Nursing Care Plan-herniated Nucleus Pulposus

NURSING CARE PLAN ASSESSMENT

SUBJECTIVE: P-unilateral back pain -pain from movement of neck. Q- compressing pain. R- radiating to butt T- pain aggravated when coughing, sneezing, bending and doing vulsulva maneuver -pain suddenly subsides for few days. -pain when raising leg.

OBJECTIVE: -limited ability to bend forward -tenderness in affected area upon palpation. - (+) lasegue’s sign. -muscle atrophy of affected area.

NURSING DIAGNOSI S -Acute pain related to trauma to intervertebral disk.

SCIENTIFIC RATIONALE -the bones of the spinal column or vertebrae, run down the back connecting the skull to the pelvis. These bones protect nerves as they exit the brain and travel down the back and then to the entire body. HNP usually occurs in a posterior or posterolateral fashion, compressing the spinal cord and or nerve roots causing pain and neurologic symptoms.

PLANNING

STG: -after 8 hours of nursing intervention , patient will be able to report relieved or controlled pain.

INTERVENTIO NS -perform a comprehensive assessment of pain each time pain occurs.

-to rule out worsening of underlying condition or development of complications.

-note patients locus of control.

-individual with external locus of control may take little or no responsibility for pain management.

LTG: -after 2 weeks of nursing intervention patient will be able to demonstrate use of relation techniques or skills and diversional activities as indicated for individuals situation.

RATIONALE

-observe for nonverbal cues. -monitor vital signs. -provide comfort measures. -encourage use of relaxation exercise. -encourage diversional activities. -administer analgesics as indicated to maximal dosage as needed. - encourage adequate restperiods.

-observations may or may not be congruent with verbal reports indicating need for further evaluation. -vital signs usually altered in acute pain. -to provide non pharmacologic pain management. -to divert attention of the patient to the activity rather than the pain. -to maintain acceptable level of pain. -to prevent fatigue.

EVALUATION

-patient may have different levels of pain every time pain is assessed. -patient may show locus of control aggravating pain if its identifiable by the patient. -patient may show grimacing, guarding behavior. -patient may elicit increase in vital signs. -provided comfort measures such as back rub, change of position. -patient used relation technique such as focused deep breathing. -patient achieved minimal tolerable level of pain. -patient was able to have adequate rest.

PATHOPHYSIOLOGY Mechanical stress ( compression, fusion, HPN, rotational forces.)

Aggravated by age due to degenerative changes thus resulted in weak muscles.

Decreased in protein contents (oncotic agents)

Men gender are mostly predisposed to

Erosion of vertebral body by bulging disk teared annulus.

Irritated pain fibris

Local tenderness

Stimulation of new bone growth accompanied by vertebral spasm.

PAIN

-Decreased fluid in the annulus. -Dehydration of the annulus. -weakening of the annulus, thus less elastic, thus prone to tearing.

-Increased uptake of fluid in the nucleus pulposus. -Increase pressure in the nucleus pulposus.

Ligament thicken

Increased tension

Calcification

Replacement of nucleus

Results in neutral obstruction

Decrease flow of blood in the affective area

Compression of spinal nerve

Impaired mobility

Numbness occurs

Accompanied by: Autonomic responses: -inc. v/s -papillary dilatation -diaphoresis