DISC SURGERY - DISC SURGERY Laminectomy is the excision of...

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DISC SURGERY Laminectomy is the excision of a vertebral posterior arch and is commonly performed for injury to the spinal column or to relieve pressure/pain in the presence of a herniated disc. The procedure may be done with or without fusion of vertebrae. Minimally invasive procedures are taking precedence over laminectomy in many areas of the country. These include endoscopic lumbar and cervical discectomy and intradiscal electrothermal therapy (IDET) also known as thermal discoplasty. These procedures cause no damage to muscles, no bone is removed, and no large incisions are made, so they can be performed in an outpatient setting. (Also, in the early stages of testing there is a genetically designed version of a natural body chemical called OP-1. This “gene putty” acts as a bone spackle that fuses diseased vertebrae.) CARE SETTING Inpatient surgical or orthopedic unit. RELATED CONCERNS Psychosocial aspects of care Surgical intervention Patient Assessment Database Refer to CP: Herniated Nucleus Pulposus (Ruptured Intervertebral Disc). TEACHING/LEARNING Discharge plan DRG projected mean length of inpatient stay: 4.9–6.5 days considerations: May require assistance with ADLs, transportation, homemaker/maintenance tasks, vocational counseling, possible changes in layout of home Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Refer to CP: Herniated Nucleus Pulposus (Ruptured Intervertebral Disc). NURSING PRIORITIES 1. Maintain tissue perfusion/neurological function. 2. Promote comfort and healing. 3. Prevent/minimize complications. 4. Assist with return to normal mobility. 5. Provide information about condition/prognosis, treatment needs, and limitations. DISCHARGE GOALS 1. Neurological function maintained/improved. 2. Complications prevented. 3. Limited mobility achieved with potential for increasing mobility. 4. Condition/prognosis, therapeutic regimen, and behavior/lifestyle changes are understood. 5. Plan in place to meet needs after discharge.
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NURSING DIAGNOSIS: Tissue Perfusion, ineffective (specify) May be related to Diminished/interrupted blood flow (e.g., edema of operative site, hematoma formation) Hypovolemia Possibly evidenced by Paresthesia; numbness Decreased ROM, muscle strength DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Neurological Status (NOC) Report/demonstrate normal sensations and movement as appropriate. ACTIONS/INTERVENTIONS Surveillance (NIC) Independent Check neurological signs periodically and compare with baseline. Assess movement/sensation of lower extremities and feet (lumbar) and hands/arms (cervical). Keep patient flat on back for several hours. Monitor vital signs. Note color, warmth, capillary refill.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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DISC SURGERY - DISC SURGERY Laminectomy is the excision of...

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