HERNIATED NUCLEUS PULPOSUS

A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk. It is a condition in which part or the entire soft, gelatinous central portion of an intervertebral disk is forced through a weakened part of the disk, resulting in back pain and nerve root irritation Symptoms of Herniated Lumbar Disk Muscle spasm weakness or atrophy in later stages Pain radiating to the buttocks, legs, and feet Pain made worse with coughing, straining, or laughing Severe low Tingling or numbness in legs or feet

Symptoms of Herniated Cervical Disk Arm muscle weakness Deep pain near or over the shoulder blades on the affected side Neck pain, especially in the back and sides Increased pain when bending the neck or turning head to the side Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest Pain made worse with coughing, straining, or laughing Spasm of the neck muscles

Diagnostic Exam 1. EMG-may be done to determine the exact nerve root that is involved. Electromyography is a test that measures muscle response to nervous stimulation. A needle electrode is inserted through the skin into the muscle. Each muscle fiber that contracts will produce an action potential. The presence, size, and shape of the wave form of the action potential produced on the oscilloscope, provides information about the ability of the muscle to respond to nervous stimulation. 2. Nerve conduction velocity test- may also be done. The nerve conduction velocity test is performed to evaluate nerve function. It tests the speed impulses travel through a nerve. 3. Myelogram - may be done to determine the size and location of disk herniation.The contrast dye makes the spinal canal clearly visible in this X-ray image. A herniated disc can be seen compressing the spinal nerves. 4. Spine MRI or spine CT - will show spinal canal compression by the herniated disks stands for computerized tomography. In this procedure, a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes called algorithms; the computer is able to generate a 3-D image of a section through the body. CT scans are very detailed and provide excellent information for the physician. 5. Spine x-ray - may be done to rule out other causes of back or neck pain. However, it is not possible to diagnosis herniated disk by spinal x-ray alone.

Impaired mobility

Management The main treatment for a herniated nucleus pulposus is a short period of rest with pain and antiinflammatory medications, followed by physical therapy. Most people who follow these treatments will recover and return to their normal activities. A small number of people need to have further treatment, which may include steroid injections or surgery. A. Medication 1. Nonsteroidal anti-inflammatory medications (NSAIDs) and narcotic pain killers will be given to people with a sudden herniated disk caused by some sort of injury (such as a car accident or lifting a very heavy object) that is immediately followed by severe pain in the back and leg. 2. NSAIDs are used for long-term pain control, but narcotics may be given if the pain does not respond to anti-inflammatory drugs. 3. Muscle relaxants are usually given if the patient has back spasms. On rare occasions, steroids may be given either by pill or directly into the blood through an IV. 4. Steroid injections into the back in the area of the herniated disk can help control pain for several months. Such injections reduce swelling around the disk and relieve many symptoms. Spinal injections are usually done on an outpatient basis, using x-ray or fluoroscopy to identify the area where the injection is needed. B. Surgery 1. Diskectomy - removes a protruding disk. This procedure requires general anesthesia (asleep and no pain) and 2 - 3 day hospital stay. 2. Microdiskectomy- a procedure removing fragments of nucleated disk through a very small opening. 3. Chemonucleolysis - involves the injection of an enzyme(called chymopapain)into the herniated disk to dissolve the protruding gelatinous substance. This procedure may be an alternative to diskectomy in certain situations. Nursing Diagnosis Pain acute/chronic related to injuring agents, nerve compression, muscle spasm Impaired physical mobility related to pain and discomfort Fatigue related to inability to maintain usual routines, compromised concentration Ineffective coping related to situational crisis Knowledge deficit regarding condition, prognosis, and treatment related to lack of knowledge

Nursing Responsibilities 1. 2. 3. 4. 5. Reduce back stress, muscle spasm, and pain. Promote optimal functioning. Support patient/SO in rehabilitation process. Provide information concerning condition/prognosis and treatment needs. Discharge plan DRG projected mean length of inpatient stay: 4.96.5 days considerations: May require assistance with transportation, self-care, and home maker/maintenance tasks Refer to section at end of plan for post discharge considerations.

Reference: http://www.nlm.nih.gov/medlineplus/ http://www.medhelp.org/ http://adam.about.com/ http://healthline.com/ http://google.com/