Discectomy

  1. General information
    1. Excision of inter-vertebral disc.
    2. Indications
      1. Most commonly used for herniated nucleus pulposus not responsive to conservative therapy or with evidence of decreasing sensory or motor status
      2. Also indicated for spinal decompression as with spinal cord injury, to remove fragments of broken bone, or to remove spinal neoplasm or abscess
    3. Spinal fusion may be done at the same time if spine is unstable
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Teach client log rolling (turning body as a unit while maintaining alignment of spinal column) and use of bedpan.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Position client as ordered.
      1. Lower spinal surgery: generally flat
      2. Cervical spinal surgery: slight elevation of head of bed
    3. Maintain proper body alignment; with cervical spinal surgery avoid neck flexion and apply cervical collar as ordered.
    4. Turn client every 2 hours.
      1. Use log-rolling technique and turning sheet.
      2. Place pillows between legs while on side.
    5. Assess for complications.
      1. Monitor sensory and motor status every 2-4 hours.
      2. With cervical spinal surgery client may have difficulty swallowing and coughing.
        1. monitor for respiratory distress.
        2. keep suction and tracheostomy set available.
    6. Check dressings for hemorrhage, CSF leakage, infection.
    7. Promote comfort.
      1. Administer analgesics as ordered.
      2. Provide additional comfort measures and positioning.
    8. Assess for adequate bladder and bowel function.
      1. Monitor every 2-4 hours for bladder distension.
      2. Assess bowel sounds.
      3. Prevent constipation.
    9. Prevent complications of immobility.
    10. Assist with ambulation.
      1. Usually out of bed day after surgery.
      2. Apply brace or corset if ordered.
      3. If client allowed to sit, use straight-back chair and keep feet flat on floor.
  4. Provide client teaching and discharge planning concerning
    1. Wound care
    2. Maintenance of good posture and proper body mechanics
    3. Activity level as ordered
    4. Recognition and reporting of signs of complications such as wound infection, sensory or motor deficits

Tuesday, May 20, 2008 | Labels: |

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