3-06-08 Mrs.

Banks

Degenerative Disk Disease

Herniation of Intervertebral Disc

• Intervertebral disc-cartilaginous plate forming a cushion between the

vertebral bodies. The tough fibrous material is incorporated in a capsule

• Nucleus pulposus-ball like cushion in the center of disc.

• Each disc has a soft center (nucleus) surrounded by tough, fibrous outer
rings. Healthy discs are elastic and springy, absorbing pressure which allows
the vertebrae to move

• The nucleus of the disc protrudes into the annulus (which is the fibrous ring
around the disc.) resulting in subsequent nerve compression

• Healthy spine protects spinal cord and supports the body while allowing it to
bend, sit, twist, turn, and lift freely and comfortably.

Causes

• Injury

• Natural aging process

• Premature aging due to misuse

• Certain spinal problems

o Congenital (scoliosis, etc.)

Clinical manifestation

• Depends on location, rate of development, and effect on surrounding tissue

structures

• Pain at the site of the injury and then radiating pain (to the shoulder, arms,
lower extremities)

• Stiffness

• Tingling

• Numbness

• Herniated disc may occur in any portion of the vertebrae

o Cervical
 o Thoracic (not as common)

o Lumbar

Diagnostic Evaluation

• Neurological exam

• MRI

• EMG

• Myelogram-uses dye through lumbar puncture (outlines tissue bed better)

hold all phenothiazides after they return (phergan) because it could cause
seizures

o Check strength of lower extremities when they come back, check

insertion site

o Hydrate them very well to get the dye out

Management

• Goal

o Decrease nerve root pressure to prevent and reverse neurological

damage (if possible)

• Employ conservative management first

o Bedrest

o Medication-analgesics, muscle relaxants, NSAID’s

o Immobilization devices-cervical collar, traction (pelvic sling-done at

home), lumbar braces

Surgical Procedures

• Disectomy-removal of herniated or extending fragments of intervertebral disc

• Laminectomy-removal of entire laminae, helps release pressure when disc is

bulging

• Laminotomy- division of the laminae of the vertebrae, removes, a portion, of

the laminae

• Disectomy with fusion-bone graft used to fuse vertebral spinous process.

Bridges over defective disk to stabilize spine and decrease occurrence.
3-06-08 Mrs. Banks

Cervical Disectomy

• Post-op

o Vital signs

o Make sure they can swallow (watch for hoarseness-sign of edema)

CALL THE DOCTOR

o Check respiratory status

o Check neurological status (primarily movement and sensation in upper

extremities)

o Check dressing for drainage and bleeding (usually have a Jackson Pratt
drain)

o Incision is usually anterior on the side of the neck/ monitor for pain

• Complications

o Swallowing problems (aspiration)

o Bleeding

o Infection

Lumbar Laminectomy

• Post-op

o Check vital signs

o Check neurological status of lower extremities

o Look at dressing

o Urine output

o Monitor for pain

o Log roll every 2 hours and handle them very gently

• Complications

o Infection

o Bleeding

o Urinary retention
 Diffuse Connective Tissue Diseases
Diagnostic Studies

• Erythrocytic sedimentation rate (shows inflammation)

• C-reative protein (shows inflammation, but is more specific)

• Anti-nuclear antibodies (ANA)

• Rheumatoid factor test (RF) specific for RA either positive or negative

• Decreased RBC’s (usually anemic)

• C3 C4 complement components

• Arthrocentesis (pulling fluid of the joints, to see if it’s clear like it should be)

• Radiography

Goals for Rheumatic Diseases

• Suppress inflammatory and autoimmune response

• Pain control

• Maintaining and/ or improving mobility of joint

• Maintaining and/ or improving function status

• Knowledge of disease

• Self-management of therapeutic regimen

Management

• Pharmacological therapy

• Non-pharmacological therapy

• Exercise and activity

Pharmacological therapy

• Salicyates

o Aspirin (enteric coated)

• Non-steroidal anti-inflammatory drugs (NSAID’s)

3-06-08 Mrs. Banks

o Used for pain relief and decrease in inflammation, no effect on

underlying disease

• Disease-modifying antirheumatic drugs (DMARD’s)

o Alters progression of RA, can be toxic, frequent lab and physical

evaluation of skin, liver, renal, bone marrow, and GI function essential.
Include drugs in other classes. Delayed reaction of drug may take
weeks to months. Side effects: N&V, diarrhea, renal toxicity, and
decreased blood counts.

o To include immunosuppressives

o More potent drugs

o May include: gold salts, antimalarial agents, penicillamine, and

sulfasalazine

• Immunomodulators

• Methotrexate is usually first drug of choice for active RA

• Corticosteroids

• Topical Analgesics

Nursing Diagnosis

• Acute and chronic pain

• Fatigue

• Impaired physical mobility

• Disturbed sleep pattern

• Self-care deficits

• Disturbed body image

• Ineffective coping

Rheumatoid Arthritis

Systemic Lupus Erythematosus

Scleroderma

Polymyalgia Rheumatica