Week 7: Herniated Disk and Spinal Cord Tumors Flashcards Preview

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Flashcards in Week 7: Herniated Disk and Spinal Cord Tumors Deck (25):
1

Function of disc is to?

allow for mobility of the spine and act as a shock absorber

2

Herniated disk

-herniated nucleus pulposus, (HNP) slipped disc, ruptured disk
-HNP- annulus becomes weakened/torn and the nucleus pulposus herniates through it
Risk factors: standing erect, aging changes, poor body mechanics, overweight, trauma

3

Common manifestations/complications of herniated disk

-sensory root or nerve usually affected: pain, parenthesis, or loss of sensation
-motor root or nerve may be affected: paresis or paralysis
-Manifestations: depend on what nerve root, spinal nerve is being compressed-which dermatomes
-radiculopathy: pathology of the nerve root

4

symptoms of lumbar HNP

-postural changes
-urinary.male sexual function changes
-paresis or paralysis
-paresthesisa
-numbness
-muscle spasms
-absent cord relexes

5

Cervical HNP manifestations/complications

-pain-neck, shoulder, anterior upper arm to thumb
-absent/diminished reflexes to the arm
-motor changes-paresis or paralysis
-sensory- paresthesias or pain
-muscle spasms

6

treatment: conservative

-Bed rest with firm mattress: log roll, side lying position with knees bent and pillow between legs to support legs
-avoid flexion of the spine: brace/corset, cervical collar to provide support
-medication: non-narcotic analgesiscs, anti-inflammatory, muscle relaxants, antispasmodics, tranquilizers
-heat and cold, massage therapy
-weight loss
-TENS units

7

Laminectomy

remove portion of the lamina to relieve pressure to get the herniated nucleus puplosus that is protruding

8

foraminotomy

enlargement of the bony overgrowth at the opening which is compressing the nerve

9

microdiskectomy

use of electron microscope through a small incision to remove a portion of the HNP that is displaced

10

prevention of HNP

-education on causes (obesity, improper body mechanics, aging, etc.)
-exercise and strengthen leg and abd. muscles
-changes in lifestyle

11

Post op assessment for HNP

-sensory/motor assessment -care not to injure op site
-assess for csf drainage or bleeding from op site
-encourage turn (log roll, cough, deep breathe)
-assess for postural hypotension: especially if client was on bed rest for several days/weeks prior to surgery

Anterior cervical: assess injury to carotid, esophagus, trachea, laryngeal nerve, respiration, neck size, swallowing and speech

Lumbar: asses bowel sounds, voiding, minimize stress of post op site: glat with pillow between knees, log rolling, etc.

12

Nursing Problem/intervention acute Pain

-post surgery the individual may have similar pain as pre-op due to lack of resiliency of the spinal nerves to 'bounce' back quickly
-donor site (iliac crest) may cause more pain than laminectomy
-individual may be in pain-spasm-pain cycle, therefore may need both antispasmodic as well as analgesic

13

Home care nursing problem/intervention

-when riding in a car, take frequent stops to move and stretch
-prevention-back school approach
-may have to deal with pain as a chronic condition
-may need to make life/job changes

14

intermedullary

arise from neural tissues of the spinal cord

15

extramedullary

arise from tissues outside the spinal cord may be benign or malignant

16

intradural

from the nerve roots or meninges in subarachnoid space

17

extradural

from the epidural tissue or vertebra

18

primary

originating in the spinal cord or meninges

19

secondary

metasteses from other parts of the body

20

most spinal cord tumors are found?

in the thoracic region

21

spinal cord tumors can

compress (bening), invade the nerual tissue, or cause ischemia to the area because of vascular obstruction

22

common manifestations/complications (cord tumors)

-symptoms depend on the anatomical level of the spinal column, the anatomical location, the type of tumor and spinal nerves affected
*PAIN that is NOT relieved by bed rest is the most common presenting symptom
-sensory and motor

23

manifestations of thoracic cord tumor

-paresis and spasticity of one leg then the other
-pain back and chest, not relieved by bedrest
-sensory changes
-babinski reflex
-bowel, bladder dysfunction

24

therapeutic interventions for cord tumor

-control pain- narcotic analgesics, epidural catheter, PCA, NSAIDS
-reduce cord edema and tumor size: steroids, usually high dose dexamethasone

25

nursing interventions/problems are similar to

similar to spinal cord injury problems:
Anxiety, risk for constipation, impaired physical mobility, acute pain, sexual dysfunction, urinary retention, home care