor, paresthesia, and pupils
Pain, pulses, pallor, paresthesia, and paralysis/paresis
An older adult patient is diagnosed with scoliosis. Which collaborative therapy should the nurse expect for this patient? Acupuncture Immediate surgery Physical therapy Chiropractic treatment
Physical therapy Treatment in older adults is similar to the conservative treatments used in childhood. This includes physical therapy, exercise, and braces. Surgery is considered a last resort. Chiropractic therapy and acupuncture may be options to improve comfort but are not treatments. Further teaching points include: It is rare but not impossible for scoliosis to occur in older adults. Myopathic deformity and secondary scoliosis are most probable.
Symptoms of cauda equine syndrome include:
Severe low back pain. Bladder or bowel dysfunction. Impaired sensation in the genital or saddle region. Sexual dysfunction. Unilateral or bilateral sciatica.
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? Muscle relaxant Anticonvulsant Nonsteroidal anti-inflammatory drug (NSAID) Steroid injection
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.
